An In-Depth Look at Parkinson's Disease - The Evidence-Based Facts You Need to Know
Could it be true that Parkinson's disease has a unique smell? It is true. The smell is likely to be the future biomarker for identifying Parkinson's disease long before the symptoms appear.
The smell of Parkinson's disease is a phenomenon that began with one nurse from Scotland who was hypersensitive to smells. Joy Milne singled out a musky odor from her husband, who had Parkinson's disease. She could later smell the same odor from other Parkinson's disease patients she came across while in her duties hence linking the smell to the disease.
Doctors can only diagnose Parkinson's disease many years later after its onset through noticeable and severe symptoms such as tremors.
What is Parkinson's Disease?
It is a progressive condition that affects brain neurons that produce dopamine neurotransmitters to control movement. The brain part most affected by Parkinson's disease is called substantia nigra.
The disease attacks nerve cells either to weaken and destroy them. Your healthy brain requires the right amount of dopamine to function body movements. When the neurons fail to produce enough dopamine due to a health issue such as Parkinson's disease, it affects body movement.
Parkinson's disease degenerates different symptoms as it progresses in stages. The initial symptoms of Parkinson's disease may be a tremor of one hand. Although body tremor is a common symptom of PD, it can also slow movement or cause joints stiffness leading to disability.
Core Facts About Parkinson's Disease
Parkinson's disease got its name from one English physician, James Parkinson, who identified it. He comprehensively described the condition in his essay published in 1817 and titled "An Essay on the Shaking Palsy."
In 1870, a French neurologist Jean-Martin Charcot named Parkinson's to honor the original description author, after an intensive study of the disease,
Parkinson's disease is the second prevalent neurological disease coming second to Alzheimer's disease. Approximately 10 million people globally are living with Parkinson's disease.
According to statistics by Parkinson's Foundation, the number of Parkinson's disease cases in the U.S is projected to be about one million in 2021. Of these projected cases, male patients might have the most significant number by 1.5 times more than female.
The average prevalent age of Parkinson's disease by the time of diagnosis is 56, and only 4 percent are below age 40, which doctors consider being young-onset. The youngest patient in the record of young-onset Parkinson's disease (YOPD) was 12 years old.
Parkinson's disease develops differently with each patient. Some can have negative non-motor symptoms related to dopamine neurotransmitters such as anxiety, depression, irritability, and anger. Such mental disorders can affect not only the patient's life quality but also those around.
One notable symptom of the disease is the expressionless face or a serious look. The patient might appear as if angry, and yet they are smiling. Although they might not be aware of the facial expression, the facial muscles become stiff and fail to smile when you need to.
Due to stiff wrist muscles, the disease can affect handwriting. The writing becomes smaller and cramped. The little script, also called micrographia, could be an early sign of Parkinson's disease.
Although body balancing and tremor issues are the common symptoms with Parkinson's disease patients, it would be better for the patient to make movements. It is not the same when the patient experiences non-movement symptoms, which may lead to disability.
Parkinson's disease has no known cause, and neither is it curable. Nevertheless, some factors such as family history are high risk closely associated.
While Parkinson's disease progresses in stages or phases, it might not follow all the stages systematically in some cases. Therefore, the disease progresses differently from person to person. For instance, early-stage symptoms in one patient might occur at a later stage in another person or may not occur at all.
The Progressive Parkinson's Disease Stages
Parkinson's disease is an unpredictable disease that affects individual people differently, with the symptoms occurring erratically.
There are two symptoms groups of Parkinson's disease. One has motor symptoms such as rigid muscles and tremors without non-motor symptoms. Another group may have both motor and non-motor symptoms such as pain, dementia, loss of smell, depression, and anxiety.
Besides these erratic symptoms, the disease follows a distinctive progression pattern, although at a varying pace. Some people may experience progressive changes slower than others. Others may have new symptoms popping up in between the stages.
The following are five stages of Parkinson's disease:
Stage one, being the initial and the mild stage of Parkinson's disease, does not have severe symptoms. Although the patient may have motor symptoms such as tremors on one side of the body, they may not interfere with your daily activities. The patient can also have changes in facial expression, posture, or walking in stage one.
As we mentioned earlier, Parkinson's disease is a progressive neurological disease. At stage two, it has progressed slightly to worsen the existing symptoms while adding others. The additional symptoms are rigidity, while the motor symptoms affect the other body side as well.
The existing symptoms may become more noticeable, although the patient can continue with daily activities, albeit with challenges.
The symptoms at stage three have intensified. At this stage, the reflexes may have declined, leading to losing balance or experiencing postural instability. The brain reflexes are essential in helping the patient to stand and walk with stability and without falling.
Body movements may also be unstable and slower, which can affect everyday activities. At this stage, the patient might require some assistance in performing some personal duties such as dressing.
The disease at stage four has progressed to severe symptoms, and therefore close assistance would be necessary. Although people at this stage can stand amid tremors without assistance, they may find challenges to walk unaided. Such a patient may require human assistance or a walker to help move around.
Eating, dressing, and other daily activities might also be challenging, and they may require some assistance. Therefore, at this stage, anyone would require a caregiver or a family member to assist with the daily needs.
Stage five is the end-stage when Parkinson's disease becomes critical. The symptoms of stage five are more severe and may contribute to debilitation. The patient at this stage may experience severe bradykinesia and rigidity.
Stage five is a dependent phase when the patient entirely depends on others for assistance, especially for mobility and basic daily needs. At this stage, the patient may have severe neck, back, and hips posture issues that would affect movement.
The patient might be using a wheelchair or have become bedridden. For both instances, a professional caregiver is a must-have. The two would be essential for the patient's personal needs and therefore avoid overburdening the family members.
The symptoms a patient in stage five may experience are confusion, delusions, hallucinations, and dementia.
Parkinson's Disease Symptoms
Parkinson's disease begins long before the early symptoms appear. Some people may notice some changes which may lead to Parkinson's disease. It is essential to differentiate Parkinson's symptoms from aging signs to get an early diagnosis for effective treatment.
Symptoms of Parkinson's disease may vary with individuals and at different stages of the disease.
Parkinson's Disease Early Symptoms
- Voice changes
- Regular constipation
- Anosmia (smell defect)
- Writing changes to small handwriting
The Four Cardinal Symptoms of Parkinson's Disease
- Rest tremor
- Rigidity (stiff and aching muscles)
- Bradykinesia (slowness in movement)
- Balance problems
- Stooped posture
Mid-stages Symptoms of Parkinson's Disease
- Speech changes such as slurring, speak softly, monotone, and muffled.
- A mask-like facial expression or a serious look
- Decreased arm swings when walking
- Postural instability that leads to falling backward
- Freezing moments of movement blocks such as when walking or turning
- Decreased blinking rate
- Weakness in face and throat muscles
Advanced Parkinson's Disease Symptoms
- Challenges in visual-spatial relations
- Seborrheic dermatitis causes a unique Parkinson's disease scent
- Disrupted sleep rhythm (circadian rhythm) causing daytime sleepiness and insomnia
- Impaired attention and memory problem
- Psychosis leading to occasional illusions and hallucinations, vivid dreams, sleepwalking and talking
What Causes Parkinson's Disease
The death of brain nerve cells in the substantia nigra, which produces dopamine, is the cause of Parkinson's disease. Dopamine is a chemical messenger that serves the brain to help the body's motions.
However, the dopamine-producing neurons can get damaged or die, which would reduce the amount of the chemical in the brain. The reduced dopamine can affect signals from the brain to the muscles and further affect body movement.
Even though it can take a long time for the neuron to become entirely damaged to affect movement, it eventually does. The question now is, what causes the loss of these vital neurons?
Studies are ongoing to establish the exact reason for the damage and death of such vital neurons.
Currently, we know that two factors that may affect the neurons to cause PD are:
It is likely that Parkinson's disease can be familial, which means it can run in the family. Researchers have established some genetic mutations that could contribute to PD.
Gene mutations could affect some proteins, such as alpha-synuclein made by a gene called SNCA. When the gene mutates, it leads to Lewy bodies or clumps formation when the protein builds up.
Other inherited genes that can mutate to cause Parkinson's disease are PARK2, PARK7, PINK1, and LRRK2.
However, not everyone with gene mutation can develop Parkinson's. Therefore, it is a rare occurrence for the disease to pass through families.
Environmental factors and exposure to toxins can be a high risk of Parkinson's disease, albeit rarely. Scientists believe that genetic makeup in some people would lead to vulnerability to toxic substances, which can activate Parkinson's disease.
Some of the toxic substances associated with PD are; heavy metals, chemicals such as herbicides, and pesticides.
Most postmortems of PD casualties who were once industrial workers showed a high concentration of solvents and polychlorinated biphenyls (PCBs). PCBs are occupational toxins from electrical equipment. One study demonstrates that PCBs in the brain are associated with Parkinson's disease.
Other Risk Factors of Parkinson's Disease
Age: Parkinson's disease is prevalent with the aged. An overwhelming majority of people with PD are seniors of 60 and above. Parkinson's disease could begin in mid-life and progress to develop symptoms later in life.
Gender: Parkinson's disease is more likely to occur in men than in women. It is possibly because men are at a high risk of chemical and other toxic substance exposure while working in industries. Again, women may have estrogen neuroprotection, which inhibits PD from developing.
How to Diagnose Parkinson's Disease
Diagnosing Parkinson's disease can be challenging, as the MDS (Movement Disorder Society) realized it, and hence they laid down criteria to guide clinical diagnosis.
The three major categories of diagnosing Parkinson's disease are:
The clinician or the neurologist attending to the patient may ask questions that would lead to answers concerning the patient's health history. From the medical history, the doctor can establish whether the symptoms related to Parkinson's disease.
Another diagnosis is a neurological examination, which is necessary to ascertain the body's stability, coordination, and balance. The examining doctor may require the patient to take different body activities such as walking, sitting, standing, extending arms, and others as may seem appropriate.
Lab tests such as a blood test would be essential when the doctor suspects another disease and would like to rule it out.
In most cases, the patient's symptoms are enough to diagnose Parkinson's disease. However, imaging examination might be necessary when the doctor or a neurologist prefers to clarify a particular issue.
MRI (Magnetic Resonance Imaging): A new MRI diagnosis has about 85% accuracy in diagnosing Parkinson's disease at its early stage. According to Parkinson's UK, which funded the research, the new MRI is a future promise to improve diagnosis for Parkinson's disease at its earliest stage.
fMRI (functional MRI): The brain imaging test is useful in examining brain functioning, although not a routine diagnosis of Parkinson's disease.
PET (Positron Emission Tomography): PET scan is not a Parkinson's disease diagnosing procedure. However, a neurologist can include it to rule out a likelihood of Parkinson's comorbidity with Alzheimer's disease.
DaTscan: DaTscan (dopamine transporter scan) is an imaging examination that can reveal how dopamine functions in the brain. It is also a diagnostic procedure to rule out other neurological disorders. Although the U.S Food and Drug Administration has approved DaTscan for use in hospitals, it is not readily available in most health facilities.
After the initial diagnosis, the doctor may prepare a treatment plan according to the diagnosis results.
Parkinson's Disease Treatment
Parkinson's disease is incurable. However, any Parkinson's disease patient deserves the right to treatment, no matter the stage of the disease.
The treatment can help ease the symptoms and restore control, providing relief to the patient. Some of the Parkinson's disease treatments are:
Most of the medications may substitute dopamine and also increase its production. Although there has not been a treatment to stop the disease from progressing, some medicines can significantly improve a PD patient's health. The Parkinson's disease medications include:
Levodopa: Levodopa is the doctors' first choice of Parkinson's treatment. It helps to increase dopamine or substitute it in the brain.
Carbidopa: Carbidopa is an accompaniment of levodopa since it prevents levodopa from breaking down outside the brain.
Dopamine agonists (DA): The dopamine agonists medication act and behave like dopamine by binding to dopamine receptors. The nerve cell receptors are useful in regulating motor function and body movement.
MAO B (monoamine oxidase B) inhibitors: They help prevent dopamine breakdown by blocking MAO B, a brain enzyme that metabolizes dopamine. Since it is common for levodopa efficacy to wear off after extended use, the MAO B inhibitors can prevent it from wearing off.
Anticholinergics: The medication is for controlling Parkinson's tremors. However, some of the anticholinergics' side effects, such as hallucinations, confusions, and impaired memory, can counter the drug benefits.
Amantadine: The drug is useful in symptoms short-term relief in the early stages of Parkinson's disease. The doctor can also prescribe it alongside carbidopa-levodopa therapy for controlling dyskinesia (involuntary movements) in the disease's later stages.
Parkinson's Disease Surgery
Some of the Parkinson's disease cases can fail to respond to medications and other therapies due to disease's advancement and other reasons. For such cases, the doctor can opt for surgery.
The two unique PD surgery types are:
Deep brain stimulation: DBS is a therapy that complements levodopa's treatment by controlling fluctuating and sometimes erratic effects. The surgery can also help to prevent dyskinesia, a side effect of levodopa.
DBS is also useful in treating tremors when they fail to respond with levodopa. However, DBS surgery can cause critical health issues such as brain bleeding, stroke, or infection.
Duopa Therapy: Duopa is a pump-delivered therapy that bypasses the stomach to get into the duodenum and into the intestines to deliver carbidopa/levodopa medication. The medication in gel form known as the enteral suspension works akin to oral therapy of carbidopa/levodopa.
A gastroenterologist or radiologist can perform the procedure by incising a stoma in the stomach for the PEG-J tube to pass through. Duopa therapy is useful for Parkinson's patients who may be experiencing motor fluctuations even after using dopamine agonists or MAO-B inhibitors.
Alternative therapy means a treatment that is not on the list of mainstream or conventional treatments. For many diseases, alternative therapies are essential in supporting modern therapies for various diseases.
As we mentioned earlier, Parkinson's disease affects every patient differently; therefore, treatment may also vary. If you have PD, you should consider incorporating any alternative therapies in your daily treatment.
Some of the alternative treatments are:
Tai Chi: It is a breathing and mind therapy that can improve movement and posture.
Yoga: Yoga can help ease painful muscles, loosen tight muscles, and improve posture. It can also energize the mind and body to reduce stress and improve concentration.
Acupuncture: It is a minimally invasive process for enhancing the functions of body organs, tissues, and glands by stimulating energy-rich skin areas.
Aromatherapy massage: It is a body stimulation therapy that works by exerting pressure on the skin to relax muscle spasms, relieve psychological stress, ease tension, manage pain, improve circulation, and eliminate body wastes and toxins.
Dance: Dancing can help to improve balance, posture, and gait. It can also help to reduce stress, depression and improve other cognitive functions.
Music: Music can help relax the mind to enhance sleep during sleeping difficulties.
Singing: Singing can help exercise vocal muscles, which are also useful in breathing and swallowing, a common problem with Parkinson's patients.
Speech and sound: Speech and sound therapy performed by speech therapy can improve swallowing, restore voice from the low tone, monotonous speech problems, and maintain communication skills.
Supplements: Quality-controlled supplements are useful for a PD patient by supplementing dietary values for general health and well-being. Since some of the supplements could interfere with the ongoing treatment, it is essential to discuss them with the doctor.
Some of the supplements are:
- Coenzyme Q10
- Vitamins C and E
Herbal therapy: There are many herbs known to contain antioxidants useful in eliminating oxidative stress common with PD. Since the herb variety is vast, it is essential to discuss this herbal therapy with your herbalist. Many natural alternatives may help and can be discussed in an in-clinic analysis.
Parkinson's Disease Complications
Parkinson's disease can cause other health complications such as:
- Emotional changes
- Cognitive problems
- Sleeping disorders
- Chewing and swallowing difficulties
- Bladder and bowel control problems
- Sexual dysfunction
- Sense of smell loss
- Blood pressure changes
Parkinson's Disease vs. ALS (Amyotrophic Lateral Sclerosis)
Amyotrophic Lateral Sclerosis, or ALS, as many people call it, while others refer to it as Lou Gehrig's disease, has almost similar symptoms as PD. But in the medical field, the two conditions are quite different.
ALS is a neurodegenerative disease with symptoms such as tremors, rigidity, and slow movement similar to PD. However, while Parkinson's disease affects the brain dopamine-producing neurons that control movement, ALS affects the spinal motor neurons.
ALS causes the motor neurons in the spinal cord to degenerate and deteriorate and eventually die. In nerve cell death, an ALS patient may progressively lose the ability to move muscles or perform moves.
The affected motor nerve cells cause the muscles to weaken or completely paralyze, leading to movement challenges. As the disease progresses, several muscles continue to weaken, such as the respiratory muscles, which affect breathing.
ALS does not affect the patient's mental health, different from Parkinson's disease, which can lead to mild cognitive impairment. Some PD patients may experience cognitive disorders such as hallucination, illusions, anxiety, sleep disorder, and depression.
Parkinson's Disease Cure in the Near Future
Scientists and researchers are digging deep to get to the bottom of Parkinson's disease cure. One research group led by Xian-Dong Fu, a cellular and molecular medicine professor at the University of California San Diego (UCSD), is rewriting astrocytes into dopaminergic nerve cells.
After creating the new nerve cells gets approval, it could be the breakthrough to Parkinson's disease cure. The discovery would not only benefit Parkinson's disease, but other conditions such as Alzheimer's, stroke, and Huntington's diseases.
Early PD diagnosis can be challenging because of its conflicting symptoms similar to other neurological disorders.
However, accuracy in early PD diagnosis can positively benefit the patient for effective treatment. For instance, carbidopa/levodopa treatment for Parkinson's disease has more potential when administered in the early stages.
You can also visit us at our Island Healthworks Natural Health Clinic for Live Blood Analysis and other health testing procedures using our modern technology for precision results.
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