FAQ
Q: What are the signs of Parkinson’s disease?
A: Originally described as the “shaking palsy” by James Parkinson, the diagnosis of PD is based on the presence of one or more of the cardinal symptoms of the disease easily remembered as TRAP.
TREMOR: Early in the stages of the disease, approximately 70 percent of people experience a slight tremor on one side of the body; usually in the hand or foot although it can appear in the jaw or face. The PD tremor has a characteristic appearance that takes the form of a rhythmic back and forth motion at a rate of 4-6 beats per second. It is most obvious when at rest or when a person is under stress.
RIGIDITY: A resistance to movement affects most people with PD. This inflexibility or stiffness of the muscles is caused by the disruption in the normal movement of muscles that stretch when in motion and relax when at rest. In Parkinson’s rigidity, the muscle tone of an affected limb does not relax which can contribute to decreased range of motion, such as the inability to swing the arms when moving. Rigidity can also cause pain and cramping.
AKINESIA/BRADYKINESIA: Is the loss of spontaneous automatic movement (akinesia) or the slowing down in movement (bradykinesia) making even simple daily tasks difficult. Over time, Parkinson’s disease can reduce the ability to initiate voluntary movements, creating difficulty in doing things such as taking a shower, buttoning a shirt, or combing your hair. When you walk, your steps may become short and shuffling.
POSTURAL INSTABILITY: Impaired balance that causes people to fall easily. A person with postural instability may not be able to recover if bumped and may topple over. Some develop retropulsion, which is a dangerous tendency to sway backwards. Affected people may also develop a stooped posture in which the head is bowed and the shoulders are drooped. Neurologists test postural instability by using the “pull test” in which a moderately forceful tug backwards is done to observe how well the person recovers. The normal response is a quick backwards step to prevent a fall. If the person has postural instability, the neurologist is there to catch them.
There are other symptoms that accompany PD; some of them are minor and others are more involved. Many symptoms can be treated with medications and therapy. The symptoms can include: depression, emotional changes, swallowing problems, speech changes, urinary problems, constipation, skin problems, sleep problems, edema, dementia or cognitive problems, orthostatic hypotension (drop in blood pressure when standing up), muscle cramps, dystonia, pain, fatigue, sexual dysfunction, drooling, and inability to initiate movement.
Q: Who gets Parkinson’s disease?
A: Getting an accurate count of the number of cases may be impossible because many people in the early stages of the disease assume their symptoms are the result of normal aging and do not seek help from a physician. However, it is estimated that one out of every 100 people age 60 and over has Parkinson’s disease. For those ages 40 and over the estimate is one out of every 250. Approximately 15% of those diagnosed fall into the young-onset group, or those under 50. The disease affects men and women equally with just slightly more men diagnosed than women. The disease does not discriminate by race or socio-economic standing. The average onset is 60 years of age with the incidence of occurrence rising with increase in age.
Q: How is Parkinson’s disease diagnosed?
A: Diagnosis of PD is difficult because there are no specific tests, such as blood work or x-rays that will diagnose it. Diagnosis may be delayed because the symptoms presented are mistaken for another disorder or passed off as related to normal aging. On the other hand, people who have other disorders have been mistakenly diagnosed as having PD. The diagnosis of PD is made by full medical history and neurological exam completed by a neurologist Since there are no diagnostic tests, the diagnosis rests on the clinical information provided by the patient and the findings on the neurological exam.
Q: What is the treatment for Parkinson’s?
A: Currently, there is no cure for Parkinson’s. Parkinson’s is a very individualized disease and each person requires their own unique treatment plan. The goal of treatment is to reduce symptoms and allow the person to function as normal as possible.
There are several medications and surgery that can manage the symptoms of PD. The medication used most frequently is Levodopa-carbidopa, otherwise known as Sinemet™. This medication is very successful at reducing the tremors and other symptoms of PD during the early stages of the disease. It allows the majority of people with PD to extend the period of time in which they can lead relatively normal, productive lives.
The other medications used in the treatment of PD include: dopamine agonists, Catechol O-methyltransferase (COMT) inhibitors, Monoamine Oxidase (MOA) inhibitors and amantadine and anticholinergics. For most, the choice of medication is based on side-effects and ability to tolerate.
Aside from medications, there is a surgical procedure for treating PD. The deep brain stimulation (DBS) has become the standard for treatment. The DBS uses an electrode surgically implanted into part of the brain. The electrodes are connected by a wire under the skin to a small electrical device called a pulse generator that is implanted in the chest beneath the collarbone. The pulse generator and electrodes painlessly stimulate the brain in a way that helps to stop many of the symptoms of PD. It is most effective for individuals who experience disabling tremors, wearing-off spells and medication-induced dyskinesias. The DBS also reduces the need for Levodopa and other similar drugs.
Q: What other additional treatments are helpful for people who have Parkinson’s disease?
A: There is a variety of complimentary and supportive treatments for managing PD including physical therapy, occupational therapy, and speech therapy. These are standard treatments in addressing issues with gait, balance, rigidity and tremors and voice disorders. Additionally, people often use supportive therapies including:
Diet: A high fiber diet is helpful in dealing with constipation along with plenty of fluids. Additionally, avoiding a high protein diet is important if you are taking Sinemet ™ as it can interfere in the effectiveness of Levodopa. Studies are also being done on Coenzyme Q10 (coQ10) which is produced by the human body and is necessary for the basic functioning of cells. It is reported to decrease with age and to be low in patients with some chronic diseases such as PD. Studies are being conducted to determine if the supplement of coQ10 slows the progression of PD.
Exercise: Exercise can help people with PD improve mobility and flexibility. Many physicians will order therapy or muscle-strengthening exercises to reduce rigidity and improve range of motion. Exercises for PD can take many forms including structured exercises, walking, gardening, exercise machines and Tai Chi.
Q: What other services are available to those with PD or their loved ones?
A: Many areas offer support groups that provide those with Parkinson’s disease the opportunity to meet with others with the same diagnosis, while learning about treatments and other ways of managing the disease. The Florida Hospital Parkinson’s Outreach Center offers the Central Florida area several support groups that include exercise classes and music therapy. If you reside outside of the Central Florida area, the Parkinson’s Outreach Center can help you locate a support group in your location. The Outreach Center also offers resource information on Parkinson’s disease as well as offers information and referral services and supportive counseling services. Contact the Outreach Center at 407-303-5295 or email fh.parkinson@flhosp.org for more details.
