Introduction

Photo of woman with flowers (PantherMedia / Tylor Olson ) Parkinson's is a disease of the nervous system that mostly affects older people. It typically begins after the age of 50. The disease can be very hard to live with because it severely restricts mobility and as a result makes daily activities increasingly difficult. Parkinson's is a progressive disease, which means that in most cases it will continue to gradually get worse. Many people who develop Parkinson’s will require nursing care. There is no cure for the disease and its exact cause is not known, but there are effective treatments that can relieve the symptoms.

Symptoms

The signs of Parkinson's can be very different. The typical symptoms are:

  • Slowed movement (akinesia): Movements can only be performed slowly. Affected people might walk very hesitantly and only take short, increasingly small steps. They find it hard to start moving – taking the first step is often particularly difficult. Once they are moving, it becomes increasingly difficult to stop again, for example to stand still on command. As the disease progresses, the arms stop swinging when walking. Gripping with the hands and tasks that require a certain degree of dexterity like tying shoelaces also become more difficult. Due to reduced activity in the facial muscles, the face becomes more and more mask-like. Speech becomes quiet and monotone and swallowing also becomes harder.
  • Muscle stiffness (rigidity): Especially the arms, legs and neck can become stiff and tense. Even if somebody else tries to move the person's arms and legs, the muscles usually put up resistance or cannot be moved at all, and stiffen up even more during such attempts. This excessive tensing of the muscles often causes aches.
  • Tremor at rest: Most people with Parkinson's have a tremor. It decreases during movement. It is particularly common in the hands. That causes people's handwriting to become smaller and less clear.

The symptoms are often more pronounced on one side of the body. Possible other effects of Parkinson's include bladder and digestion disorders, circulation problems, increased oil secretion on the skin, difficulties concentrating, and depression.

Causes

Distinctions are made between different forms of Parkinson’s depending on the cause. Idiopathic parkinsonism is most common, with "idiopathic" meaning that no cause can be found. Parkinson's damages nerve cells that produce the chemical messenger dopamine. One of dopamine's tasks is to transmit electrical impulses through the nerves from the brain to the muscles. These impulses control our movements. Destruction of the cells reduces the ability to begin or coordinate movements. People who have Parkinson's may therefore have problems with balance. That increases the risk of falls and broken bones.

But the symptoms of Parkinson's can also be the result of other disorders of the nervous system such as dementia. Infections, tumors and medications like psychotropic drugs can also cause these kinds of symptoms.

Prevalence

On average, about 1 to 2 out of 1,000 people have Parkinson's. The disease is much more common in older age: Around 18 out of 1,000 people over 65 are affected.

Outlook

The first signs of Parkinson's can become apparent long before the disease is diagnosed. They are often not noticed at all or are considered to be a normal part of the aging process. Fine motor skills typically deteriorate and handwriting changes. People sometimes lose their sense of rhythm or their arms no longer swing when walking. Many people's facial expression becomes more fixed. Constipation, difficulty sleeping and mood swings are also common. Many people experience a deterioration or complete loss of their sense of smell.

It is not unusual for several years to pass between the first signs of the disease and it actually being diagnosed. The course of the disease varies greatly.

The symptoms usually come on gradually. Over time movements become slower, muscles stiffer and tremors more intense. In early stages medication can usually considerably improve symptoms or even make them go away.

After about five to ten years the symptoms often get worse again. That is because the brain cells are damaged further as the disease progresses. The effects of the medication are no longer strong enough and fluctuate a lot. The symptoms alternate between extreme slowness of movement and normal mobility. These are referred to as "off" and "on" phases. The disease can also cause involuntary movements, and people with Parkinson’s may occasionally flap their arms, smack their lips or make sudden, jerky motions. Additional symptoms like speech difficulties, poor memory, bladder disorders, hallucinations and depression can follow. Some people also develop dementia.

In later stages, people with Parkinson's need support with lots of everyday activities like eating and drinking, standing up and moving about, getting dressed and washing. They find it increasingly difficult to move, and some people can only speak very quietly or have trouble swallowing.

Diagnosis

Doctors generally make a diagnosis following a physical examination and a detailed discussion of symptoms and medical history. It can be helpful for relatives or friends to be present because they might have noticed symptoms that you have not noticed yourself. As well as a general physical examination, the doctor will test your reflexes, sensitivity (to pain or pressure, for example) and agility, for instance whether your joints can be moved normally or if the muscles put up resistance.

To ensure correct diagnosis, an L-Dopa test is sometimes performed. You have to take the medication L-Dopa (Levodopa) to see whether the symptoms reduce. Rapid improvement is a sign of Parkinson's.

Particularly in the early stages it is not easy to differentiate Parkinson's from other diseases. It is therefore a good idea to observe how symptoms develop for a while. Computed tomography (CT) or magnetic resonance imaging (MRI) scans are sometimes carried out, especially to rule out other diseases.

Treatment

Parkinson's is usually treated with medication. At the beginning of the disease – when the symptoms are not problematic – treatment is sometimes not necessary. If the symptoms get worse, medication can help. Treatment with medication generally aims to replace the lacking dopamine. That often relieves symptoms, but does not slow the progress of the disease. Because over time the drugs are no longer effective, the type and dose of medication has to be adjusted again and again. One option is to use a medication pump. It provides the drug either under the skin or directly into the small intestine and ensures a constant supply.

Occupational therapy is used to practice everyday movements and activities. Restricted movement means that the muscles lose strength. Movement exercises (physiotherapy) and sports aim to help counteract that and improve movement and coordination. Speech therapy can be an option if the voice becomes quieter and speech less clear.

Deep brain stimulation is recommended to some people whose symptoms are not relieved enough by taking medication. That involves surgery to implant electrodes in certain parts of the brain. They continuously emit electrical impulses that influence muscle activity.

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Everyday life

Parkinson's affects many areas of life, be it work, relationships, family or leisure activities. Even if everyday life only changes slightly in the early stages of the disease, many people affected are worried about losing their independence and needing special care. But it can be possible to lead a life that is not restricted too much by the disease for a long time.

It is nevertheless a good idea to be prepared for a time when you will require more help. Good medical support is very important. Most people are also more successful in dealing with their illness if they do not hide away, but rather talk to other people about it from the very beginning and ask for help with routine activities.

Many people with Parkinson's say that it helps them to stay as active as possible. It is essential to know your own limits and to only ever do as much physical exercise, everyday activities and work tasks as you feel up to.

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Labels: Aging and geriatric care, G20, G25, Head and nerves, Parkinson's disease, Shaking palsy