Today I will continue the series on some of the health conditions that usually require a caregiver. Last week, I presented an overview of Alzheimer’s Disease. It is estimated that at least one-fourth of care recipients suffer from Alzheimer’s or other memory loss problems. This year, approximately 5.8 million Americans age 65 and older are living with Alzheimer’s.

In comparison, a study published by the Parkinson’s Foundation found that about 930,000 people in our country are now living with Parkinson’s Disease. Whether your recipient suffers with this long-term degenerative disease of the central nervous system or you have a relative or friend who has been diagnosed with PD, the following information covers some of the basics. 

Where does PD get its name?  Since ancient times, PD has been noted in medical literature, including in the Indian medical system of Ayurveda more than 3,000 years ago. In AD 175, the physician Galen described it as “shaking palsy.” In modern times, the first clear medical description was written by British physician James Parkinson in “An Essay on the Shaking Palsy” in 1817. Dr. Parkinson published his findings with the intent of encouraging more study of the disease. Almost 60 years later, as Jean Martin Charcot, a French neurologist, further researched Parkinson’s findings, he recognized the importance of his work and named the disease after him. 

What is PD? As mentioned above, PD is a long-term degenerative (characterized by progressive deterioration) disease of the central nervous system. The motor system – the structures that support body movement – are most effected. The resulting symptoms are caused by the death of cells in the substantia nigra, which is a region of the midbrain, the forward-most part of the brainstem. Along with motor control, this part of the brain is also associated with vision, hearing, sleep and temperature regulation. 

Although the reason these cells die is not fully understood, research indicates that it involves the build-up of proteins into Lewy bodies in the neurons, resulting in a decrease in the neurotransmitter dopamine.

“Parkinsonism” is the term used to describe the main motor symptoms. Non-motor symptoms, such as cognitive and behavioral changes including dementia are common later in the disease process. 

What are the most common symptoms and signs and the course of Parkinson’s? Early in the disease, a tremor in one hand may be noticed. A feeling of stiffness in the body is also common. There are many other possible motor symptoms which usually appear slowly over time. These include a loss of coordination that may lead to falling or dropping objects.  A person’s gait (manner of walking) and posture may change. Leaning forward (as if hurrying) or a shuffling gait often occur.

Due to changes in the nerves that allow facial expression, some people develop an inability to raise eyebrows or smile and present with a blank expression which is referred to as facial masking. Often combined with changes in speech, such as a lowered voice volume, these may cause people to misunderstand a person’s demeanor, interpreting the mood as sad or upset.

The loss of the sense of smell is a commonly reported symptom. Often, the person’s handwriting becomes smaller and difficult to read. Various sleep problems emerge as do depression and anxiety in about one-third of cases. In the advanced stages, dementia is common.

Please note, other signs and symptoms may occur and any one of these by themselves do not indicate PD.

How does PD relate to aging and gender? Almost one percent of people over the age of 60 have PD. When it is diagnosed in someone younger than 50, it is called early-onset PD. Studies show that the incidence of PD is 1.5 – 2 times greater in males than females, and the average age of on-set is later for women. Signs, symptoms and disease progression also vary between genders.

What are the risk factors for PD? Since 1960, research into the cause of PD has grown significantly, but there is still no definitive known cause. Genetic and environmental factors are both believed to be involved.

Most researches agree that it is rare for PD to run in families, yet a genetic link has been found in a small number of people. Studies indicate that a person with a family member affected by PD are more likely to get the disease. Most people who have been diagnosed have what is referred to as idiopathic Parkinson’s which means there is no known cause. 

One risk factor that has been identified is exposure to certain pesticides. Another is a previous head injury that resulted in trauma to the skull or brain (such as a fall, physical assault or automobile accident). 

What are current treatments for Parkinson’s? Despite no cure at present, there has been and continues to be great intent to find one. From my research in preparing this blog, it seems there is hopeful progress and a goal of developing a cure in the near future. 

Until that cure comes, treatment is available that can lessen suffering and control or at least reduce the severity of symptoms. However, these medications often decrease in effectiveness as neurons continue to die causing PD to exacerbate. Side effects, such as involuntary writhing movements, occur in many situations. Some sufferers have received a degree of relief through diet and physical rehabilitation. 

In severe cases, a surgery in which microelectrodes for deep brain stimulation have been placed, has seen some success in motor improvement. 

This synopsis is meant to be a non-medical introduction of the basic facts of PD. There is a wealth of additional information online. Of course, if your loved one has been diagnosed with PD, ask questions every chance you get. Keep a list of questions and concerns than come up so you will have them ready at the next doctor’s visit.  

Caring Info: Do you know the difference between a symptom and a sign? Although sometimes used interchangeably, in health care, symptoms are manifestations that are apparent to the patient (a subjective evidence) and signs are indications perceived by the physician or someone else (objective evidence.)