What is the progression of Parkinson's disease?

What causes Parkinson's disease?

The cause of Parkinson’s is not known, but many scientists think the condition is due to a combination of family history and environmental factors. Approximately 10-15% of people with Parkinson’s can attribute the disease to genetics. Head trauma, exposure to pesticides, occupation, and area of residence have been identified as environmental factors linked to increased rates of Parkinson’s disease.

Parkinson’s disease is more common in men than women, and people with siblings or parents who developed the disease at a younger age are at a higher risk for developing Parkinson’s.

What are risk factors for Parkinson's disease?

While genetics and environmental factors have been linked to Parkinson’s disease, age and gender also impact your risk for the movement disorder. Most people are diagnosed with Parkinson’s in their late 50s-early 70s. In addition, men tend to be more at risk for developing Parkinson’s disease than women.

What is early onset Parkinson's?

Also referred to as young onset Parkinson’s disease, early onset Parkinson’s occurs when someone is diagnosed with the disease between the ages of 21-50. The progressive nature of the movement disorder is usually slower in early onset patients as they typically have fewer underlying health conditions than people who are diagnosed with Parkinson’s in their 50s and older.

Early onset Parkinson’s disease may be under-diagnosed as the condition more commonly occurs in older adults. Roughly 10-15% of all Parkinson’s diagnoses are considered early onset Parkinson’s. Treatment options are similar to Parkinson’s disease, although younger people may have more side effects from levodopa, one of the most commonly prescribed Parkinson’s medications.

What are signs and symptoms of Parkinson's disease?

There are many symptoms of Parkinson’s disease, which vary from one individual to another. Almost all patients report handwriting that has decreased in size over the years and some patients report an abnormal twisting or turning movement of an arm or leg (dystonia). Many symptoms are caused by the disease advancing into areas of the brain that control movement.

As with any progressive disease, symptoms begin slowly and in a few places, spreading throughout the body and/or worsening over time.

Tremor is the most common symptom associated with Parkinson’s disease. Typically patients will notice an occasional rhythmic tremor that starts in one finger, eventually spreading to the whole arm. Some patients notice tremors when an arm or leg is resting or in an unsupported position. These tremors can occur on one or both sides of the body. If left untreated, tremors can affect the head, lips, tongue, and feet.

Specific signs of Parkinson’s disease include:

• slowness of motion, especially when beginning a movement
• stooped posture and a slow, shuffling walk; After a number of years, muscles may freeze up, increasing the risk of falls.
• compromised ability to swallow or digest foods
• rigid muscles, often beginning in the legs and neck. This can produce a mask-like or staring appearance when muscles of the face are involved.
• muscle movements that normally happen automatically (such as blinking) may need to be performed consciously
• soft voice and slurred speech

What are the five stages of Parkinson's disease?

Parkinson’s disease is progressive as symptoms worsen over time. The progression can be broken down into five stages:

Stage 1: Mild symptoms with tremor only occurring on one side of the body. Posture, facial expressions, and walking may start to be impacted. Symptoms don’t typically interfere with daily activities.

Stage 2: Movement symptoms, tremors, and rigidity impact both sides of the body. Walking and posture issues become more apparent. Independent living is completely realistic but completing daily activities becomes more difficult.

Stage 3: Balance is an issue and falls become more regular occurrences. Movements become slower. Independent living is still possible but dressing, eating, and bathing may require assistance.

Stage 4: Parkinson’s symptoms are much more pronounced and greatly impact daily activities. Walking requires assistance from a walker or person. Independent living is not possible.

Stage 5: Symptoms are most advanced, which often make walking impossible. In the most debilitating stage, some patients become bedridden. Around-the-clock nursing care is required. Mental impairment from delusions to hallucinations may be present.

Is there a Parkinson's test?

Parkinson’s disease can be difficult to diagnose as there is no Parkinson’s test, and laboratory and imaging tests are unable to detect the condition. Physicians and neurologists frequently use a combination of the your medical history along with a neurological exam to diagnose Parkinson’s.

During the physical and neurological exam, you will be asked to sit, stand, walk, and extend your arms. Your body’s responses to this test will help your physician determine if you have Parkinson’s or a similar condition.

Parkinson’s may also be confirmed with a drug challenge test. Your physician or neurologist may try prescribing a drug called levodopa (or L-dopa) and monitor your symptoms. If your symptoms improve while taking the drug, Parkinson’s is the likely diagnosis.

How long can I live with Parkinson's disease?

Parkinson’s disease is not a terminal condition. However, the symptoms and complications of Parkinson’s can impact how long you are able to live with the disease.

In general, many people with Parkinson’s live 10-20 years after their initial diagnosis. Identifying and treating the movement condition early is important in extending life. Deep brain stimulation for Parkinson’s has been shown in limited studies to increase survival time.

How is Parkinson's disease treated?

Your treatment plan for Parkinson’s disease depends on the stage you are in, your symptoms, and other personal health factors. Medication is the first line of treatment, often combined with exercises you do at home or professional physical, occupational and speech therapy. Some patients respond well to drug therapies while others battle to balance side effects with symptoms. Most Parkinson’s patients have periods of time when the medicine effectively controls symptoms, called “on” time, and times when the medicine doesn’t control symptoms, called “off” time.

If you are not experiencing adequate symptom control on medication or you have side effects from the medication, you may want to consider deep brain stimulation (DBS).

Can I treat Parkinson's disease at home?

Certain lifestyle changes and exercises that you do at home can help you live with Parkinson’s symptoms, particularly in earlier stages. Programs such as “Big and Loud” as well as professional physical, speech, and occupational therapy help you learn how to use your body and voice more effectively to overcome symptoms, such as a shuffling walk or quiet speech.

Because Parkinson’s is a progressive disease, you should understand that your symptoms will worsen over time, even with treatment.

Is there a cure for Parkinson's disease?

There is no cure for Parkinson’s disease, although treatment can help control symptoms so that you can live with the disease. There are a wide variety of surgical and non-surgical treatment options for improving your quality of life. The goals of treatment are to relieve physical disabilities and balance symptom control with medication side effects.

When should I consider DBS for Parkinson's?

Deep brain stimulation (DBS) is surgery to implant a small device, similar to a heart pacemaker, that controls electrical impulses sent to the brain to disrupt the activity causing your seizures.  DBS offers many benefits for people with Parkinson’s disease, including fewer tremors to more “on time” to reduced medications. First approved by the FDA for Parkinson’s disease in 2002, DBS is effective in early stages of Parkinson’s disease and may extend your life. While every Parkinson’s patient must be evaluated to determine if DBS  is right for you, below are general criteria:

• Clear diagnosis of idiopathic (arising spontaneously) Parkinson’s disease
• Absence of dementia
• Any fluctuations in symptoms with levodopa therapy (Parcopa, Sinemet, Stalevo)
• At least some improvement with levodopa therapy
• Lack of serious disease that would prevent surgery
• No age parameters, but patients under 75 generally do better

New research shows that undergoing DBS in the earlier stages of Parkinson’s disease is effective, contrary to earlier recommendations that patients must have the disease for at least seven years to benefit. The study also found DBS to be more effective than medications in controlling tremors in patients with Parkinson’s disease.

What are the benefits of DBS for Parkinson's?

DBS for Parkinson’s disease offers a multitude of benefits, from increased control to reduced medication. New research published by the Journal of Neurology, Neurosurgery and Psychiatry that DBS may prolong life for Parkinson’s patients.

Benefits of DBS for patients with Parkinson’s may include:

• DBS plus medications can nearly double the number of “on” hours without dyskinesia each day.
• DBS can alleviate tremor, even if medications do not. Patients who have undergone the procedure have reported up to 80% symptom improvement.
• DBS reduces dyskinesia by reducing medications.
• DBS is more effective than medications in controlling tremors in patients with Parkinson’s disease.
• DBS results in a nearly 50% average reduction in medication compared to medical therapy alone.
• The initial cost of DBS is offset by savings in medications by patients with Parkinson’s disease in less than two years after the procedure.
• Improvement in all motor symptoms—rigidity, tremor, facial expression, freezing—leads to improvements in quality of life, bodily discomfort and emotional well-being.
• DBS may extend life for Parkinson’s patients.