What is parkinson's disease?

When you have Parkinson's disease, part of your brain cannot make enough dopamine, a chemical that helps control movement. It gets worse over time. But usually this happens slowly, over years. The disease can cause tremors, stiffness, and other problems with movement. It can also cause problems with thinking.

There are many things that can cause symptoms of Parkinson's disease. They include some medicines, some toxins, and trauma to the head as well as genetic factors. In most cases, the cause isn't known. There are many treatments that can help your symptoms and improve your quality of life. Taking your medicines correctly and getting regular exercise may help with symptoms. You may not need medicine if your symptoms are mild.

The course of Parkinson's disease varies, but it can include tremors, slow movement, stiffness, and problems with balance or walking. It may also include pain, depression, sleep problems and other non-movement symptoms. Parkinson's disease gets worse over time.

Mild symptoms

Tremor is often the first symptom. Early on, tremor and other symptoms occur in just one arm or leg or on only one side of the body. Changes in posture, walking, and facial expressions may occur. Other movement symptoms may include stiffness and moving slowly. Symptoms may not cause trouble in your daily life.

Moderate symptoms

With time, symptoms usually spread to both sides of the body. As the disease gets worse, movement is usually slower. Poor coordination may be a problem. Tasks such as writing, shaving, or brushing teeth may be hard. Changes in handwriting are common. Stiff muscles may cause pain or changes in posture.

Over time, Parkinson's medicines may not work as well. And they can cause side effects that include other movement problems or behavior changes. Changing doses or medicines may help.

Changes in posture and balance may get worse. A person with Parkinson's tends to walk in a stooped manner with quick, shuffling steps. Sometimes the person may freeze. This is a sudden, brief inability to move. It most often affects walking. Falls may be common.

The disease can affect many of the muscles used for chewing and swallowing. This can lead to problems with eating, as well as drooling and choking. It can also affect the muscles that are used for speech. This can lead to low or soft speech, unclear speech sounds, and other problems.

Problems with sexual function and drive are common in people with Parkinson's disease. You may:

• Have trouble getting or keeping an erection.
• Have vaginal dryness or urinate during sex.
• Have muscle stiffness that can make sex difficult.

Severe symptoms

After years, muscle stiffness, slow movement, tremors, and balance get worse. Walking becomes very hard. Some people may need to be in a wheelchair or bed most of the day. They will need help with most or all of the tasks of daily living.

There may be other movement problems. These can get somewhat better with changes to the person's medicine.

Mild changes in thinking may occur in earlier stages of Parkinson's disease.Dementia, hallucinations, and delusions may develop in many people who have late-stage Parkinson's disease. Dementia symptoms may include confusion, getting lost, and memory loss. Some Parkinson's medicines can make this problem worse.

The main symptoms of Parkinson's disease are tremors, stiff muscles, slow movement, and problems with balance or walking. Other symptoms include pain, depression, and sleep problems. Symptoms differ from person to person. Over time, the disease affects muscles all through your body. This can lead to trouble with swallowing, speech, and vision.

At this time, Parkinson's disease can't be cured. You may decide to wait to start medicines if your symptoms aren't bothering you. You may get occupational, physical, or speech therapy to help you function better. Exercise can also help. Brain surgery, such as deep brain stimulation, may be an option.

Movement problems

Movement problems are common from long-term levodopa use. Most people who take levodopa develop some of these problems within 5 to 10 years. The main types of levodopa-related movement problems include motor (movement) fluctuations and dyskinesias.

Motor fluctuations .

These are changes in the ability to move throughout the day. They may be called “on” and “off” times. When the medicine is working and movement is easy, it is “on.” When it's harder to move and symptoms cause more problems, it is “off.”

Wearing off happens when the effects of a dose of levodopa don't last as long as they used to. Symptoms come back before the next dose of levodopa. These changes can be predicted based on the timing of each dose.

“On" and "off" periods can also occur without warning. They can be hard to predict. An "off" period can occur suddenly, over seconds or minutes, and the person may freeze. Sometimes, long muscle spasms cause movement that can't be controlled. This can happen during on or off times.

Dyskinesias.

Dyskinesias are sudden, random, uncontrollable, often jerky or twisting movements caused by the medicine. They may affect the head, neck, arms, and legs or other parts of the body.

Changing the dosage or when it is taken may help movement problems. Or other medicines may be added to help with these movement problems. Examples are amantadine, dopamine agonists, COMT inhibitors, MAO-B inhibitors, and apomorphine.

Your doctor will ask questions about your symptoms and your past health and will do a neurological exam. This exam includes questions and tests that show how well your nerves are working. For example, your doctor will watch how you move and check your muscle strength and reflexes. The doctor may check your vision.

Your doctor also may check your sense of smell and ask you questions about your mood.

In some cases, your doctor will have you try a medicine for Parkinson's disease. If that medicine helps your symptoms, it may help the doctor find out if you have the disease.

There are no lab or blood tests that can help your doctor diagnose Parkinson's. But you may have tests to help your doctor rule out other diseases that could be causing your symptoms. For example, you might have an MRI to look for signs of a stroke or brain tumor.

An imaging test called a DaTscan may be done to help make the diagnosis.

Medicines are the most common treatment for Parkinson's disease. The goal is to correct the shortage of the brain chemical dopamine. This shortage causes the symptoms of Parkinson's.

Your doctor can help you decide when to start medicine. This may be when symptoms affect your daily life. Symptoms change as the disease gets worse. So your doctor will adjust your medicine as symptoms appear.

Medicines often improve symptoms. But they also may cause side effects. Levodopa works best to control movement symptoms. But after a few years, it can cause movement problems like uncontrollable jerking movements. It also may suddenly stop working. Levodopa is usually combined with carbidopa. Carbidopa decreases the possible side effects from levodopa.

Dopamine agonists also help movement symptoms. They can cause side effects like behavior changes and sleep attacks (sudden severe sleepiness). Talk to your doctor about what medicine is right for you.

Other medicines may also be used to help control non-movement symptoms, such as pain or depression.

It may take some time to find the best medicines for you.

Several medicines may be used at different stages of the disease. They include:

• Levodopa with carbidopa.
• Dopamine agonists.
• MAO-B inhibitors.
• Amantadine.
• Anticholinergic agents.
• COMT inhibitors.
• Apomorphine.

The tremor of Parkinson's disease isn't always severe, but it may affect many of your daily activities.

To help control tremor in your hand or arm when you are trying to use the hand, press the affected elbow against your body to make your upper arm stable. Then perform the movement. Wearing a rigid brace across a joint or putting a little weight on your hand may help to reduce tremor and restore control. Caffeine can make tremor worse, so reducing the amount of tea, coffee, or cola you drink may make the tremor less of a problem.

Surgery may be considered when drugs:

• Don't control symptoms.
• Cause severe or disabling side effects.

The types of surgery include:

• Deep brain stimulation. This uses electrical impulses to stimulate part of the brain. It's the preferred surgery for treating most cases of advanced Parkinson's.
• Levodopa-carbidopa intestinal gel (LCIG) surgery. This surgery places a tube in the intestines. The tube delivers levodopa. It can decrease "off" time and movement side effects.
• Thalamotomy. This surgery destroys a very small area in part of the brain that causes tremor.
• Pallidotomy. This surgery destroys a very small area in a deep part of the brain that causes symptoms.
• MRI-guided focused ultrasound. This uses MRI and ultrasound to destroy brain tissue. It can help with tremor.

Surgery isn't a cure. Drugs are usually still needed after surgery. But you probably won't need as much medicine as before. And you may have fewer side effects.

Parkinson's disease is a problem with certain nerve cells in the brain that control movement. The disease affects the way you move. It can include tremors, slow movement, stiffness, and problems with balance. Parkinson's disease gets worse over time. But usually this happens slowly, over years.

Normally, nerve cells in the brain make an important chemical called dopamine. Dopamine sends signals to the part of your brain that controls movement. It lets your muscles move smoothly and do what you want them to do. When you have Parkinson's, these nerve cells break down. Then you no longer have enough dopamine, and you have trouble moving the way you want to.

No one knows for sure what makes these nerve cells break down. But researchers are studying many possible causes, including aging and poisons in the environment.

Most people with Parkinson's disease can eat the same healthy, balanced diet recommended for anyone. This includes plenty of fruits, vegetables, grains, cereals, legumes, poultry, fish, lean meats, and low-fat dairy products.

Protein may interfere with how your body absorbs levodopa. This can make the effects of the medicine less predictable. It may be helpful to spread your protein intake evenly throughout the day. It is also recommended that you take your levodopa 30 minutes before or 1 hour after you eat a protein meal or snack. If that doesn't help, your doctor may have other suggestions.

Follow your doctor's advice on diet and medicine. Protein is an important part of your diet. Don't change the total amount of protein you eat without the help of a dietitian or doctor.

Symptoms of Parkinson's disease and side effects of medicines used to treat the disease can change your appetite and ability to eat. Nutrition also can be affected by mood, dementia, chewing and swallowing problems, tremors, not being able to move, and not being active. It can also be affected by changes in smell and taste. Ask your doctor or a dietitian for help if you have questions about nutrition.

A physical therapist can help you learn exercises and stretches to do at home to improve your posture, strength, flexibility, balance, and endurance.

A physical or occupational therapist can also help you to:

• Plan more efficient movements for daily living activities (such as bathing and dressing) so that these activities are easier and less tiring.
• Improve your walking and prevent falls.
• Use walking aids (such as canes or walkers) correctly.