What is Parkinson's disease?

Parkinson's disease results when some of the nerve centers in the brain lose their ability to regulate the movement of muscles. As a result, the person may have rigid muscles and tremors and difficulty walking and swallowing.

Parkinson's disease is one of the most common diseases that affect movement in people over age 55.

How does it occur?

When some of the nerve centers lose their ability to work normally, the balance is upset between dopamine and acetylcholine, two chemicals that occur naturally in your body. The chemical imbalance means that your brain has less control over the way your muscles move.

It is not known why the nerve centers lose their ability to control movement. Injury to the brain by an infection earlier in life, reactions to drugs, or exposure to carbon monoxide or heavy metals may be part of the cause in some cases.

What are the symptoms?

One of the major symptoms of Parkinson's disease is a tremor of the hands and sometimes the head. A tremor is an involuntary, rhythmic shaking. The tremor is often accompanied by continuous rubbing together of the thumb and forefinger.

If Parkinson's disease worsens, you may gradually stop making some movements that are normally automatic, such as the natural swinging of arms that makes walking smooth. It may become more difficult to:

• write legibly

• move your mouth and tongue to speak clearly

• start to do something

• change positions

• keep your balance when you walk

• get out of a chair.

In the earliest stages of Parkinson's disease, the symptoms may be unnoticed or very slight. Someone close to a person with the disease might notice a slight limp, stooped posture, or a mild tremor of the hands.

Other possible symptoms are drooling and abdominal cramps. In later stages, the abilities to think and remember often decline.

Parkinson's disease may become disabling after many years, but proper treatment often makes it possible for those with the disease to lead a fulfilling, productive life.

How is it diagnosed?

Your doctor will ask about your medical history and give you a physical exam. The physical signs of tremor, muscle rigidity, and slow movements support the diagnosis of Parkinson's disease.

There are no blood tests or x-rays that will confirm the diagnosis. However, additional tests are sometimes used to rule out the presence of other diseases or diseases that resemble Parkinson's disease.

How is it treated?

Medication is often prescribed to help restore the proper balance of chemicals in your body. The main goal of treatment is to keep your movements as normal as possible with the smallest amount of medication. It may not be possible to eliminate all your symptoms.

Along with medication, your treatment may include speech therapy and physical therapy. In severe cases not helped by medication, surgery may help prevent uncontrollable tremors.

In mild cases of Parkinson's disease, medication may not be prescribed because of possible side effects. Your doctor will want to see you regularly to monitor your symptoms and to determine if you might benefit from medication.

In severe cases, computer-assisted neurosurgery, called pallidotomy, may be considered. Tissue transplantation has also been used in severe cases of Parkinson's disease.

Medication:

Several different medications are used to treat Parkinson's disease. Side effects from these medications can be a problem, so your doctor will try to use the smallest effective dosage to minimize the unpleasant side effects.

Levodopa is commonly used to help restore the imbalance between dopamine and acetylcholine. Possible side effects of this medication are abnormal movements of the face, trunk, arms, and legs, along with nausea and vomiting, short-term memory loss, and confusion. If you have closed-angle glaucoma, you should not take levodopa.

Some of the other medications your doctor may prescribe include bromocriptine, amantadine, and procyclidine.

Eating less protein may help to make levodopa more effective. However, do not begin a low-protein diet without first consulting your doctor, because a major risk with a low-protein diet is weight loss and malnutrition.

Constipation may be a side effect of your medication. To help avoid this problem, be sure your diet includes whole-grain bread and cereal, fruits, vegetables, and beans. Also, drink plenty of liquids.

Exercise:

A program of daily exercise will increase your muscle strength, improve your coordination, reduce muscle rigidity, and prevent deformities that occur when muscles are not used. Physical therapy can teach you how to walk and move in a way that will reduce the possibility of a fall.

How long do the effects of the disease last?

Relief from some symptoms as a result of treatment has kept many people with this disease in relatively good health. The disease continues, however, despite drug treatment.

Research aimed at finding improved treatments for Parkinson's disease is ongoing, and your doctor will follow the medical literature to learn about new developments.

What can be done to help prevent Parkinson's disease?

There is no reliable way to prevent Parkinson's disease. If you work at a job where you are regularly exposed to carbon monoxide or heavy metals, be sure to follow all recommended precautions.

How can I take care of myself?

To cope with Parkinson's disease and to relieve your symptoms:

• Be sure you and your family know how any prescribed medications work, what the side effects are, and which side effects you should call your doctor about.

• Do not take any medication, including nonprescription products, without letting your doctor know.

• Make your house safer by installing handrails in walkways, removing anything that might cause a fall, and using chairs with high arms. Carpeting helps cushion a fall, if one occurs. Be sure seats (including shower seats) have sturdy backs. Put handrails in the bathroom, and consider installing a mechanical device that raises the toilet seat.

• Use an electric shaver to avoid cuts from razors.

• Wear loafers or shoes that close with Velcro strips instead of shoes with laces. Wear clothing that is easy to get on and off. Velcro strips on clothing are easier to use than zippers or buttons.

• Take as much time as you need to eat meals if you have problems swallowing. Sit in an upright position. Thick liquids are easier to swallow than thin liquids. Consider using an electric warming tray to keep food hot during the long time it may take to finish a meal. Weigh yourself once a week to make sure that you are not losing too much weight.

• Reduce constipation by drinking more water and eating more foods that are high in fiber (for example, whole-grain breads and cereals, beans, fruits, and vegetables).

• If you have problems with speech, work on various ways to communicate your needs. Practice any speech exercises your doctor or speech therapist may prescribe.

• Stay as active as possible. Keep involved in your work, hobbies, and other activities.

• Get encouragement and support from family and friends. Keeping a positive attitude can be quite helpful.

• For more information write or call:

  Parkinson's Disease Foundation, Inc.
  710 West 168th Street
  New York, New York 10032

  Phone, toll-free: 1-800-457-6676.

  or

  National Parkinson Foundation, Inc.
  1501 N.W. 9th Avenue/Bob Hope Road
  Miami, Florida 33136

  Phone, toll-free: 1-800-327-4545,
  or in Florida, 1-800-433-7022

When should I call the doctor?

See your doctor regularly for an evaluation of your progress and a check on the effectiveness of your treatment. Discuss any questions and concerns you have with the doctor.

Call the doctor if:

• You have side effects from your medicine, such as nausea, dizziness, and mental changes.

• Your weight drops 3% to 5% in any month.

• You develop fever.

• Swallowing becomes more difficult.

• You become depressed. (Your doctor may be able to prescribe medicines to lessen depression.)

• You begin to have hallucinations, which can be a side effect of your medicines. (Your doctor may be able to adjust the dosages of your medicines.)