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Parkinson's disease (PD)
Parkinson disease (PD) is a disorder of the brain that seems to start gradually, and gets worse over time. Usually what a person (or family member) notices first is tremor (shaking), but that isn’t always the case. Not everyone who shakes has PD, and not everyone with PD has tremor. There is also a certain slowness and stiffness, and often trouble with balance and walking as well as a bent posture. Traditionally, we have understood that PD is a movement disorder. It is classified that way because people have trouble with coordinating movements, or may have extra unwanted movements that interfere with function. We have come to understand over the last 10-15 years that there is actually more to this disease than just trouble with motor function. Most people with PD have some kind of difficulty with sleep (drowsiness in day time, or interrupted or inadequate sleep at night). Depression and anxiety are very common (up to half of people with PD). Cognitive function (thinking, decision making, memory, etc) can be impaired in PD as well. Sensory symptoms, such as an urgent need to get up and move (restlessness), numbness, tingling, or even pain, can happen. And seemingly non-neurological symptoms such as constipation, sweating, and bladder urgency can be related to PD. Blood pressure can drop at times, causing lightheadedness, falling, or passing out. For all of the above “non-motor” symptoms mentioned, there are many other possible causes, so it’s not always obvious whether to blame them on PD. That requires careful exploration and analysis by the doctor. |
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| The reason for the symptoms is a gradual disappearance of certain brain cells, so for that reason PD is called a neurodegenerative disorder. Many of the disappearing neurons are supposed to provide a brain chemical called dopamine to other cells nearby, which is somehow related to their function. The loss of dopamine is thought to be responsible for many of the symptoms in PD. It turns out that there are other neurons that are dying off as well, not just those that make dopamine. | |||
A “cure” for PD would mean that we apply a treatment, stop the loss of brain cells, restore the ones that have disappeared, and not have to take any more treatments after that. No one has a cure for PD, but there is also no cure for hypertension, diabetes, or heart disease. On the other hand, treatment for PD can improve symptoms and restore function. Many available treatments are quite effective and worthwhile. |
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By and large, treatment of motor symptoms of PD (tremor, slowness, imbalance, posture) is the replacement of the missing dopamine (not unlike replacing missing insulin in diabetes). The most effective agent is called levodopa, which gets turned into dopamine once it has entered the brain. A major disadvantage of this medication is that the body gets rid of it very quickly, so a patient must take several doses per day. This becomes more apparent the longer one has been living with PD. Other medications have been developed to extend duration of action of levodopa (entacapone, rasagiline), or substitute for it (pramipexole, ropinirole). Not all symptoms are motor, and not all the disappearing cells are dopamine producers. For that reason, there are other kinds of medications that are useful even though they are not related to dopamine. For example, antidepressants can be used for mood and anxiety. Certain medications can be used to counteract problems due to impaired cognitive function. A variety of choices are available for sleep, though selecting one is not necessarily simple. Some medications can even be used to raise blood pressure if needed. PD is a moving target. There is generally not a standard dose of what to take, and your doctor will usually will start with low doses and gradually increase them. Once an optimum treatment has been found, the amount and timing and blend is likely to change over months and years. Expect your doctor to be inquiring about a variety of aspects of how you live with the disease so that adjustments can be made. |
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