Parkinson’s disease

Parkinson’s disease is a “movement disorder”. The underlying pathology is a degenerative process affecting the brain. Its onset may be subtle. Initially, there are unintended and uncontrollable limb tremors, rigidity of the muscles, compromised balance, and the loss of coordination. As the condition progresses sufferers may have challenges with walking, writing, talking, and swallowing. The range of symptoms and rate of progression varies from individual to individual.

There is at present no cure for Parkinson’s, however, there are non-pharmacological and pharmacological interventions that can significantly control the symptoms and improve the quality of life of the sufferer, especially when administered in the early to moderate stages of the disease. The majority of persons with Parkinson’s can achieve their normal life expectancy.

Symtoms & Signs

The early symptoms and signs of Parkinson’s vary. While both sides are affected, in some, one side of the body may be more affected than the other. In such cases, this disparity is maintained longitudinally throughout the course of the disease.

The primary symptoms and signs are:

• Tremor – Initially most noticeable in the hands. A pill-rolling tremor where the thumb and the index finger appear to be rolling a pill back and forth is often noticed. Parkinson’s tremors are worst at rest, and they diminish with intentional movement.
• Slowed movements (bradykinesia) – The sufferer is often observed to be moving in “slow motion”.
• Rigid muscles – The muscles lose their suppleness and to both the observer and sufferer there is resistance to all joint movements.
• Impaired posture and balance – Parkinson’s patients often appear to adopt a slouched and drooping posture and often report unprovoked falls due to compromised balance.
• Loss of automatic movements – Natural movements such as arm swinging while walking, smiling, and blinking are compromised.
• Speech changes – The sufferer’s speech becomes softer, hesitant, and, slurred.
• Writing changes – The font often becomes much smaller than usual.

Diminished smell –

• Loss of the sense of smell is often reported.
• Depression and anxiety are commonplace.
• Forgetfulness and even dementia may occur.
• Insomnia is not unusual.
• In its very advanced stage, the person often develops swallowing challenges to the extent that they are unable to swallow their saliva.
• Loss of bladder control and constipation often develop.
• Extreme fatigue.
• Generalised body pain.
• Dizziness on sudden standing.

Predisposing Factors

Within the brain of a Parkinson’s patient, there is the progressive breakdown and death of nerve cells (basal ganglia) which produce the neurotransmitter dopamine. When there is a 50% or more depletion in the levels of the brain’s dopamine, the aforementioned symptoms and signs start to appear.
We are unsure as to what is the aetiology of the pathological changes in the brain which lead to Parkinson’s, however, the below factors may play varying roles:

Age – Being over the age of 60 is the primary risk factor.

• Genes – In up to 20% of cases there seem to be genetic factors predisposing to the development of Parkinson’s.
• Environmental factors – Numerous studies have implicated pesticides, herbicides, solvents, detergents, and heavy metals.
• Head trauma – A landmark US Veterans study published in 2018 showed that even mild head trauma may trigger the development of Parkinson’s.
• Being male – Males are 50% more likely to develop Parkinson’s when compared to females.
• Medications – Some medications used to treat schizophrenia and acute paranoia can precipitate Parkinson-like symptoms.

Prevention

• Minimize head trauma, for example when playing certain sports.
• Exercise regularly.
• Maintain good Vitamin D blood levels.
• Control cholesterol and uric acid.
• Have a healthy caffeine intake.
• A daily low-dose aspirin.
• Minimize (over) exposure to heavy metals whenever possible – e.g. Mercury, aluminium, lead, copper, manganese, zinc, and iron.

Treatment

Treatment is intended to:

•  Improve the quality of life.
•  Slow progression.
•  Reduce possible complications.

Non-Pharmacological

• Exercise
• Dancing
• Yoga
• Acupuncture
• Body massage
• Physiotherapy
• Occupational therapy
• A healthy and balanced diet
• Tai Chi
• Surgery – Ablation or destructive surgery; deep brain stimulation (DBS); or transplantation or restorative surgery can all help.
• Pharmacological
• Coenzyme Q 10

• Levodopa – By itself or along with adjuvant treatments such as benserazide or carbidopa.
• Dopamine agonist – When combined with levodopa a lower dose of levodopa can be used.
• Monoamine oxidase-B inhibitors- Treatment option in the early stages of Parkinson’s.
• Catechol-O-methyltransferase inhibitors – Often reserved for more advanced cases of Parkinson’s. May be used in conjunction with levodopa or a dopamine agonist.

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale. For appointments: clinic@familycaresvg.com, 1(784)570-9300, (Office), 1(784)455-0376 (WhatsApp)
Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper, or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided.