A Simplified Guide: Parkinson’s Disease

Parkinson’s disease is a common chronic neurodegenerative disorder of the central nervous system i.e. it is a progressive disorder that worsens with time & is the result of the loss of either the structure or the function of a neuron. A detailed description of the condition was first published in 1817 in An Essay on the Shaking Palsy, by an English doctor, James Parkinson.

It is a disease that has been known to mostly affect the aging population ( Over the age of  60 years) & hence, is commonly considered a geriatric disorder. Moreover, it primarily affects the mobility & locomotion abilities of the individual, thus it can also be considered a movement disorder.


Symptoms
The characteristic symptom of Parkinsonism is involuntary movement or tremors. Some other symptoms may include :

  • Increased muscle tension

  • Rigidity of the muscles

  • Mask-like  appearance (characterised by wide-eyed & a gaping mouth).

  • Bradykinesia - slowness of movements

  • Hypokinesia - a decreasing range of movements are observed which results in hampering performance of everyday activities like  walking, tying shoelaces, buttoning-unbuttoning etc. & may also result in slurred speech.


Causes
The five primary  motor symptoms of Parkinsonism are tremors, rigidity, bradykinesia (slow movement), postural instability (balance problems), & walking/gait problems. These motor symptoms result from progressive damage of the dopamine-generating cells of “substantia nigra”, of the basal ganglia, which is situated below the cerebral cortex which is called the midbrain.

Parkinson’s disease is caused by the damage to the dopaminergic neurons that are responsible for the release of the neurotransmitter dopamine. This results in the decrease in the release of dopamine, however the levels of the neurotransmitter acetylcholine does not decrease as the cholinergic neurons aren’t affected. This causes an imbalance in the levels of dopamine & acetylcholine in the brain, thus resultsing in the imbalance in the neurotransmitter activity which is thought to cause most of the symptoms.

A very small Percentage of the population, only about 5% has a family history of Parkinson's disease. The main cause of PD is unknown however, the contributing agents comprise of toxic chemicals such as herbicides, carbon monoxide, trichloroethylene (TCE) & perchloroethylene (PERC). These can usually be found in the air, soil or water, & sometimes even household products.


Treatment

  • Medication
    The treatment of Parkinson's disease focuses on eliminating the imbalance between the two neurotransmitters Dopamine & Acetylcholine.

    • Increasing the Dopamine
      Since there is a decrease in the level of dopamine, a prodrug (the inactive form of the drug which is metabolized to the active form of the drug)  L-dopa or Levodopa is used, it is then converted to dopamine- which is the active form of neurotransmitter, by the body.

    • Decreasing the Acetylcholine
      Other kinds of drugs may be  anticholinergic (drugs that have actions opposite to acetylcholine)  such as benztropine & trihexyphenidyl which are used to block the effects of Acetylcholine,  balancing out the levels of dopamine & acetylcholine, & thus reducing symptomatic tremors, rigidity & drooling.

  • Surgical Procedures

    • Pallidotomy
      In this procedure,  a part of the midbrain (Globus pallidus) that is responsible for generating tremors & producing muscle rigidity is destroyed.

    • Deep-brain stimulation (DBS)
      This  procedure involves the implantation of electrodes into another section of the midbrain (subthalamic nucleus). The Implanted electrodes release electrical currents which can reduce the many symptoms of Parkinson’s disease like tremors, rigidity, stiffness, slowed movement & slowed walking.


Prevention

  • Exercise
    It has been proven  that exercising on a regular basis benefits people with Parkinson’s disease by helping reduce stiffness/ rigidity, improving mobility, posture, balance, & gait. Aerobic exercise can be one of the measures of decreasing the symptoms because it increases the delivery of oxygen & neurotransmitters.

  • Diet
    Consumption of different kinds of foods covering the various food groups especially vitamins, minerals & an  increased fiber intake is advised. Fiber eases constipation & helps us feel full for longer. Whole grain foods such as brown rice, pasta, whole wheat bread, oatmeal, or crackers must be consumed.
    Too many sugary foods & drinks should be avoided as should excessive protein intake as consuming large amounts of protein may affect the effectiveness of Parkinson’s medications. Consumption of sodium, trans fat, cholesterol, & saturated fats in large amounts must be avoided.
    Consumption of Omega 3 fatty acids, Vitamin D3 & coenzyme coQ10 as dietary supplements may help in prevention of parkinson’s disease.

  • Cognitive Stimulation Activities for People with Parkinson’s Disease
    These activities can help with attention, visuospatial skills, information processing speed &, especially, executive function. Some of them are listed below:


If you or someone you know is seeing symptoms of Parkinson’s, contact your doctor immediately.
For further information about Parkinson’s support in India, Click here.

Rohang MishalComment