Parkinson’s mainly affects people in later life by slowing the body’s functions and impacting its ability to control movement.

Neuraxpharm provides medication alternatives for Parkinson’s disease and once your doctor has determined your specific needs, they can prescribe the product that best adapts to your needs and condition.

Find out about the symptoms, diagnosis, and treatment.

What is Parkinson’s disease?

Parkinson’s disease (PD) is a progressive neurodegenerative condition. This means the symptoms start gradually and slowly become worse over time. PD affects the health of the brain’s nerve cells (neurons) that control movement, and as a result, many bodily functions and movements become affected.

What are the main types of Parkinson’s?

Parkinson’s belongs to a group of conditions called parkinsonism. This is an umbrella term that also includes other conditions with similar symptoms (for example, tremor, slow movement, muscle stiffness, and problems with walking).

Parkinson’s disease is the most common neurodegenerative cause of parkinsonism. Other parkinsonism conditions are sometimes referred to as atypical parkinsonism or parkinson-plus syndromes. These conditions tend to have a worse prognosis than PD and they don’t respond to traditional PD treatment, which focuses on increasing dopamine levels.

How many people have Parkinson’s?

In 2016, the Global Burden of Disease Study estimated that approximately 6.1 million people worldwide have Parkinson’s. This was a significant increase from 2.5 million people in 1990. In the EU, it’s estimated to affect 1.2 million people.

The same report estimated that by 2040, the number of people living with Parkinson’s would be closer to 13 million people. This estimated increase is because:

  • Many people go undiagnosed
  • The prevalence of PD rises significantly with age, and people are living for longer

Symptoms

The symptoms of Parkinson’s can vary from person to person. They usually start off very subtly and can consequently be overlooked for some time.

What are the symptoms of Parkinson’s?

Symptoms can be divided into motor symptoms (those involving movement) and non-motor symptoms, which don’t involve movement. There are three primary symptoms, and many other secondary symptoms which are less noticeable but can still affect quality of life.
Symptoms differ for everyone and it’s unlikely that someone with PD will experience all of them.

Motor symptoms

The three main symptoms associated with Parkinson’s all affect the body. They are:
  • Tremors (shaking hands, arms, legs, or head)
  • Stiff, rigid muscles
  • Slow movement (also known as bradykinesia)
Other physical symptoms may include:
  • Problems with balance
  • Loss of smell
  • Constipation, incontinence, or sexual dysfunction
  • Sleep problems
  • Difficulty chewing, swallowing, or speaking

Non-motor symptoms

  • Feelings of depression and anxiety
  • Tiredness
  • Cognitive problems such as memory loss, and difficulties with thinking or reasoning
  • Behavioural problems, such as acting impulsively, and changes to the personality, where an outgoing person becomes withdrawn, for example

What are the stages of Parkinson’s?

To start with, symptoms tend to be very mild and often go unnoticed, which can lead to a delay in diagnosis. Symptoms normally begin on one side of the body but eventually affect both sides.

The progression of PD can vary greatly from one person to another, which makes it hard to predict how quickly a case of Parkinson’s will progress. Many people also find that their symptoms fluctuate from day to day, resulting in good and bad days.

It’s common to experience a tremor or shaking in the hand or fingers in the early stages. Over time this can gradually worsen, until it becomes difficult to carry out simple, everyday tasks such as eating. The shaking can develop in other parts of the body too.

Movement can also slow down progressively. People in the later stages of Parkinson’s often have difficulties with walking and may end up using small, shuffling steps to get around.

The other primary symptom, muscle stiffness, can progress to the point where it becomes difficult to make facial expressions; it can also cause painful muscle cramps.

An individual’s response to drugs can also change over time. Medication may produce a clear improvement initially, but the effectiveness can ‘wear off’ or become inconsistent over time and may need to be adjusted as the disease progresses.

What are the early signs of Parkinson’s?

The progression of PD is different for everyone, but it’s common for symptoms to be mild at first, and they often go unnoticed in the early stages. Symptoms normally start on one side of the body and eventually affect both sides. It’s common for PD to start with a tremor or shaking in the hand or fingers.

Causes, risk factors and life expectancy

It’s not known exactly why people get Parkinson’s, but the symptoms are triggered when the nerve cells that produce dopamine in the brain weaken and die. Researchers believe that the death of these nerve cells is linked to a combination of age, genetics and environmental factors, such as exposure to certain chemicals.

Known risk factors for developing PD include exposure to fungicides and pesticides, such as maneb, rotenone and paraquat, and traumatic brain injury.

What causes Parkinson’s?

Chemicals in the brain called neurotransmitters help to control body movements by passing messages between nerve cells and the rest of the body. One of the most significant neurotransmitters in this process is dopamine. In people with PD, around 70–80% of dopamine-producing cells deteriorate and eventually die.

This process is called neurodegeneration. It means that people with PD have low levels of dopamine in the part of the brain that controls movement and balance. Symptoms of Parkinson’s appear because the nerve cells are no longer able to pass on the right messages to control the body’s movements.

Is Parkinson’s hereditary?

In some cases, a faulty gene can be passed down by parents to children and cause them to inherit Parkinson’s, but this is extremely rare; the disease is not generally inherited.

Who gets Parkinson’s?

Parkinson’s affects people of all races and backgrounds. The chance of getting the disease increases with age, but it’s estimated that around 4% of people with Parkinson’s are diagnosed under the age of 50.
Men are more likely to get PD than women. Some research suggests that as many as twice as many men as women are diagnosed, and women are an average of 2.1 years older than men at the time of diagnosis.

How long can you live with Parkinson’s?

Parkinson’s is a lifelong disease that significantly affects day-to-day life and can make people more vulnerable to other illnesses and infections. However, thanks to advances in treatment, most people with the condition have a normal or near-normal life expectancy.

Diagnosis

A range of assessments are used to help doctors to determine whether someone has Parkinson’s. They may also use certain tests to help rule out other conditions.

How is Parkinson’s diagnosed?

It can be difficult to diagnose Parkinson’s, for several reasons. In the early stages, symptoms are often mild, making it hard for doctors to be certain that they are caused by Parkinson’s. Symptoms can vary considerably between individuals, and other illnesses – such as essential tremor and Alzheimer’s disease – have similar symptoms, which can lead to misdiagnosis.

The other factor that makes PD difficult to diagnose is that there is no single test for the condition. Specialists may use a number of tests to help them rule out other conditions, but the diagnosis is primarily made based on the combined results of:

  • An assessment of a patient’s symptoms
  • An assessment of a patient’s medical history
  • A detailed physical examination

Tests to diagnose Parkinson’s

Doctors may use one or more of the following tests to help them rule out other conditions:

  • SPECT (single photon emission computed tomography) scan: This can help to identify whether there is a loss of dopamine-producing cells in the brain, which may indicate PD.
  • CT (computerised tomography) scan: These x-ray images of the brain can help to rule out vascular disease and tumours.
  • MRI (magnetic resonance imaging) scan: Magnetic charges are used to form images of the brain. These can be used to help distinguish Parkinson’s from Parkinson’s-like conditions such as progressive supranuclear palsy (PSP) and multiple system atrophy (MSA).
  • Blood tests: A range of blood tests can help to rule out conditions such as abnormal thyroid hormone levels or liver damage.

Treatment and medication

There is no single treatment to cure Parkinson’s, but there are many medications and therapies that can help to control its symptoms.

How is Parkinson’s treated?

Various medications are available to help improve the symptoms of PD. Supportive therapies such as physiotherapy, speech and language therapy, and occupational therapy can also make a big difference in helping people with Parkinson’s to continue to live independently.

Medication

Many medications produce a marked improvement initially, but their effectiveness can ‘wear off’ or become inconsistent over time and so they may need to be adjusted as the disease progresses.

PD symptoms are linked to a decrease in dopamine levels in the brain; however, it’s not possible to take dopamine as a treatment, because it can’t cross into the brain where it is needed. This means that most medications focus on increasing dopamine levels in some other way.

Medications include:

  • Dopaminergic agents:These aim to increase dopamine in the brain or mimic the effects of dopamine (dopamine agonists).
  • Monoamine oxidase B inhibitors: These help to increase dopamine levels and are useful in the earlier stages of PD.
  • Catechol-O-methyltransferase (COMT) inhibitors:These are taken alongside a dopaminergic agent to help prolong its effectiveness and are generally prescribed in later stages of Parkinson's disease.
Each medication has a range of side effects which should always be considered and discussed with a doctor before the medication is taken. Medication can come in different forms, including tablets, injections, and gels, giving patients a wide range of options to suit their individual needs.

Therapy

Many people with Parkinson’s find that supportive therapies are beneficial for certain symptoms. In the early stages, supportive therapies may be enough to help people continue with day-to-day activities without medication.

Physiotherapy sessions can be helpful for improving flexibility, relieving muscle stiffness, and reducing joint pain; a speech and language therapist can help with exercises and assistive technology to help patients relearn speech skills as well as assisting with eating and swallowing; and occupational therapy assessments can identify changes that can be made around the home, helping patients to maintain independence for longer.

Learning to live with Parkinson’s disease can be extremely frustrating. Many different forms of support can help to address this, from support groups with others in similar situations to one-to-one professional counselling. Doctors can provide more information about what’s available locally.

Alternative therapies

Many people find that alternative therapies are helpful in combination with other treatments as a means of reducing stress, depression, tiredness, and pain. For example:

  • Massage promotes relaxation and reduces muscle tension
  • Yoga increases flexibility and improves balance
  • Meditation reduces stress and anxiety
  • Alexander technique focuses on posture and balance and may help to reduce muscle tension and pain

Intervention

Surgery for Parkinson’s is called deep brain stimulation. It involves a pulse generator, which is similar to a heart pacemaker, being implanted into the chest wall. The pacemaker is connected to the brain with fine wires, and a tiny electrical current is used to stimulate the part of the brain affected by Parkinson's disease.

Deep brain stimulation is not common, but it is recommended in some cases – mainly when the available drug treatments no longer help to control symptoms.

Diet

Changes to the diet won’t reduce the effects of Parkinson’s, but they can help address certain symptoms. These include:

  • Increasing fibre intake and ensuring enough fluids are being consumed to help with constipation.
  • Avoiding dehydration (which can be caused by PD medication) by maintaining an adequate intake of water and fluids.
  • Ensuring the right amount of salt is included in the diet to avoid low blood pressure and dizziness. Eating small meals more often may also be helpful.
Some research shows that a Mediterranean diet may be beneficial in helping to reduce the chances of developing Parkinson’s disease. These diets are generally high in vegetables, fruits, legumes, nuts, beans, cereals, grains, fish, and unsaturated fats such as olive oil, and low in meat and dairy foods.

Exercices

Exercise can be helpful for people with Parkinson’s because it:

  • Helps to increase muscle strength
  • Improves flexibility and balance
  • Can boost mental health and reduce depression or anxiety
Exercise such as walking, swimming, gardening, and yoga can often be continued independently after someone is diagnosed with Parkinson’s, or doctors may recommend sessions with a physical therapist.

Prevention

No treatment or therapy has yet been found to prevent Parkinson’s from developing, although there has been extensive research into the benefits of physical exercise in earlier life; it has been shown that people who exercise are less likely to develop Parkinson’s.

However, while research indicates that exercise is associated with a lower risk of Parkinson’s, it has not proved that physical exercise is the cause of the decreased risk. More research is needed to establish whether there is a direct link.

Scientific studies

The treatment and prevention of Parkinson’s disease is a big area of research, and better understanding of the condition is an important factor in developing appropriate new drugs.

Studies such as one in Finland in 2020 are looking into ways to boost levels of dopamine and protect the dopamine-producing brain cells from dying, while other research is focusing on the causes of the motor symptoms in Parkinson’s. Such studies give scientists reason to believe that better ways of treating Parkinson’s disease can be developed in future.

Referenced sources

  1.  GBD 2015 Neurological Disorders Collaborator Group. Global, regional, and national burden of neurological disorders during 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurol. 2017;16(11):877-897. doi:10.1016/S1474-4422(17)30299-5
  2.  European Commission. Health research on Parkinson’s disease Accessed February 23, 2021. https://ec.europa.eu/research/health/pdf/factsheets/parkinsons.pdf
  3.  Aaseth J, Dusek P, Roos PM. Prevention of progression in Parkinson’s disease. Biometals. 2018;31(5):737-747. doi:10.1007/s10534-018-0131-5
  4.  Delic V, Beck KD, Pang KCH et al. Biological links between traumatic brain injury and Parkinson’s disease. Acta Neuropathol Commun. 2020;8(1):45. doi:10.1186/s40478-020-00924-7
  5.  Parkinson’s causes. The European Parkinson’s Disease Association (EPDA). Updated September 2018. Accessed February 2021 https://www.epda.eu.com/about-parkinsons/causes/
  6. The European Parkinson’s Disease Association (EPDA). Response to the European Commission’s Consultation on the Green Paper on a Common Strategic. Framework for future EU Research and Innovation Funding. Accessed February 2021. 
  7. Miller IN, Cronin-Golomb A. Gender differences in Parkinson’s disease: clinical characteristics and cognition. Mov Disord. 2010;25(16):2695-2703. doi:10.1002/mds.23388
  8.  Alcalay RN, Gu Y, Mejia-Santana H et al. The association between Mediterranean diet adherence and Parkinson’s disease. Mov Disord. 2012;27(6):771-4. doi:10.1002/mds.24918
  9.  Fan B, Jabeen R, Bo B et al. What and how can physical activity prevention function on Parkinson’s disease? Oxid Med Cell Longev. 2020;2020:4293071
  10.  Mahato AK, Kopra J, Renko J‐M et al. Glial cell line–derived neurotrophic factor receptor rearranged during transfection agonist supports dopamine neurons in vitro and enhances dopamine release in vivo. Mov Disord. 2020;35:245-255. doi:10.1002/mds.27943
  11.  Heo JY, Nam M-H, Yoon HH et al. Aberrant Tonic Inhibition of Dopaminergic Neuronal Activity Causes Motor Symptoms in Animal Models of Parkinson’s Disease. Curr Biol. 2020;30(2):276-291.e9. doi:10.1016/j.cub.2019.11.079
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