Parkinson’s disease: Symptoms, Treatments, Causes

Dr. Sneha Ganatra
November 18, 2020

Parkinson’s disease is a neurodegenerative brain disorder that is characterised by motor symptoms such as tremors, rigidity, imbalance, and slowed movement, and non-motor symptoms like loss of smell and sleep problems. In India, Parkinson’s disease affects over 1 million persons a year. The disease gets worse over time and affects the dopamine-producing nerve cells in the brain. When the dopamine levels drop by ~60-80%, the body shows signs of Parkinson’s meaning that you may notice a tremor in one hand, rigidity, or slowness of movement.

Parkinson’s symptoms intensify over time and sadly, there is no cure for the disease at present. Nevertheless, there are medical means of managing and improving symptoms. Parkinson’s disease tends to show up more in men and affect those who are of 60 years of age and above. Knowledge of the causes of Parkinson’s and its symptoms will help you tend to the affected and avail the best of healthcare to improve the condition.

Here is a short primer on Parkinson’s disease.

What is Parkinson’s disease?

A simple Parkinson’s disease definition is that it is a long-term neurodegenerative disorder that affects a section of the brain called the substantia nigra and causes problems with the motor system. The substantia nigra produces the hormone dopamine, which is required for coordinated motor movements. Since these dopamine-producing neurons are affected by Parkinson’s disease, motor-system symptoms like shaking, imbalance while walking and stiffness are common with patients of the disease. When Parkinson’s progresses and becomes worse, non-motor symptoms emerge and become common.

Parkinson’s disease causes

There is ongoing research on what causes Parkinson’s disease. Here are some factors that contribute or may contribute to it.

Reduced dopamine levels: Dopamine is a neurotransmitter that is important to movement and coordination. In Parkinson’s patients the neurons that produce dopamine become impaired or die. The motor symptoms aggravate when the dopamine levels continue to fall.

Low norepinephrine levels: Parkinson’s patients tend to exhibit reduced amounts of norepinephrine, a neurotransmitter that is important to automatic body functions such as heart rate and blood pressure. Here, the nerve endings that produce this chemical die.

Presence of Lewy bodies: Brain cells of Parkinson’s patients have been found to contain abnormal clumps of protein called Lewy bodies. Scientists are researching the link between the protein alpha-synuclein, a substance found in Lewy bodies, and Parkinson’s disease. Some hold that this research is key to understanding the cause of Parkinson’s disease.

Genetic & Environmental factors: Scientists are exploring whether certain genetic factors or mutations may lead to Parkinson’s. Sometimes the disease may appear to be hereditary, but some research points in the direction of genetic factors in combination with environmental triggers, such as exposure to toxins and pollutants.

Parkinson’s disease symptoms

Four main symptoms of Parkinson’s disease are:

  • Tremor in hands, legs, arms, jaw, or head
  • Rigid muscles or stiffness of the arms, legs, and trunk
  • Slowed movement (bradykinesia), for instance, dragging feet
  • Impaired balance, which can lead to falls

Other symptoms, including those which are not linked to movement (non-motor) include:

  • Loss of smell
  • Change is posture and gait, sometimes as if leaning forward
  • Depression
  • Anxiety
  • Changes in emotion
  • Difficulty in swallowing or chewing
  • Tremor in voice or softer voice
  • Cramped handwriting
  • Sleep problems
  • Skin problems
  • Constipation or urinary problems
  • Reduced automatic movements like smiling or swinging arms when walking

Even though Parkinson’s disease is linked to motor problems, non-motor issues such as a reduced sense of smell may precede motor symptoms by several years. Other early signs include voice and handwriting changes, a stooped posture and constipation.

Early signs of Parkinson’s disease may slip by unnoticed, often under the guise of normal aging. However, early detection of Parkinson’s disease leads to better treatment and so, it is good to keep an eye out for them.

Parkinson’s disease stages

Parkinson’s disease does not affect everyone in the same way. The rate of progression of the disease differs, and the symptoms and their order and intensity may differ too. Nevertheless, below is a generalised 5-stage progression you can acquaint yourself with.

Stage 1: Mild symptoms such as changes in posture, facial expression and walking, and tremors and other motor symptoms in one side of the body occur. These usually do not interfere with everyday living.

Stage 2: Stiffness and tremors may intensify and now affect both sides of the body, albeit one less than the other. Symptoms like poor posture and impaired walking become more apparent. The time it takes to complete tasks increases, but the person is independent.

Stage 3: This is the mid-stage and is characterised by a loss of balance, slower movements, and decreased reflexes. Hence, persons in this stage are prone to falls. The person is still independent, but the disease significantly affects the ability to perform daily tasks such as eating and dressing.

Stage 4: At this stage, persons display the need of a walker for movement, though they can stand on their own. The motor symptoms impair movement and reaction times, making it difficult for the patient to live alone and perform daily tasks without assistance.

Stage 5: If Parkinson’s disease progresses to this stage, the person may become bedridden. At any rate, though, the rigidity in the limbs severely affects the ability to stand or walk. Mental symptoms like hallucinations, confusion and delusion may also occur. The person needs 24/7 assistance.

Treatments for Parkinson’s disease

To date there is no cure to Parkinson’s disease, meaning that treatment efforts are mainly aimed at controlling, relieving, and improving the symptoms.

Lifestyle changes like resting, exercising and a new diet can help. Doctors may also suggest:

  • Speech therapy
  • Occupational therapy
  • Physical therapy

In terms of medication, commonly-prescribed drugs are:

  • Levodopa: To improve dopamine levels
  • Carbidopa: To enhance the effect of Levodopa and reduce its side effects
  • Dopamine agonists like bromocriptine : To mimic the action of dopamine in the brain
  • Anticholinergics like Benztropine: To reduce rigidity and tremors
  • Amantadine: To reduce involuntary movements
  • COMT inhibitors: To break down dopamine and prolong the effect of levodopa
  • MAO B inhibitors: To slow the rate of dopamine breakdown in the brain

These medications must be taken under observation of a doctor and in case they do not yield results, the patient may need to undergo Parkinson’s disease surgery, namely:

  • Deep brain stimulation (DBS) or
  • Pump-delivered therapy

As you can see, the treatment techniques range from lifestyle changes and physical therapy to medication and surgery. Early diagnosis is sure to help in all treatment efforts and for this you need two things: to spot the mild symptoms in stage 1 or 2 and, secondly, to discuss them with a doctor. This becomes easier when you have the Bajaj Finserv Health app on your smartphone. Using it you can track your lifestyle and symptoms, search for relevant doctors, consult over video, and store and share personal health records for better diagnosis. The Bajaj Finserv Health app also helps with booking appointments online, allowing you to sidestep queues.

Moreover, your doctor can help you distinguish between Parkinson’s disease and other forms of Parkinsonism, which may include disorders, called Parkinson’s syndrome, such as brain tumours and head trauma. So, as you learn more about Parkinson’s disease, download the Bajaj Finserv Health app from Google Play or the Apple App Store to be best prepared to address your healthcare needs holistically.