What is PD

WHAT IS PARKINSON’S DISEASE?

Parkinson's disease (PD) is a chronic, progressive, neurodegenerative disorder of the central nervous system associated with damage to and loss of dopamine-producing nerve cells (neurons) deep in the brain. Parkinson’s disease is second only to Alzheimer’s affecting between 1 million to 1.5 million people in the United States. Between 7 and 10 million people are estimated to be living with Parkinson’s around the world. Clinically, the disease is characterized as a movement disorder by a decrease in ease of movements, difficulty in walking, postural unsteadiness, rigidity, and tremor, as well as other non-movement related symptoms. Parkinson's disease results from loss of dopamine-producing nerve cells (neurons) deep in the brain. Degeneration of neurons in a region of the brain substantia nigra a basal ganglia structure located in the midbrain , resulting in decreased availability of the neurotransmitter dopamine.

The English doctor James Parkinson first described Parkinson’s disease in 1817.  From Dr. Parkinson’s initial insights, we now know Parkinson's as a disorder of the central nervous system resulting from damage and cell death of the substantia nigra dopaminergic neurons cells.  Substantia nigra cells produce dopamine, a chemical called a neurotransmitter responsible for carrying nerve signals within the brain for coordination of movement. Loss of dopamine causes neurons to function abnormally, impairing body movement.  Parkinson's is classified as a movement disorder; other diseases in this class include essential tremor, dystonia, torticollis, and Tourette’s syndrome.

 Parkinson’s disease affects men and women and according to the National Institutes of Health, Parkinson’s disease affects about 50% more men than women. Although the average age of onset is about 60, the disease can occur in younger people. Typically, first onset of symptoms before age 50 (about 4%) are referred to having early onset or young-onset Parkinson’s disease (YOPD)

There is no definitive test, or biomarker, for Parkinson's disease; it is usually diagnosed by exclusion, or “ruling things out.”   The rate of misdiagnosis can be relatively high, especially for young-onset cases or when a non-specialist makes the diagnosis. Diagnosing is especially challenging for individuals who do not display the characteristic tremor. To determine if you have Parkinson’s your doctor will review your medical history, self-reported symptoms and conduct a clinical examination.

A Parkinson’s diagnosis requires you have two out of these primary motor symptoms:

  • Tremor (usually a resting tremor, often in the hands, arms, legs, torso, or lips and face.  The tremor tends to be relatively slow, about 4-6 cycles per second, and often shows a “pill-rolling” movement in the hands and fingers.)
  • Rigidity (muscular stiffness and tightness, often displaying a “start and stop” jerky motion called “cogwheel rigidity” when a limb is manually moved)
  • Bradykinesia / Akinesia ( lack of movement or extreme slowness in movement)

To support the diagnosis, your doctor will also look for other symptoms:

  • Micrographic (small handwriting)
  • Facial masking (reduced facial expression)
  • Postural instability ( Decreased arm swing or leg drag on one side of the body while walking, shuffling gait, or balance problems, often resulting in falls)

Also important are the non-movement symptoms of Parkinson’s disease, sometimes called "non-motor" or "dopamine non-responsive" symptoms.  These common symptoms can have a major impact on people with Parkinson’s. For example,

  • Cognitive impairment, ranging from mild memory difficulties to dementia
  • Mood disorders, such as depression and anxiety, occur frequently, particularly in people with Parkinson’s (PWPs) with later onset. 
  • Sleep difficulties
  • Loss of sense of smell
  • Constipation
  • Speech and swallowing problems
  • Unexplained pain
  • Drooling
  • Orthostatic hypotension, fall of blood pressure when standing

Just because something is listed as a symptom of Parkinson’s disease it does not mean a person with Parkinson’s will experience that symptom. Each case is different and do not respond in the same way, such as symptoms, the rate of progression, or treatment response.

 

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The Crooked Path Blog

The Crooked Path is a blog written by Corey King, a CCPSG member and diagnosed with PD at the age of 47.  

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