Understanding Parkinson’s disease

Parkinson’s disease is a disease of the brain in which the neurons that produce dopamine in the brain are destroyed. Because of this loss of dopamine, people with Parkinson’s develop slowness of movements with stiffness or resting tremors. They also can have a shuffling gait, decreased arm swing, lower volume of their voice, decreased facial expressions, problems with their sense of smell, and issues with depression, anxiety, sleep, constipation, blood pressure and balance.

We still do not know the exact cause or mechanism of how Parkinson’s disease begins. We think Parkinson’s may be caused by a combination of environmental factors and genetic susceptibility. We do not know all the environmental factors, but some that we do know include certain farming and manufacturing chemicals, welding exposures and carbon monoxide exposure.

Only about 5 to 10 percent of Parkinson’s disease patients have a clear genetic link throughout their family. Most people with Parkinson’s are the only person in their family to have the disease.

While there is a nuclear medicine imaging test that can help with the diagnosis of Parkinson’s disease, called the DaT scan, the diagnosis is usually made by history and exam from a neurologist — usually one specialized in movement disorders. Because there is so much involved in the diagnosis and management of Parkinson’s disease, and because research is continually revealing new information about Parkinson’s, a movement disorders specialist should generally be involved in the care of Parkinson’s patients.

Parkinson’s disease is not widely understood among the general public, and there are many myths about the disease. I’ll attempt to dispel a few:

Does starting medication early for patients with Parkinson’s disease cause it to not work when they are older?

No. This is a common misconception, especially related to the drugs carbidopa and levodopa, commonly used in combination under the brand name Sinemet. As Parkinson’s disease progresses, the brain has fewer dopamine receptors available to respond to the medication. It does not matter when you start medication but how long you have had symptoms. Why wait to start medications that will improve your function and quality of life when they will not work as well later, whether you start them now or later?

Can medication help slow the progression of Parkinson’s disease?

There is only one current therapy known to slow the progression of Parkinson’s disease: exercise. We recommend at least 150 minutes per week with an equal amount of cardiovascular endurance training and strength training.

Will a person with Parkinson’s disease suddenly become bed-bound?

Parkinson’s disease, for the most part, progresses in a steady linear course over many years. The only things that can complicate the progression are hospitalizations, falls and swallowing problems.

Are dyskinesias bad?

Dyskinesias are involuntary writhing or dance-like movements of different parts of the body. They may be side effects later in Parkinson’s disease from being on the drug levodopa. There are many ways to manage this complication, and it is not a permanent side effect. Most patients who develop dyskinesias are not bothered by them and would rather be in motion than in an “off” state where the medication levels are too low in their system.

Does everyone develop the same symptoms with Parkinson’s disease?

Parkinson’s disease is truly a spectrum of a disease with different symptoms and progression when comparing patients. While there are common features and problems that carry a higher risk for developing in concert with the disease, this does not mean that everyone will develop the same symptoms at all or at the same time.

Learn more about Parkinson’s disease

Delaware is becoming one of the top destinations for retirees, and with that comes an aging population of new Parkinson’s disease patients. While we do not have exact numbers, there are likely more than 2,000 people currently living with diagnosed Parkinson’s disease in Delaware, and likely many more that are undiagnosed.

If you or a loved one is in need of care for Parkinson’s disease, please reach out to my practice at 302-623-3017. Christiana Care also hosts a regular Parkinson’s Disease Education and Support Group. For general Parkinson’s disease information, here are some websites that I recommend: