Parkinson’s Disease (PD) can be one of the most devastating illnesses that can strike us as we get older.  It is not a normal aspect aging any more than is memory loss, but the incidence increases in an aging population.  Precise statistics are not available but it is believed that about 1.5 million Americans currently have a diagnosis of Parkinson’s.  Many more suffer with signs and symptoms that mimic the disease and others have symptoms that are mild enough that they do not seek medical care.  It is not unusual for people with Parkinson’s to remain undiagnosed because they attribute their condition to old age.  Probably the most recognizable sign of PD is a tremor that starts on one side of the body in a hand and arm and occurs when the person is “at rest”, or not using the limb.  Once they make an intentional movement, the tremor will improve or disappear.  This is true more so in the early stage of the disease than later.  Not everyone who has Parkinson’s, however,  has the classic tremor.  Symptoms range from muscular rigidity to slow movement to speech and writing difficulty to thought, mood and behavior disorders.  A version of dementia may occur in the latter stages called Lewy Body dementia.

It has been widely believed that the disease occurs more commonly in men than women but a recent study by a group of researchers at the University of Pennsylvania showed that this is not the case.  Men and women are equally affected but they noted there are other factors that seem to increase the risk of acquiring the disease.  They are:  white race, older age, increased utilization of healthcare visits and low income.  Numerous research studies are being conducted to determine the cause of PD.  One recent study suggested that a deficiency of Vitamin D may play a role while another found that people who had a regular habit of moderate to vigorous physical exercise had a lower risk of developing the illness.  Other researchers suspect a link with a common insecticide called rotenone.  A commonly used rating scale, the Unified Parkinson’s Disease Rating Scale, characterizes the stages of the illness by describing detailed changes in mental and physical abilities and gives medical personnel a tool for following the course of a given individual’s illness. 

Many people continue to work and lead productive lives for many years after a diagnosis of Parkinson’s.  More and more evidence indicates that regular exercise can also delay or moderate some of the physical symptoms such as muscular stiffness, rigidity and balance problems.  Physical Therapist, Kevin Lockette, has an interesting website that I recommend at http://www.parkinsonsmoveit.com/dvd.  He has written and produced a book and video called MOVE IT! – An Exercise and Mobility Guide for Parkinson’s Disease.  A video on the website is narrated by Wally Amos of Famous Amos cookie fame.  It reportedly is the first publication of its kind.   Speech therapy may prove useful for swallowing and speech production difficulties.  Another commercial website by Theracycle promotes a new type of stationary exercise bicycle that utilizes what’s called “high cadence” cycling found to be useful for Parkinson’s patients by Dr. Jay Alberts of the Department of Biomedical Engineering at the Cleveland Clinic in Ohio.   The cycle employs both passive and active effort. 

Parkinson’s Disease is a clinical diagnosis.  That means that there is no laboratory or imaging tests that can make the diagnosis, but the doctor may want to utilize lab and X-ray testing to rule out other causes that could explain the symptoms.  Typically a neurologist will make the diagnosis after a careful medical history and physical examination, and begin medical management.  Because Parkinson’s is a brain disease, the medications that will be utilized are those that affect the chemistry of the brain.  The disorder is caused by a decline in the level of a brain chemical known as dopamine.  The cause of this change is not known at this time.  The area of the brain affected is shown below.

The medications attempt to either replace or mimic dopamine and help to control symptoms such as tremor, slowness and stiffness.  Finding the right balance of medicines can be a challenge and it is common to be placed on trials of various doses and medicines until a compatible “recipe” is found.  While medications help control symptoms in most PD patients, they also tend to have a rather significant side effect burden and sometimes patients may choose to tolerate some of the disease symptoms over taking an increased dose of medicine.  Surgical options are usually reserved for those who do not respond well to medications or for those who have periods when they essentially “freeze” between does of medication.  A technique called Deep Brain Stimulation is performed by many neurosurgeons and is now covered by Medicare as well as some commercial insurance.  During the surgery a device is implanted that sends regular low level electrical impulses to the affected area of the brain, similar to the way that a heart pacemaker works.

One group of researchers uses a similar device but instead of electrodes they implant an optical fiber that emits a special kind of blue light to stimulate specific cells responsible for PD symptoms.  Dr. Michael Kaplitt, of New York Presbyterian/Weill Cornell Medical Center is in the early stages of using gene therapy to relieve PD symptoms.  Preliminary work by a group of Canadian researchers suggests that omega-3 fatty acids (found in certain fish, green leafy vegetables, nuts, flaxseed, canola and soy oil) lower the risk of developing the disease.

At present treatment approaches for Parkinson’s are palliative – that is, they relieve or mask the symptoms without offering a cure.  Ultimately, those afflicted with PD go on to develop gait, balance, swallowing, speech and intellectual deficits that require routine caregiving to meet daily needs.  As with most degenerative neurologic diseases the cause of death is usually respiratory or urinary tract infection due to the immobility and feeding problems that accompany the terminal stage of the disease.  It’s never to soon to begin planning for the eventual outcome of disability and death.  While unpleasant to contemplate you need to be sure that you have your legal documents such as your Living Will, Durable Power of Attorney and resuscitation wishes recorded in writing and available to your doctor and other healthcare personnel.  You also need to think about how you will arrange to be cared for if you become so debilitated you can’t care for yourself and what you want in terms of funeral arrangements and the disposition of your estate.

Fortunately, a lot of research has been done and is still being done on Parkinson’s.   An Osteopathic research study from 2002 demonstrated that a pattern of “strain” in the upper cervical (neck) vertebra was present in PD patients.   Clinical case studies from the Chiropractic profession followed Parkinson’s patients over time and showed relief of some symptoms from regular upper cervical chiropractic treatment of the occipitoatlantal (first two cervical vertebrae) joint.  Other research varies from cellular chemistry to environmental toxins to the origin of language and speech problems.

Several organizations exist to provide consumer education, caregiver support and research dollars for Parkinson’s disease.  In addition there are several academic centers associated with medical schools that specialize in the study of the disease.  They include the National Parkinson’s Foundation , the Michael J. Fox Foundation for Parkinson’s Research , the American Parkinson’s Disease Association the University of Pennsylvania School of Medicine Udall Center for Parkinson’s Disease , and The Parkinson’s Disease Foundation.  In addition The National Science Foundation and other government entities provide research dollars to determine how the illness can be prevented or cured.