Parkinson's Disease

Symptoms

Parkinson's disease signs and symptoms can be different for everyone. Early signs may be mild and go unnoticed. Symptoms often begin on one side of your body and usually remain worse on that side, even after symptoms begin to affect both sides. Parkinson's signs and symptoms may include:

• Tremor - A tremor, or shaking, usually begins in a limb, often your hand or fingers. You may a rub your thumb and forefinger back-and- forth, known as a pill-rolling tremor. Your hand may tremor when it's at rest.
• Slowed movement (bradykinesia) - Over time, Parkinson's disease may slow your movement, making simple tasks difficult and time consuming. Your steps may become shorter when you walk. It may be difficult to get out of a chair. You may drag your feet as you try to walk.
• Rigid muscles - Muscle stiffness may occur in any part of your body. The stiff muscles can be painful and limit your range of motion.
• Impaired posture and balance - Your posture may become stooped, or you may have balance problems as a result of Parkinson's disease.
• Loss of automatic movements - You may have a decreased ability to perform unconscious movements, including blinking, smiling or swinging your arms when you walk.
• Speech changes - You may speak softly, quickly, slur or hesitate before talking. Your speech may be more of a monotone rather than with the usual inflections.
• Writing changes - It may become hard to write, and your writing may appear small.

Causes

In Parkinson's disease, certain nerve cells (neurons) in the brain gradually break down or die. Many of the symptoms are due to a loss of neurons that produce a chemical messenger in your brain called dopamine. When dopamine levels decrease, it causes abnormal brain activity, leading to symptoms of Parkinson's disease. The cause of Parkinson's disease is unknown, but several factors appear to play a role, including:

• Your genes - Researchers have identified specific genetic mutations that can cause Parkinson's disease. But these are uncommon except in rare cases with many family members affected by Parkinson's disease. However, certain gene variations appear to increase the risk of Parkinson's disease but with a relatively small risk of Parkinson's disease for each of these genetic markers.
• Environmental triggers - Exposure to certain toxins or environmental factors may increase the risk of later Parkinson's disease, but the risk is relatively small. Researchers have also noted that many changes occur in the brains of people with Parkinson's disease, although it's not clear why these changes occur. These changes include:
  • The presence of Lewy bodies - Clumps of specific substances within brain cells are microscopic markers of Parkinson's disease. These are called Lewy bodies, and researchers believe these Lewy bodies hold an important clue to the cause of Parkinson's disease.
  • Alpha-synuclein is found within Lewy bodies - Although many substances are found within Lewy bodies, scientists believe an important one is the natural and widespread protein called alpha-synuclein (a-synuclein). It's found in all Lewy bodies in a clumped form that cells can't break down. This is currently an important focus among Parkinson's disease researchers.

Risk Factors

Risk factors for Parkinson's disease include:

• Age - Young adults rarely experience Parkinson's disease. It ordinarily begins in middle or late life, and the risk increases with age. People usually develop the disease around age 60 or older.
• Heredity - Having a close relative with Parkinson's disease increases the chances that you'll develop the disease. However, your risks are still small unless you have many relatives in your family with Parkinson's disease.
• Sex - Men are more likely to develop Parkinson's disease than women.
• Exposure to toxins - Ongoing exposure to herbicides and pesticides may slightly increase your risk of Parkinson's disease.

Diagnosis

There is no single test to conclusively diagnose Parkinson’s disease (PD). However, there are various symptoms and diagnostic tests used in combination. Making an accurate diagnosis of Parkinson’s, particularly in its early stages, is difficult, but a skilled practitioner can come to a reasoned conclusion that it is PD. It is important to remember that two of the four main symptoms must be present over a period of time for a neurologist to consider a PD diagnosis:

• Shaking or tremor
• Slowness of movement, called bradykinesia
• Stiffness or rigidity of the arms, legs or trunk
• Trouble with balance and possible falls, also called postural instability

Often, a Parkinson’s diagnosis is first made by an internist or family physician. Many people seek an additional opinion from a neurologist with experience and specific training in the assessment and treatment of PD - referred to as a movement disorder specialist.