Parkinson's Disease

Parkinson's disease (PD) is a progressive movement disorder that causes:

• Difficulty moving and gait instability
• Muscle rigidity
• Slowing down of movements (bradykinesia)
• Tremor at rest

It is caused by a loss of nerve cells in the brain. This includes loss in an area called the substantia nigra . The loss decreases the amount of dopamine in the brain. Low dopamine results in PD symptoms.

Factors that cause the loss may be from the genes, the environment, or some combination of the two. A small amount of people with PD have an early onset form. This type is caused by an inherited gene defect.

Secondary PD has similar symptoms but is caused by several factors such as:

• Antipsychotic drugs, such as haloperidol (Haldol), fluphenazine (Prolixin), trifluoperazine (Stelazine), and chlorpromazine (Thorazine)
• AIDS
• Brain tumors
• Carbon monoxide poisoning
• Cardiovascular drugs such as some calcium channel blockers and antiarrhythmic drugs
• Encephalitis
• Hydrocephalus
• Insecticide exposure
• Intravenous drug abuse contaminated by MPTP (a type of neurotoxin)
• Manganese poisoning
• Meningitis
• Reserpine (medicine to treat schizophrenia and high blood pressure)
• Stroke
• Trauma
• Valproic acid (a medication used for seizures, migraines , and bipolar disorder )

Factors that increase the chance of PD include:

• History of polio
• Age: 50 or older
• Exposure to toxins, drugs, or conditions listed above
• Family members with PD
• Gender: men (slightly more likely to develop PD)
• High cholesterol
• Melanoma skin cancer
• Nonsmokers

Symptoms of PD begin mildly. They will worsen over time.

Symptoms include:

• "Pill-rolling" tremor in the hands
• Anxiety
• Bowel movement symptoms (straining, constipation)
• Decreased sense of smell
• Dementia
• Depression
• Difficulty and shuffling when walking
• Difficulty thinking, problems with memory
• Difficulty with rising from a sitting position
• Drooling and excessive salivation
• Flat, monotonous voice
• Hallucinations
• Increasingly mask-like face, with little variation in expression
• Loss of smell
• Poor balance
• Seborrhea (a skin problem that causes a red rash and white scales)
• Shaky, spidery, or small handwriting
• Short steps
• Sleep problems such as REM-behavior disorder
• Slowness of purposeful movements
• Stiffness and rigidity of muscles, usually beginning on one side of the body
• Stooped posture
• Stuttering
• Tendency to fall
• Tremors are present at rest, improve with movement, and are absent during sleep
• Trouble chewing and swallowing
• Trouble performing usual tasks, due to shaking in hands
• Trouble speaking (often speaking with a low volume)
• Urinary symptoms (frequency and urgency)
• “Freezing”

The doctor will ask about your symptoms and medical history. A physical exam will be done. There are no tests to definitively diagnose PD. The doctor will ask many questions. This will help to rule out other causes of your symptoms.

Tests to rule out other conditions may include:

• Blood tests
• CT scan —a type of x-ray that uses a computer to make pictures of structures inside the head
• MRI scan —a test that uses magnetic waves to make pictures of structures inside the head
• PET scan —a scan that makes images that show the amount of activity in the brain
• Urine tests

Currently, there are no treatments to cure PD. There are also no proven treatments to slow or stop its progression. Some medications are used to improve symptoms. Over time the side effects may become troublesome. The medications may lose their effectiveness.

There are no guidelines for preventing PD.