I’ve been diagnosed with Parkinson’s Disease. What does that mean?

Parkinson’s Disease is a neurodegenerative movement disorder that affects the central nervous system. We currently do not know the exact cause of Parkinson’s Disease, but we do know that it results in a loss of dopamine producing cells in an area of the brain known as the basal ganglia. Prevalence of Parkinson’s Disease increases as age increases (41 per 100,000 worldwide at age 40-49, 1,903 per 100,000 worldwide at age >80). There is a slight male predominance, it is more common in Caucasians and the mean age of onset is 63. There is currently no cure for the disease, but the consensus from the American Academy of Neurology is to initiate treatment with a class of dopamine mimicking drugs that helps make up for the lost dopamine and improves disability.

What are common initial symptoms?

Initially, you, family members, or friends may notice changes that we can subdivide into motor symptoms (related to movement), and non-motor symptoms (not related to movement).

Common initial motor symptoms include:

  • Resting tremor
  • Bradykinesia = slowness in initiating voluntary movements
  • Rigidity = stiffness and resistance when trying to move joints/muscles of the body
  • Micrographia = small handwriting
  • Hypophonia = decreased loudness of voice
  • Gait abnormalities = lack of arm swing, small steps, shuffling of feet, falling
  • Difficulty maneuvering in bed
  • Mild incoordination

Common initial non-motor symptoms include:

  • Pain, fatigue
  • Lack of smell
  • Sleep disturbances = REM sleep disorder, insomnia, increased daytime sleepiness
  • Mood disorders = anxiety, depression, visual/auditory hallucinations
  • Autonomic disorders = orthostatic hypotension, bowel and bladder incontinence, drooling, erectile dysfunction
  • Cognitive deficits = attention, executive function, visuospatial domain
  • Dysphagia = difficulty swallowing
  • Impulse control disorders

There are typically 4 cardinal early signs that doctors will use to diagnose Parkinson’s:

    • Bradykinesia
      • Slowness of movements with a progressive loss of amplitude or speed
    • Rigidity
      • Non-velocity dependent increase in resistance to passive movement (stiffness)
    • Tremor (absent in 20% of pts)
      • Resting tremor (not present during active movement)
    • Postural instability/Decrease in Balance

Other early signs such as severe balance impairments, freezing of gait (being stuck in one place unable to move), hallucinations unrelated to medications, dementia preceding motor symptoms, and severe fluctuations in blood pressure/heart rate unrelated to medications are suggestive of an alternative diagnosis.

Is it important to see a specialist?

Yes! It is important to see a Movement Disorders Neurologist as soon as possible in order to get the most accurate diagnosis and establish an individualized plan of care. Rates for accuracy of Parkinson’s diagnosis:

  • Non-specialists: 73%
  • Neurologists: 93.5%
  • Movement disorder specialists: 97%

These specialty movement disorder neurologists will work with you to determine when to start medication, what medications to try, and general treatment goals for your symptoms. Movement disorders often work as part of a specialized Parkinson’s team (physicians, nurses, physical therapists, occupational therapists, speech language pathologists, psychologists, pharmacists, dieticians) in order to meet all your healthcare needs.

How important is exercise?

Current research has shown that regular exercise has a neuroprotective and neurorestorative effect on Parkinson’s Disease. Exercise has also been shown to slow functional decline and improve strength in people with Parkinson’s Disease. Many individuals who had Parkinson’s Disease do not meet the American Council on Sports Medicine recommendations for daily activity levels. Parkinson’s leads to decreased strength and difficulty with walking, which can be made worse with inactivity and a sedentary lifestyle. Moving is the best treatment! For more information on exercise and physical therapy with Parkinson’s, be sure to check out Parkinson’s 101: Part 2

 

Author: Cam Jadali PT, DPT, NCS