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A Guide to Care: Parkinson’s Disease Causes, Symptoms, and Treatment

By Haines EasonFebruary 24, 2022
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Parkinson’s disease (PD) is one of the fastest-growing neurological disorders in the world, with around 60,000 Americans receiving a Parkinson’s diagnosis each year and nearly 1 million Americans currently living with the disease, according to the Parkinson’s Foundation.

The condition usually affects people over age 65: Approximately 1.6% of seniors have some form of the disease. However, there’s a lot we know about the disease and a lot a caregiver can do to help ensure their loved one receives the best support possible.

Read on to learn about Parkinson’s disease causes, symptoms, and treatment and for guidance on the best care strategies for your loved one.

What is Parkinson’s disease?

Parkinson’s disease is a neurological disorder that affects a specific area of the brain and leads to tremors, stiffening of the limbs and regions of the body, and difficulty moving. General coordination is affected, with walking and balancing becoming difficult, which brings an increased risk for falls and injuries. Eventually, Parkinson’s may affect a person’s speech.

Parkinson’s is progressive — meaning it worsens with time — and is not curable. Beyond its effects on movement, the disease may alter a person’s sleep, memory, and behavior.

Parkinson’s disease causes

Parkinson’s disease occurs when certain neurons in the brain die or become impaired. These nerve cells are located in a midbrain structure called the basal ganglia, a structure that controls muscle movement and produces dopamine — a chemical responsible for coordinated muscle function. While researchers don’t know how many neurons must die for Parkinson’s-related motor symptoms to appear, estimates range from 50% to 70%.

As to what causes the onset of Parkinson’s, there’s still no single, clearly identified cause. Currently, evidence supports both genetic and environmental factors in the cause of Parkinson’s, with environmental toxins playing a significant role in the disease’s progression, according to a study published in the journal Annals of Neurology.

The prevalence of Parkinson’s varies by region, and it affects men more than women — both facts that add to the complexity of the disease. Research is underway to determine the reasons for these new discoveries.

Parkinson’s disease causes can be traced to a midbrain structure called the basal ganglia, pictured here.

Symptoms of Parkinson’s disease in older adults

Persistent body tremor is one of the most readily observed symptoms of Parkinson’s disease in elderly adults. However, Parkinson’s patients early in their diagnosis also indicate the following as the most troubling symptoms, in order:

  • Sluggish movement
  • General or specific stiffness
  • General or specific pain
  • Loss of smell and/or taste

Other common symptoms may include:

  • Challenges with balance
  • Depression
  • Disrupted sleep
  • Frozen facial expressions or decreased facial movement
  • Hand cramps
  • Muffled speech
  • Shuffling

How is Parkinson’s disease diagnosed?

Parkinson’s disease in the elderly is not easily diagnosed, as no screening or tests readily reveal the condition. However, some screenings and tests may rule out other conditions and help your loved one’s physician proceed in their evaluation.

Because there’s so much variability among patients in how the disease progresses, doctors can’t accurately predict how quickly symptoms will worsen or even which specific symptoms will develop for each patient. This makes it difficult to say which symptoms of onset of Parkinson’s disease will actually result in a diagnosis.

“How one person displays symptoms may be quite different from another patient,” explained Ruth Hagestuen, former director of field studies at the National Parkinson Foundation. “However, the sooner a patient visits a neurologist, the better. That way, a treatment regimen can be implemented, because this is a chronic illness and will require many modes of treatment over time to maintain life quality.”

To further complicate diagnosis, the onset of Parkinson’s symptoms doesn’t necessarily mean a patient has the disease. Parkinsonism, the term for displaying symptoms without actually having Parkinson’s disease, was found in 35% of those patients monitored in a 2002 study. Parkinsonism can be caused by medication complications, blocked blood vessels in the brain, or other chronic conditions like dementia.

To properly diagnose Parkinson’s disease in older adults, a neurologist or other qualified physician must complete a neurological examination and evaluate the patient’s complete medical history. Most importantly, your loved one’s doctor must also observe as many physical symptoms as possible.

Conditions that mimic Parkinson’s

Certain diseases can obscure early diagnosis of PD, which is another significant reason why a neurology appointment should be scheduled early in the diagnosis process. According to the Parkinson’s Foundation, conditions that are most similar to Parkinson’s display a wide range of familiar symptoms:

Essential tremor disorder

Many elderly people experience essential tremor disorder. These tremors are different from Parkinson’s tremors in that they affect both hands and result in shaking of the head and voice.

Progressive supranuclear palsy

Progressive supranuclear palsy typically affects people after the age of 50, usually worsens more rapidly than Parkinson’s, and results in imbalance, falling, stiffening of the midsection, and difficulty with eye movement.

Corticobasal degenerationis

Corticobasal degenerationis is an uncommon condition that affects speech, balance, and posture and also leads to slowness of movement. Affected limbs often become severely or completely disabled as this condition progresses.

Multiple system atrophy

Possibly the most difficult disease to distinguish from Parkinson’s, multiple system atrophy has an earlier onset (mid 50s) and rapid progression, which are two key characteristics of this neurodegenerative disease. As this condition intensifies, more symptoms arise and may indicate that other systems of the body are compromised.

Vascular parkinsonism

Caused by a series of small strokesvascular parkinsonism usually leads to mobility challenges and is located more often in the legs than the arms. Though treatment is the same for PD, it’s much less successful for vascular parkinsonism.

Lewy body dementia (LBD)

Lewy bodies are round protein structures that develop among brain cells and displace them, disrupting their functioning. Patients with LBD will typically exhibit parkinsonism in addition to cognitive impairment similar to Alzheimer’s disease. Vivid hallucinations are also possible.

How is Parkinson’s disease treated?

While some symptoms of Parkinson’s disease in older adults can be managed with medication, the disease remains irreversible and progressive. Some medications are very effective at helping people live with Parkinson’s, and your doctor may even suggest surgical options.

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Parkinson’s medications

Because symptoms vary with each patient, the choice and dosage regimens of medications need to be customized and adjusted as the disease progresses. The past decade has seen the development of new medicines that have “significantly improved the quality of life for people with the disease,” according to Cleveland Clinic.

If medications seem like the right path for your loved one, review those listed on Cleveland Clinic’s website (linked above), and discuss your loved one’s options with their doctor.

Surgeries used in treating Parkinson’s

Several surgical techniques have been developed for Parkinson’s, although it’s important to emphasize that none of them offers a true cure — and there are risks. Here are two of the more common and extensively researched techniques:

  • Brain lesioning procedures, including thalamotomy and pallidotomy, destroy different regions of brain tissue involved in Parkinson’s disease. This permanent effect on the brain is not recommended for both sides of the brain, and the improvements don’t always last. Thalamotomy is only effective at reducing severe tremors, while pallidotomy may also help to reduce the dyskinesia side effects that can result from long-term drug therapy.
  • Deep brain stimulation (DBS) is an alternative treatment to brain-lesioning surgery. A metal electrode is placed in the targeted area of the brain, and a pulse is generated to alter the abnormal function of that region. No brain tissue is destroyed in this procedure. The patient’s general health often determines the success of surgical treatment. DBS may be conducted on both sides of the brain if symptoms warrant it, but only if the patient is in good health.

Living with Parkinson’s

A patient with Parkinson’s disease benefits from a multidisciplinary approach to therapy, including physical, occupational, and speech, as well as psychological counseling. Creating an exercise plan, improving diet, and redesigning daily routines may improve your loved one’s well-being significantly. There is even promising evidence showing acupuncture can help relieve discrete symptoms of Parkinson’s and help with sleep.

“Parkinson’s disease will definitely impact every facet of a person’s life,” Hagestuen explained. “But a closely monitored treatment regimen including medication, exercise, and therapy proves tremendously beneficial in most cases.”

Hagestuen also recommended water exercise, Pilates, tai chi, and even dance therapy as ways to stay active and keep the muscles moving. Walking is also essential.

“Many people become much more physically active after they have received a Parkinson’s diagnosis,” she says. “And many people live healthier lives and function quite well.”

However, patients with Parkinson’s often feel a great deal of anxiety knowing that the progression of the disease is irreversible. Shielding themselves from what they perceive to be their future state, patients often turn inward and avoid others with the disease, Hagestuen noted. This obstinacy can make it difficult for family and caregivers to persuade their loved one to join Parkinson’s support groups and other activities with peers.

The first step a recently diagnosed patient should take, according to Hagestuen, is to talk with someone who really understands the disease.

“Often people don’t hear what they don’t want to hear and so continue onward in less than beneficial ways,” she explained. “Finding a care team that really listens and provides good feedback will really help the patient maintain a good quality of life.”

A Place for Mom’s interview with Hagestuen was conducted in January 2018.

Sources:

Baylor Medicine – Healthcare: Neurology. (2021). Vascular (multi-infarct) parkinsonism.

Schrag, A., Ben-Schlomo, Y., & Quinn, N. (2002). How valid is the clinical diagnosis of Parkinson’s disease in the community?Journal of Neurology, Neurosurgery & Psychiatry.

Cheng, H-C., Ulane, C. M., & Burke, R. E. (2010, June). Clinical progression in Parkinson’s disease and the neurobiology of axonsAnnals of Neurology.

Cleveland Clinic. (2020, May 1). Parkinson’s disease.

Cleveland Clinic. (2014, October 10). Medications for Parkinson’s disease.

Lee, D. J., Dallapiazza, R. F., De Vloo, P., & Lozano, A. M. Current surgical treatments for Parkinson’s disease and potential therapeutic targetsNeural Regeneration Research.

Johns Hopkins Medicine. (n.d.). How Parkinson’s disease is diagnosed.

Knowlton, B. J., & Yin, H. H. (2006) The role of basal ganglia in habit formationNature Reviews Neuroscience.

Lanciego, J. L., Luquin, N., & Obeso, J. A. (2012, December). Functional neuroanatomy of the basal gangliaCold Spring Harbor Perspectives in Medicine.

Merck Manual: Consumer Version. (2020, September). Parkinsonism.

National Institute of Neurological Disorders and Stroke. (2019, March 27). Corticobasal degeneration information page.

National Institute of Neurological Disorders and Stroke. (2021, November 15). Multiple system atrophy fact sheet.

National Institute of Neurological Disorders and Stroke. (2021, November 15). Progressive supranuclear palsy fact sheet.

National Institute of Neurological Disorders and Stroke. (2021, November 15). Tremor fact sheet.

National Institute on Aging. (2017, May 16). Parkinson’s disease.

National Institute on Aging. (2021, July 29). What is Lewy body dementia? Causes, symptoms, and treatments.

Parkinson’s Foundation. (n.d.) Deep brain stimulation (DBS).

Parkinson’s Foundation. (n.d.). Statistics.

Politis, M., Wu, K., Molloy, S., Bain, P. G., Chaudhuri, K. R., & Piccini, P. (2010, August). Parkinson’s disease symptoms: The patient’s perspectiveMovement Disorders: Official Journal of the International Parkinson and Movement Disorder Society.

Shulman, L. M., Wen, X., Weiner, W. J., Batemen, D., Minagar A., Duncan, R., & Konefal, J. (2002, July 22). Acupuncture therapy for the symptoms of Parkinson’s diseaseMovement Disorders: Official Journal of the International Parkinson and Movement Disorder Society.

Warner T. T. , & Schapira A. H. (2003). Genetic and environmental factors in the cause of Parkinson’s diseaseAnnals of Neurology.

Willis, A. W. (2013, October). Parkinson’s disease in the elderly adultMissouri Medicine.

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Haines Eason

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