What is Parkinson's Disease

Parkinson's disease (PD) is a slowly progressing neurodegenerative disorder caused by the loss of neurons within the substantia nigra area of the brain. These neurons produce a substance called dopamine, which is responsible for enabling smooth, coordinated functioning of the body's muscles and movement. As more dopaminergic neurons die and become impaired, the symptoms of Parkinson's slowly develop.

The four main symptoms of PD are resting tremor (shaking), bradykinesia (slow movements), rigidity (stiffness), and postural instability (balance issues). Neurologists usually don't diagnose PD until at least two of the four primary symptoms are present. There are no cli

nical tests to prove a diagnosis of Parkinson's, so it is important to see a neurologist, preferably one who specializes in Movement Disorders, in order to receive the most accurate diagnosis and treatment.

Other symptoms that may be attributed to PD include: small handwriting, reduced arm swing (usually on one side of the body at first), walking changes, reduction of facial expression, softer voice, sleep disturbances, anxiety, and depression. Be sure to discuss all medical concerns with your neurologist at your appointment, as many of these seemingly unrelated issues may be caused by PD.

The important takeaway of learning about PD is that no two Parkinson's patients are alike! You will not necessarily develop all, or even most, of these symptoms over the course of the illness. Individuals will all have a unique combination of symptoms. So if you've seen one person with PD, you've only seen ONE person with PD!

Parkinson's Disease Vocabulary

Neurodegenerative disorder: A condition caused by the death or degeneration of neurons in the brain or nerve cells in the spinal cord.

Substantia nigra: Literally means "black substance" and indicates the area of the brain where cells produce dopamine (which is black and causes the color of the area).

Micrographia: Small, cramped handwriting.

Hypomimia: Loss of facial expression or "masked face".

Dysarthria: Softer vocal volume.

Freezing: Temporary, involuntary inability to move.

Non-motor symptoms: Symptoms that don't affect movement (mood, constipation, sleep disturbances).

  • Blood pressure changes- low blood pressure when standing up (orthostatic hypotension) can cause dizziness or lightheadedness and if severe enough, may even result in fainting. PD itself, as well as the medicines used to treat PD can contribute to this problem. Proper evaluation can determine the cause and appropriate treatment options that can be used. Genitourinary dysfunction urinary frequency or urgency occurs commonly in PD. If PD related, a "neurogenic" bladder may be responsible (the bladder is smaller and is unable to hold as much urine). Urologists should always be consulted to rule out other causes. If PD-related, there are effective treatment options available.
  • Constipation - slowed gastric motility is commonly related to the disease process. Some studies have shown that constipation occurs in up to 70-80% of PD patients. Constipation must be taken seriously, as severe cases can result in serious illness or even death. With proper attention, constipation can be well-managed using the effective treatments that are now available. A common problem contributing to constipation is dehydration, and PD patients should be attentive to their level of fluid intake.
  • Sexual dysfunction decreased libido and erectile dysfunction are relatively common in PD. Erectile dysfunction is a common problem in males with PD, occurring in up to 60% of males at some point in the course of the illness. Interestingly, studies suggest decreased libido is significantly more common in females. There may be many other causes for these problems, including psychological factors, prostate and urinary issues, etc., and therefore a thorough evaluation should be undertaken. Specialists are available for consultation in the fields of urology and psychology and should be consulted. Physical intimacy is an important part of a relationship quality of life and with proper treatment can be maintained.
  • Temperature regulation feeling very cold or warm (despite normal room temperature) as well as inappropriate sweating can occur in PD. Less common is the troublesome phenomenon of "acute drenching sweats" requiring patients to change clothes. As with all of the non-motor symptoms, all other causes (including endocrine dysfunction) need to be evaluated.

Other Non-Motor Problems

  • Sensory complaints- numbness, tingling, burning and pain can be related to PD. The sensory disturbances may mimic other pathological processes (e.g., a herniated disc causing radiating nerve pain). A thorough workup is required, but if no cause is found and if PD medicines relieve the sensations, it is likely that the problem is a non-motor feature of PD. It should be noted that a common finding in PD patients is anosmia, or loss of smell. Interestingly, anosmia may predate the onset of motor symptoms by many years and may now be considered a risk factor for the future development of PD.
  • Dermatological problems- oily, red and flaky skin, also known as seborrheic dermatitis, is common in PD patients. Seborrheic dermatitis is commonly found on the face and scalp, where many oil glands are located. A variety of treatments and shampoos are available to manage this problem. For unknown reasons, malignant melanoma, the most lethal form of skin cancer, appears to have a 2-4% increased incidence in people with PD compared to the general population. It is therefore important to see a dermatologist regularly for "melanoma screening," since early detection can be curative.

Parkinsonism: A general term to describe Parkinson-like symptoms. Some people may have a parkinsonism but not Parkinson's disease.

Idiopathic: A term which indicates that a disease has no known cause.

Parkinson-plus syndromes: A group of brain disorders that may resemble Parkinson's disease, but they differ in the disease trajectory and in treatments. Also called atypical parkinsonism.

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