By Beth Lueders
Across all continents, an estimated six million people are diagnosed with Parkinson’s disease; one million of them live in the United States. Each year in America, another 50,000 to 60,000 new Parkinson’s cases are detected, creating an even wider circle of loved ones, clinicians and caregivers to combat the neurodegenerative disorder.
Parkinson’s is known as a movement or motor disease, but the non-motor symptoms such as depression, sleep abnormalities and slowed thinking (bradyphrenia) can be even more disabling than the more outwardly noticeable motor symptoms of tremors, shuffled gait and altered posture. A study being conducted at 20 National Parkinson Foundation Centers of Excellence reports that together depression and anxiety create the greatest impact on the health of people with Parkinson’s disease.
Understanding the Cause
Although it’s known that Parkinson’s degrades the brain’s dopamine chemical messengers called neurotransmitters, the widespread majority of people who develop Parkinson’s disease show no clear causation for the disorder. Researchers are continuing to follow the causation theory of genetics, plus environment, plus pathogenesis (e.g., oxidative stress, inflammation, protein aggregation, etc.). Still, with all the incredible advances in understanding the disease, no doctor at this point can tell a patient how he or she developed Parkinson’s.
Do toxins including some pesticide and medications selectively destroy dopaminergic neurons? Some studies suggest rural residents and agriculture workers are at an increased risk of Parkinson’s disease. Head traumas are also pinpointed with a link to Parkinson’s, as well as 21 genes including LRRK2, Alpha Synuclein, and Parkin, but the precise cause of the nervous system condition remains a medical mystery. Ongoing research is aimed at the apparent correlation between people with more education and Parkinson’s, possibly attributable to genes that also influence the brain positively.
Similar to Parkinson’s disease, secondary parkinsonism presents with the movement abnormalities of Parkinson’s disease including difficulty with muscle control, impaired balance and rigidity, but parkinsonism is caused by certain medicines and other health problems.
Parkinsonism can stem from different non-Parkinson’s nervous system disorders including meningitis, stroke, brain injury, encephalitis, HIV/AIDS and diffuse Lewy body dementia. Narcotic overdoses, carbon monoxide or mercury poisoning, and brain damage from anesthesia drugs can result in secondary parkinsonism. Medicines used to treat certain mental disorders or nausea may also be a cause. The most common cause of secondary parkinsonism is the use of drugs that lower the brain’s dopamine levels. These medications include antipsychotics such as thioxanthene and dopamine-depleting tetrabenazine.
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Parkinsonism manifests with its own clinical features and pathology and each patient needs to be evaluated carefully to rule out classic (idiopathic) Parkinson’s or other neurological diseases. A complete parkinsonism evaluation should include a thorough family, drug and occupational history and a review of characteristics common with non-Parkinson’s neurodegenerative disorders. Clinical diagnosis is also made by testing a patient’s response to levodopa medication. If the person improves significantly with levodopa, Parkinson’s disease is typically the cause and not parkinsonism.
Parkinson Plus Syndromes are a classification of atypical parkinsonism that occurs in about 15 percent of cases. One of these parkinsonism syndromes is multiple system atrophy (MSA), a broader breakdown of the central nervous system, particularly in functions of blood pressure, heart rate and sweating. Another underlying Parkinson’s-like condition is progressive supranuclear palsy, which harms brain cells and leaves deposits in brain tissues similar to those found in Alzheimer’s disease. Cortical basal degeneration also fits in the Parkinson Plus Syndromes and is characterized by nerve cell loss and shrinkage of areas in the brain including the cerebral cortex and the basal ganglia.
Allied Team Management
Parkinson’s chronic disease trajectory differs with each person. Grouping Parkinson’s patients under one generic treatment protocol is detrimental across the board. Effective management of Parkinson’s disease symptoms requires experienced, compassionate healthcare providers teaming with each patient for a comprehensive treatment plan consisting of appropriate medications, diet, physical and mental exercise, counseling and other therapies. As the disease progresses, surgical therapeutics such as deep brain stimulation (DBS) and carbidopa/levodopa enteral therapy may be a reasonable option for certain individuals.
Successfully advocating for those with Parkinson’s encourages self-management strategies for patients to stay active and participate in their own care. It is essential for the disease management to be unique to each individual patient because both motor and non-motor symptoms require their own specific interventions. This tailored, patient-centered approach for living with Parkinson’s often includes teamwork with health providers, home care professionals and family caregivers, and the use of music, dance, yoga, pets, and educational and support resources. Participating in research studies also benefits the allied front in preventing and treating Parkinson’s.
Parkinson’s is a slowly progressing disease and with proper diagnosis, targeted care and a stay-positive approach, patients can live a rewarding life controlling Parkinson’s instead of the neurodegenerative disorder controlling them.
For additional educational resources on Parkinson’s disease, visit the National Parkinson Foundation, or the Parkinson’s Disease Foundation. For help with home care therapies and caregiver assistance, contact Right at Home at http://www.rightathome.net or call (402) 697-7537.
Beth Lueders is a journalist, author and speaker who frequently reports on health, aging and caregiving issues in the United States and globally.