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PARKINSON'S DISEASE: WHAT IS IT?


Parkinson’s Disease is a slowly progressive neurodegenerative disorder. Neurodegenerative means that brain cells and brain systems are dying, or being lost. The degeneration occurs in multiple brain circuits, and these circuits control both motor and non-motor functions. Many chemicals in the brain are involved, so it is not just a disease of the chemical dopamine.

In addition to the common motor symptoms (tremor, stiffness, gait problems, slowness, etc) there can be a multitude of non-motor manifestations including memory problems, thinking problems, fatigue, mood disturbances (depression, anxiety, mania and others), sexual dysfunction, constipation, and drooling (as well as a host of other potential symptoms).

 

Some times the symptoms of PD can be very obvious, such as a resting tremor, but in many instances they are subtle, and may manifest in ways a general doctor may not immediately identify them with Parkinson's Disease (e.g. smaller than normal handwriting (micrographia), shoulder pain, or decreased arm swing).  The earliest symptoms to detect are considered  to be the common motor symptoms, and these usually occur more prominently on one side of the body.


The common MOTOR SYMPTOMS of Parkinson's Disease may include:


  • Rest tremor (shakiness)
  • Stiffness (rigidity)
  • Slowness (bradykinesia)
  • Soft, quite voice (hypophonia)
  • Shuffling steps may be accompanied by fascination, or chasing the center of gravity with short steps. The patient may appear to be tripping in a        forward direction
  • Freezing, balance problems
  • Start hesitation
  • Micrographia (small handwriting)
  • Loss of facial expression (masked face)


   NON-MOTOR SYMPTOMS:

       

  • Memory and concentration problems
  • Mild cognitive impairment 
  • Depression, anxiety, fatigue, social phobia, apathy
  • Anosmia (loss of sense of smell)
  • Constipation
  • Bladder problems
  • Diaphoresis (drenching sweats)
  • Oily face
  • Seborrheic dermatitis (skin problem resulting in greasy, scaly scalp and forehead)
  • Orthostatic hypotention (drop in blood pressure when standing)
  • Kyphoscoliosis (exaggerated curvature of the spine)
  • Personality changes
  • Sleep problems: sleep fragmentation, or insomnia
  • Hallucinations



It is important to know that 20% of patients will not have resting tremor, and also that a small number of patients may present initially with depression or sleep disorders.

 

Parkinson's Disease is probably not one disease. It is likely a syndrome with multiple diseases that share common clinical symptoms.

There are several disorders that may masquerade as Parkinson’s diseases:

 

LEWY BODY DISEASE: Parkinson’s symptoms plus hallucinations (seeing things that are not present) and thinking problems, which occur within the first few years of diagnosis.

 

CORTICOBASAL DEGENERATION (CBD): Parkinson’s symptoms along with problems with skilled movements (apraxia), a misbehaving limb (alien limb), sensory loss, myoclonus (sudden lightening-like movements), and possibly dementia.

 

MULTIPLE SYSTEM ATROPHY (MSA)-CEREBELLAR TYPE: Parkinson’s symptoms plus problems walking and problems with coordination (also called olivopontocerebellar degeneration (OPCA))

 

MSA - AUTONOMIC TYPE: Parkinson’s symptoms plus problems with autonomic dysfunction (early erectile or sexual dysfunction, dizziness when standing up, problems with digestion and/or constipation (also referred to sometimes as Shy-Drager syndrome))

 

MSA - STRIATONIGRAL DEGENERATION TYPE: Severe Parkinson’s symptoms, but largely unresponsive to dopaminergic therapy.

 

Progressive Supranuclear Palsy (PSP): Severe Parkinson’s symptoms, plus early falling, trouble walking down stairs, abnormal postures (dystonia), dementia, and problems moving the eyes particularly in the up and down directions.

 

VASCULAR PARKINSONISM: Usually presents with shuffling feet (some people call it lower-body Parkinson) and it is usually caused by small strokes with or without other Parkinson’s symptoms. It is often, but not always, symmetrical (symptoms are the same on both sides), and it may affect the legs much more than arms.