Some researchers are investigating a link between PD and long- term exposure to environmental toxins such as pesticides and heavy metals. Toxins such as manganese and carbon monoxide Symptoms and progression of Parkinsons Parkinsonism is the name for the collection of symptoms that includes tremor, stiffness, slowness of movement, and unsteady gait. Many neurologic disorders other than Parkinson’s disease are characterized by parkinsonism. There is no definitive blood test or imaging study to diagnose PD. Thus, Parkinson’s disease is diagnosed only when a neurologist has ruled out all of the other possible causes of parkinsonism. Clinicians may order brain scan and laboratory tests as part of the process of eliminating other diseases as the cause of symptoms. Ruling out other causes and diseases is important because the treatment options and long-term outlook are different for PD. The most common initial symptom in PD is tremor, which usually begins on one side of body and often involves either an arm or a leg. The individual then begins to experience a generalized slowness of movement, known as bradykinesia . Even the early symptoms of tremor and bradykinesia can cause problems with the daily activities of living, such as cutting food and getting dressed. Impaired mobility can affect many aspects of life, such as making it difficult to get in or out of a car and to turn over in bed. Over time (in some, five years or longer), symptoms spread to the other side of the body. The muscles, particularly the flexor muscles, become permanently hypertonic. A stooped posture is common. The disruption in the motor systems produces an unsteady gait, and there is a lack of arm swing on the affected side. Because these symptoms appear gradually, older individuals often initially attribute them to aging. Bradykinesia may be considered part of normal “getting slower,” and the Treatment At present, there is no cure for PD, but drugs and treatments can help patients manage many of the symptoms, including tremor, rigidity, and gait disturbance. Progressive treatments enable Medication Medication is the first line of treatment for PD. Levodopa, a drug introduced more than 30 years ago, dramatically improved treatment for the disease, and it is still the most common initial medication given. Levodopa is converted to dopamine by enzymes in the brain, thus helping replace the body’s own supply of dopamine, which is no longer produced in the substantia nigra. Taking levodopa restores the amount of dopamine to near normal levels. Levodopa is most effective against rigidity and slowness but has less effect on tremor, balance, and gait. 3 Levodopa is usually given with a second drug, carbidopa, which inhibits enzymes in the blood from breaking down the levodopa before it reaches the brain. Patients with PD usually take a commercially prepared combination of levodopa and carbidopa, such those marketed as Sinemet and Atamet. The side effects of levodopa, with our without carbidopa, are considerable. Common physical side effects are nausea, low blood pressure, abnormal heart rhythms, constipation, and involuntary movements or jerkiness, known as dyskinesia . Psychiatric side effects such as hallucinations and confusion are less common, but they do occur. Overall, however, levodopa produces fewer psychiatric side effects than other drugs used to treat PD. Often, several hours after a dose of the medication, the individual’s tremors and other symptoms return, and dyskinesia occurs. This is known as the “wearing-off” effect. Often patients will refer to this as an “off” period, and will refer to periods when the medication is effective and they are mobile as when they are “on.” To prevent the wearing-off effect as much as possible, it is important for patients to keep to a fixed schedule of taking their medication, in order to maintain a constant level of dopamine in the brain.
cause diseases that resemble, PD, but the vast majority of individuals with PD have not been exposed to them.
stiffness can be attributed to arthritis, for example. For these reasons, individuals may have initial symptoms for a year or more before seeking medical help. As with any disease, not all individuals suffering from Parkinson’s have identical symptoms. In addition to the major symptoms of tremor, rigidity, bradykinesia, and imbalance, individuals often experience hand and foot cramps, speech and handwriting difficulties, and sleep disorders. The stiffness and imbalance makes PD patients especially susceptible to falls. The progressive nature of the PD includes other symptoms as well. The voice becomes low in volume and monotonous. A common symptom is decreased facial expression, including a staring appearance because of the reduced frequency of blinking. Some individuals have difficulty swallowing, which may lead to a slight drool. Constipation, more frequent urination, increased sweating, and impotence may develop. About 30 percent of people with PD develop changes in memory and intellectual function 2 and 20–40 percent develop dementia. 3 Anxiety about the progressive nature of the disease is common. Depression, one of the most debilitating symptoms of PD, affects about 40–50 percent of patients with the condition. 4 Some patients with PD have swelling of the ankles, which should be assessed by the individual’s primary care physician to check for cardiovascular or other causes. If it is found that the ankle edema is a result of the relative immobility caused by PD, foot exercises, leg elevation, compressive stockings, and reduction of salt intake are all strategies used to alleviate this symptom.
many individuals with PD to maintain a high level of function for the rest of their life.
Other drugs called dopamine agonists are also often used to treat PD, either instead of levodopa or in combination with it. But dopamine agonists more often have side effects of hallucinations and drowsiness. Several other medications have been found to reduce PD symptoms, but they, too can produce side effects in some people, including confusion, nightmares, agitation, and hallucinations. Thus, the medication for each individual with PD must be tailored to maximize the alleviation of symptoms and minimize side effects. Research is ongoing to find new drugs that will help control symptoms of PD. Some medications that might be prescribed for other reasons must be avoided because they will worsen the symptoms of PD or have adverse interactions with medication the patient has been prescribed. For this reason, individuals with PD must be sure to inform every physician they see of all the medications being taken, including over-the-counter drugs. Surgery Surgery may be an option for individuals who do not respond to the usual medical treatments, or when the medications being used cause significant side effects or can no longer be adjusted to improve the patient’s symptoms. Deep brain stimulation is the main surgical procedure used to treat Parkinson’s. With this surgery, a wire electrode is implanted in a part of the brain. The electrode is connected to a stimulator, similar to that of a heart pacemaker, which is placed beneath the skin, below the collarbone. The patient has a handheld device to turn on the stimulator, which sends electronic pulses to the brain to interrupt the signals that cause tremor.
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