Parkinson’s disease is a progressively degenerative disease that mainly affects the central nervous system of the human body. It is caused by degeneration of nerve cells in the substantia nigra. With the death of these nerve cells, the body loses the ability to produce an important chemical called dopamine. The body also loses the ability to create norepinephrine, which can often result in fatigue and irregular changes in blood pressure.¹

The definite cause of this cell death is unknown; however, several reasons have been proposed. These reasons include dysfunction of the process of autophagy which generally regulates cell function. Another reason is the reduction in function of mitochondria, leading to less energy production which may also contribute to cell death. People begin experiencing symptoms at around 50 years old, and have difficulty performing everyday tasks. However, it is important to note the presence of Early-onset Parkinson’s which may occur in those ranging from 21 to 40 years old. With the advancement of treatment, many people dealing with Parkinson’s can have normal life expectancies. There are an estimated 60,000 new cases of Parkinson’s disease diagnosed each year. Symptoms of Parkinson’s have been observed and recorded throughout history, as seen in Ancient Chinese and Ancient Indian texts. However, it was first clearly identified by James Parkinson in his 1817 ‘Essay on the Shaking Palsy’. Since then, many works have expanded upon Parkinson’s initial findings, most notably in the discovery of the levodopa treatment.¹

Early diagnosis and symptoms:

At the moment, there is still some ambiguity and delay in the diagnosis of Parkinson’s. CCT and MRI are unhelpful in finding evidence for the disease. Meanwhile, PET and SPECT are two methods that can identify the early stages of Parkinson’s but they may be unavailable to many due to their price and inaccessibility. Transcranial sonography, on the other hand, is a technique showing promising results for not only differentiating between the different types of Parkinson’s but also identifying certain forms of secondary Parkinson’s e.g.; Wilson’s disease. Therefore, along with manual observation of the usual symptoms, TCS may also be used for early identification.²

The identification of symptoms is incredibly important for early diagnosis. The disease often targets the ability to move, with a decreased speed of movement known as bradykinesia, tremors pain or rigidity of muscles and impaired balance. People find difficulty talking, writing and have reduced control of facial muscles, making communication difficult which can often make patients feel isolated. These symptoms may progress and worsen with late-stage symptoms including dyskinesia, falling and motor fluctuations. Non-motor symptoms such as sleep disorders, difficulty chewing and swallowing, constipation, and erectile dysfunction; while under-reported and overlooked, are just as important to focus on when treating a patient.³

Treatments:

There is no definitive cure for the disease, but there are ways to manage symptoms and increase the quality of life for patients. A variety of medications, surgical procedures and therapies are available to be used at the discretion of the patient and their physician. Dopaminergic medications (including L-Dopa) are a non-invasive treatment that helps make up for the lack of dopamine and are used with great success in late- onset Parkinson’s patients. However, they may not be suitable for early-onset patients and may lose effectiveness over time as they only manage symptoms and do not reduce the progress of the disease itself. Certain dopamine agonists such as pergolide, and pramipexole act by replacing dopamine in its working in the brain, generally administered in connection with L-Dopa to lengthen its effectiveness. Another option is Anticholinergic drugs, which reduce acetylcholine activity at choline receptors and can be used for tremor-dominant Parkinson’s and early stages of the disease, but it may not be suitable for use by elderly patients due to the lack of research in that specific field. Surgical treatments such as Deep Brain Stimulation, which is an implant that targets specific centers of the brain through electrical stimulation, are established methods of treating Parkinson’s. They have only certain side effects such as not being effective in balance and speech problems. In collaboration with these treatments, speech and physical therapy are used to improve quality of life and reduce the effects of certain symptoms. Along with this, support groups can help people cope with the changes that come with the condition.³

Risk factors and preventative measures:

There are certain activities and habits that those who may have a history of Parkinson’s in their family should adopt to reduce the risks of developing the condition. There is compelling evidence that an increased level of exercise and general physical activity can lead to a 10% and 17% decrease in women and men respectively.⁴ Exposure to toxic chemicals and pesticides may increase the risk of developing the condition. Thus, people who are in frequent contact with such materials should take extra precautions when working and try to monitor any unusual symptoms for the chance of early diagnosis.

How you can help:

There are a multitude of foundations currently working to support patients and raise awareness including Cure Parkinson's, which is based in England, Wales and Scotland. The most notable, however, is probably the Michael J. Fox Foundation, established by the ‘Back to the Future’ actor after his diagnosis, works to fund research to support those afflicted with Parkinson’s and to educate the general public about the symptoms and struggles faced by Parkinson’s patients. These organizations can be supported through donations, raising awareness with loved ones, and even including them in the inheritance of your estate. There are many helplines available for those struggling with Parkinson’s.⁵

Palliative treatment in advanced-stage patients:

With the progression of the disease, patients may no longer be able to perform daily tasks and may require specialized, around-the-clock care. Sometimes family members take on the responsibility as the primary caregiver. At other times, patients may check into nursing homes with professional nursing staff. At the moment, about one-third of LSPD patients live in nursing homes. At the moment there is no centralized, organized system to facilitate palliative care for late stage patients.⁶