What is Parkinson’s Disease?

In the United Kingdom, there are around 145,000 people with Parkinson’s disease. This figure is likely to increase by around one-fifth as the population of the country grows and ages. Every year, some 18,000 people are diagnosed with Parkinson’s, which is the equivalent of over two people per hour.

In terms of age, only 1.2% of people with Parkinson’s disease are under 50 years old. Gender-wise, it seems that there are 1.4 times more men with the condition than women. To summarise the statistics, around one in 500 people have the condition among the general population.

In this article, we’ll tell you everything you need to know about Parkinson’s – what it is, what causes it and the signs and symptoms to look out for.

What is Parkinson’s disease?

Parkinson’s disease is a neurological condition and it’s progressive. This means that it affects your brain and worsens over time.

Those who have Parkinson’s have a lack of dopamine due to the death of certain nerve cells that make this chemical.

Sometimes, you might hear people talking about Parkinsonism. This is a more general term that covers other conditions that present similarly to Parkinson’s disease as well as Parkinson’s itself.

It is not understood why some people develop Parkinson’s disease. Studies suggest a combination of environmental factors, genetics and age are at play, which results in a perfect storm for dopamine producers to die off.

What causes Parkinson’s disease?

As mentioned above, people who have Parkinson’s disease have a lack of dopamine-producing nerve cells due to cell death. This occurs in the sustantia nigra, a part of the midbrain that plays a role in movement and reward. As a result, their brains don’t receive enough dopamine. No one really knows for sure why these nerve cells die and lots of research is ongoing.

With the nerve cells no longer working and producing dopamine, the brain struggles to send messages properly and, as a result, Parkinson’s symptoms appear.

As more and more nerve cells die off, dopamine levels continue to decline. This means that symptoms worsen and new ones appear.

There isn’t much evidence to suggest that Parkinson’s can be passed on to children but researchers believe some people (a small number) could have an increased genetic risk.

There have also been studies showing that toxins in the environment could be at play when these dopamine producers die, which leads to Parkinson’s developing.

Toxins could be anything from heavy metals, toxic chemicals, and pathogens like bacteria and viruses.

There has been particularly strong speculation about Parkinson’s linking to pesticide and herbicide use.

What are the signs and symptoms of Parkinson’s disease?

Parkinson’s disease symptoms usually start off mild and develop gradually. There are many different symptoms but not everyone will experience all of them and they might develop in a different order from one patient to the next.

The main symptoms

Parkinson’s disease main symptoms are to do with physical movement.

These include:

• Muscle stiffness – patients experience tension and stiffness in the muscles. This can make it more difficult to make facial expressions and move around with ease. It can also cause dystonia (painful cramps in the muscles).
• Bradykinesia – this means slowness in movement. A person’s movements will be slower, which makes carrying out day-to-day tasks more difficult. Typically, people walk with a slow shuffle and small steps.
• Tremor – the shaking of Parkinson’s typically starts in an arm or hand and typically occurs when the person is resting and relaxed.

Other symptoms

There are also other physical symptoms with Parkinson’s as well as mental symptoms too.

Physical symptoms

• Problems with balance. When someone struggles with their balance, they’re more likely to injure themselves due to falls.
• Anosmia (loss of smell). This can even be the first symptom to develop and can occur many years before any other symptoms appear.
• Nerve pain. Someone might experience an unpleasant sensation like numbness, coldness or burning.
• Urinary problems. This might be urinary incontinence or needing to get up to pee at night.
• Constipation.
• Erectile dysfunction (men).
• Sexual dysfunction (women).
• Fainting, dizziness and blurred vision when standing after lying or sitting. This is caused by blood pressure dropping suddenly.
• Hyperhidrosis (excessive sweating).
• Dysphagia (difficulties swallowing). This can lead to dehydration and malnutrition.
• Excessive saliva production (drooling).
• Insomnia.

Psychiatric and cognitive symptoms

• Anxiety and depression.
• Cognitive impairment (mild). This involves having problems with memory or planning and organising.
• Dementia.

What are the risk factors for Parkinson’s disease?

The biggest of all risk factors for Parkinson’s disease is age. The average age for the onset of the condition is 60. Secondly, men are much more likely to develop the disease compared to women. Finally, if a person has a sibling or parent with the condition, they are twice as likely to develop the condition themselves.

As mentioned above, there are also believed to be environmental factors at play. Many experts believe that exposures to certain things in the environment play a part in the disease.

Lots of research still needs to be done but it’s believed that herbicides and pesticides can trigger the disease (thus, farmers are more at risk). This also links to Agent Orange, a herbicide that was used in the Vietnam war to eliminate crops and forest cover. It’s believed to have caused Parkinson’s in people who were exposed in the 1960s. Finally, working with detergents, solvents and heavy metals is believed to put people at a greater risk.

Another potential risk factor is head trauma, especially repeated blows to the head like the boxer Muhammed Ali.

It’s important to recognise, though, that these are all factors that increase a person’s risk. It doesn’t mean that every male farmer over 60 that indulges in boxing as a hobby is going to develop the condition.

Who is affected by Parkinson’s disease?

Parkinson’s disease primarily affects the older population. Only 1% of cases are diagnosed in under 50s. The average age of disease onset is 60 but there are some people who develop the disease earlier, which is called “early onset” Parkinson’s. It has been known to develop as young as 40 years old.

Though it affects both women and men, there are 50% more men that develop the condition.

Living with Parkinson’s disease

Being diagnosed with Parkinson’s is life changing. Patients need long-term treatment to help them control their symptoms. Eventually, they might need to adapt how they live to accommodate their condition.

It’s worth remembering that everyone experiences the condition differently, though there are lots of shared challenges too.

It’s also worth remembering that people with Parkinson’s disease have a similar life expectancy as those without. However, during the later stages of the disease, complications can lead to things like pneumonia, choking and fatal falls. The disease will progress differently in each case but those who develop the disease at a young age, will likely see more severe progression.

The importance of keeping well

When diagnosed with Parkinson’s, it’s important to lead a healthy lifestyle and stay well.

Doing regular exercise will be very important as it will help to relieve any muscle stiffness whilst also improving stress levels and mood. There are lots of ways you can keep fit, including walking, yoga, swimming and gardening if more strenuous activities are too much.

Eating a balanced diet is also important and will provide your body with everything it needs.

Another important consideration is vaccinations. When people have a long-term medical condition like Parkinson’s disease, they’re entitled to a flu jab each year in the autumn. It’s also recommended to get a one-off pneumococcal vaccination that can prevent pneumococcal pneumonia, which is a serious chest infection.

How is Parkinson’s disease diagnosed?

There are no specific tests that show one way or another if you have Parkinson’s disease. A diagnosis will be made based on symptoms, a medical exam and your medical history.

The first port of call will be a GP. The GP will talk about the problems and refer on to a specialist.

The specialist will either be a geriatrician (someone who specialises in conditions that affect older people) or a neurologist (someone who specialises in brain and nervous system conditions).

A Parkinson’s diagnosis is likely if two of the following three symptoms are present:

• Bradykinesia (slow movements).
• Tremor or shaking in a part of the body that’s at rest.
• Rigidity (muscle stiffness).

If a patient is prescribed a drug called levodopa and their symptoms improve, it means it’s much more likely that it is Parkinson’s rather than something else.

How is Parkinson’s disease treated?

Parkinson’s disease can’t be cured but there are treatments to relieve symptoms. Patients might also be given supportive therapies like physiotherapy and some might have surgery too.

Physiotherapy

Physiotherapy is useful in Parkinson’s as it can help patients relieve their joint pain and muscle stiffness with manipulation exercises.

Occupational therapy

Occupational therapists can help patients identify where they have difficulties in their lives like getting to a shop or getting dressed. They work with patients to provide solutions so that independence can be maintained.

Speech and language therapy

Since many people have dysphagia (swallowing difficulties) and speech difficulties, a speech and language therapist can work with them to improve the difficulties.

Medication

Certain symptoms like movement problems and tremors can be relieved with medication. There are three main medicines prescribed.

These are:

• Levodopa.
• Dopamine agonists.
• Monoamine oxidase-B inhibitors.

Levodopa

The majority of people with Parkinson’s disease will usually end up taking levodopa. This medicine is absorbed by the brain’s nerve cells and is then turned into dopamine. Dopamine is what’s lacking in a Parkinson’s brain and so this is used to improve that.

Levodopa is prescribed as either a liquid or a tablet and might be combined with carbidopa or benserazide, which are medications to prevent the levodopa from being broken down before it reaches the brain.

Levodopa has side effects, including dizziness, tiredness, nausea and vomiting, and these combination drugs reduce those effects too.

The initial taking of levodopa will cause dramatic improvements in Parkinson’s disease symptoms but these effects will lessen over time as the brain loses more nerve cells and so there aren’t as many around to absorb the medication.

Dopamine agonists

This medicine is a substitute for the brain’s own dopamine and has a milder effect than levodopa. This can be taken as a medicine but can also come in a skin patch form called rotigotine.

In terms of side effects, you might also feel nauseous, tired, sleepy or dizzy. Some people also report compulsive behaviours – particularly if they’re taking a high dose of the drug. This medicine has, for example, been linked to compulsive shopping, addictive gambling and an excessive sex drive.

If these side effects occur, the person might not even realise they have a problem so it’s important that family and friends are made aware that this could happen.

Monoamine oxidase-B inhibitors

These drugs are a levodopa alternative. They block a substance in the brain that’s responsible for breaking down dopamine, and thus, increase the levels of dopamine in the body. Two such medicines are rasagiline and selegiline. These can also be used alongside dopamine agonists and levodopa.

Generally, these drugs are well tolerated but patients might have nausea, headaches, high blood pressure or abdominal pain.

Non-oral therapies

If a person’s symptoms of disease mean tablets aren’t effective or possible, there are other therapies available.

Apomorphine

This is an injectable dopamine agonist that can either be a single injection administered whenever it is required, or a continuous infusion with a pump.

Duodopa

This is a type of levodopa that is used to help people with on-off fluctuations that are severe. This is a gel that is pumped into the gut via a g-tube in the abdominal wall. The end of the tube has an external pump that’s carried around.

Surgery

Very rarely, people with Parkinson’s disease will be offered deep brain stimulation surgery. This isn’t suitable for everyone and is only available in specialist UK neuroscience centres. The surgery involves implanting a pulse generator that’s similar to a pacemaker into the chest wall. This is connected to wires under the skin, which are precisely inserted into a specific area of the brain. The pulse generator will use an electric current to stimulate the part of the brain that Parkinson’s affects.

Treating other symptoms

In addition to treating the main Parkinson’s symptoms, there are treatments available for the more minor symptoms.

These include:

• Treatments for associated anxiety and depression.
• Treatments and advice for insomnia.
• Treatments for swallowing problems and excessive drooling.
• Help with urinary issues.
• Treatments with excessive sweating.
• Treatments and medication for erectile dysfunction.

Complementary and alternative therapies

Some people who are diagnosed with Parkinson’s disease find alternative therapies and complementary therapies to help ease their symptoms. While there isn’t any clinical evidence that these are effective treatments, they have no harmful effects. However, it’s important not to take certain herbal remedies as these might interfere with the medication you’re taking.

Final thoughts on Parkinson’s disease

Though getting a diagnosis of Parkinson’s disease can come as a blow, it’s worth bearing in mind that this condition does have effective treatments and isn’t a life-limiting condition. Research and clinical trials are very much ongoing and there is hope that researchers will soon know more about the disease and how to treat it more effectively.