Parkinson’s disease is a progressive neurodegenerative disorder that affects a person’s motor and non-motor abilities. Parkinson’s disease afflicts one percent of all elderly people over the age of 60. X Research sources JOHN D. GAZEWOOD, MD, MSPH, D. ROXANNE RICHARDS, MD, KARL CLEBAK, MD, Parkinson’s An Update, The American Family Physician, 2013 Feb 15;87(4):267-273 Parkinson’s disease is a progressive disorder of the central nervous system. This disease often causes muscle rigidity, tremors, slowness of action, and poor balance. If you think you or a loved one has Parkinson’s, know how to diagnose it. Recognize the symptoms of this disease first at home, then go to the doctor to get the right medical diagnosis.
Know the Symptoms of Parkinson’s Disease
Watch for tremors in the hands and/or fingers. Tremors or uncontrollable shaking in the hands, feet, fingers, arms, face, or jaw is one of the first complaints of sufferers who are then usually diagnosed with Parkinson’s disease.
There are many causes for tremors, but one of the most common causes is Parkinson’s disease. Tremors are usually the first sign of this disease.
Tremors and other symptoms may initially appear on only one side of the body, or be more severe on one side of the body.
A ” pill rolling ” movement between the thumb and the other finger is characteristic of Parkinson’s tremor.
Observe if there is slowed or distorted movement. Some of the symptoms of Parkinson’s are outweighed by slowed movements (known as “bradykinesia”). Motor function walking, balance to write, even motor functions that are usually considered spontaneous or reflexive become disturbed.
This slowing of movement is a very common early symptom of Parkinson’s, and can be present at disease onset in up to 80% of patients.
Some people may find it difficult to describe how they feel and use words such as “weak”, “tired”, or “difficult to coordinate movements” when describing their symptoms.
Observe the distortion in uncontrollable motion. In addition to involuntary movements and slowness, people with Parkinson’s can also experience problems with controlled movements. Some medications for this disease can make abnormal uncontrollable movements, or increased movements, called dyskinesia . This distortion ( dyskinesia ) can look like a jerk and is exacerbated by psychological stress.
Advanced dyskinesia is most commonly seen in patients who have been given levodopa for some time.
Notice the gait that looks dragging. One of the common symptoms of Parkinson’s is a shuffling gait with short strides and a tendency to lean forward. People with Parkinson’s disease usually have difficulty balancing and sometimes tend to fall forward, as a result, they walk faster so that their body does not fall. This is known as the ” festinating gait ” which is very commonly associated with Parkinson’s disease.
These symptoms usually appear later.
Observe body posture. When standing or walking, sufferers often bend at the waist. This happens because Parkinson’s can cause balance and posture problems, including body rigidity. There is a tendency to flex the head and arms so that the sufferer looks bent with the head down and the elbows bent.
This stiffness can affect the entire body and make you feel stiff or painful.
Observe the rigidity of the posture. This symptom, called ” cog-wheeling, ” is a hallmark of Parkinson’s disease, in which there is stiff movement when the patient’s arm is moved through basic movements of extension and flexion. Stiffness and resistance to movement are the characteristics best characterized by passive elbow and wrist motion.
Cog-wheeling may occur when stiff muscles have tremors.
Observe for any cognitive impairment. Although common, some cognitive impairments are usually not common until late in the course of the disease.
Observe for any speech disturbances. At any given time, about 90 percent of people with Parkinson’s disease appear to have signs of a speech disorder. Speech disorders can manifest as slow speech, sighing or hoarseness when speaking. The language used is also inaccurate.
The voice produced is often low or whispering because of the lack of mobility of the vocal muscles.
Watch for signs of anxiety or depression. Up to 60 percent of sufferers show signs or depression, or anxiety. Parkinson’s disease affects the part of the brain that regulates mood. As a result, the risk of depression will increase, especially with regard to the quality of life of sufferers in the late stages of the disease.
Observe for any digestive problems. Parkinson’s disease also affects the food-promoting muscles of the digestive system. As a result, various digestive problems such as incontinence to constipation will appear.
These symptoms usually occur with difficulty swallowing food.
Observe difficulty sleeping at night. The number of uncontrollable movements makes it increasingly difficult for people with Parkinson’s disease to sleep well at night. Muscle stiffness that makes it difficult to sleep at night, or bladder disorders that cause frequent awakenings at night to urinate, appear along with sleep disturbances experienced by sufferers.
Testing for Parkinson’s Disease
Test for symptoms of Parkinson’s disease at home. While symptoms alone are not enough to get an accurate diagnosis, you can tell your doctor about all of your symptoms. When you ask about this disease, the first thing the doctor does is perform a physical examination on you. Therefore, you can see for yourself some of the similar symptoms that doctors usually look for.
Place your hands in your lap to watch for tremors. Unlike most other tremors, Parkinson’s tremors are more severe when you are still.
Look at your posture. Most people with Parkinson’s usually stand slightly bent forward, with the head down and elbows bent.
Go to the doctor. Doctors are also the ones who ultimately determine the diagnosis. Make an appointment to see a doctor and share your medical history or problems. Your doctor may give you some tests to help diagnose Parkinson’s disease.
Except in the very early stages, Parkinson’s disease is easy to diagnose. There are many tests for this disease. Doctors may run other tests to rule out others who have similar symptoms like Parkinson’s (such as hydrocephalus, stroke, or benign essential tremor). Essential tremor is the condition most closely resembles Parkinson’s disease. This condition runs in families and is often characterized by an outstretched hand.
Your doctor may refer you to a neurologist, which is a doctor who specializes in diseases of the nervous system.
Have a physical examination. The doctor will first perform a physical exam on you to look for different types of indicators:
Does your expression look alive?
Is there any sign of tremor in your hand when it is placed?
Does your neck or limbs feel stiff?
Do you find it easy to stand up in a sitting position?
Is your gait normal? Do your arms swing symmetrically when you walk?
When pushed, can you quickly balance your body?
Follow your doctor’s instructions for any other necessary tests. Imaging tests are usually not helpful in diagnosing Parkinson’s, such as ultrasound , MRI, SPECT, and PET. However, in some cases, your doctor may recommend one of these tests to help differentiate Parkinson’s from other diseases with similar symptoms. The cost of this test, the invasive nature of the procedure, and the infrequent availability of testing machines are obstacles that prevent doctors from recommending such a diagnostic tool.
MRI can help differentiate Parkinson’s disease from other diseases that have Parkinson’s-like symptoms, such as progressive supranuclear palsy or multisystem atrophy.
Measure response to treatment. Parkinson’s treatment includes increasing the effects of dopamine (a neurotransmitter affected by Parkinson’s) in the brain. Treatment may include administering levodopa , the most commonly prescribed and most effective drug for Parkinson’s, either as levodopa alone or in combination with carbidopa ). In some cases of Parkinson’s, your doctor may also prescribe a dopamine agonist, such as premipexole , which stimulates dopamine receptors.
If you think your symptoms can be reduced by taking medication, your doctor may prescribe medication to determine how it affects one of these symptoms. Compared to Parkinson’s disease, diseases that mimic it are less likely to respond to treatment.
Treating Parkinson’s Disease
Take medication. Until now, there is no cure for Parkinson’s disease. There are only drugs available to treat the various symptoms. Some of them are:
Levodopa / Carbidopa (Sinemet, Stalevo, Parcopa, etc.), which treats motor symptoms in early and advanced Parkinson’s disease
Dopamine agonists (Parlodel, Neupro, Apokyn, etc.), which stimulate dopamine receptors to make the brain believe it has received dopamine
Anticholinergics (Cogentin, Artane, etc.), which are used primarily to treat tremors
MAO-B inhibitors (Eldepryl, Zelapar, Carbex, etc.), which enhance the effect of levodopa
COMT inhibitors (Tasmar, Comtan), which block the body’s metabolism to levodopa , prolong their effect
Do exercise to slow down Parkinson’s disease. While this is not a permanent solution to the effects of Parkinson’s disease, exercise has been shown to increase mobility and reduce stiffness, improving balance, posture and gait. Aerobic exercise that requires biomechanics, rotation, posture, and rhythmic movement has proven to be very beneficial for the body. The types of exercise that can help include:
Tennis and volleyball
See a physical therapist. Talk to a physical therapist to see which fitness habits are best for you, based on your level of Parkinson’s disease. Physical therapists can adjust exercise routines to target areas of the body that are experiencing stiffness or decreased mobility.
Consultation with a physical therapist is also necessary to periodically re-evaluate your exercise routine to ensure it remains effective and continues to monitor disease progression.
Ask about surgical options for treating Parkinson’s disease. Deep brain stimulation (DBS) is a surgical procedure that is revolutionizing the treatment of advanced Parkinson’s disease. Electrodes will be implanted into a target area in the brain, which is then connected to an impulse generator that is inserted under the collarbone. The patient is then given a controller to turn the device on or off at the desired time.
The effects of DBS are often dramatic. This action is usually recommended by doctors for patients who experience paralyzing tremors, patients who experience side effects from taking medication, or if the drug is no longer effective.