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Parkinsons Disease

By Apollo 24|7, Published on- 08 December 2022 & Updated on -

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  • Symptoms: Impaired speech, involuntary movements, rhythmic shaking that starts in the limbs, slow reactions and movement, rigid muscles, loss of balance, nerve pain, blurred vision, erectile dysfunction, urinary incontinence, excessive sweating
  • Causes: Loss of nerve cells, nerve cell damage, shortage of dopamine 
  • Risk factors: Genetics, exposure to fertilisers or industrial pollution, antipsychotic medicine, cerebrovascular disease, progressive brain disorders like corticobasal degeneration
  • Severity: Mild to severe (a progressive condition that can get worse with time)
  • Which doctor to consult: Neurologist

Overview

Parkinson's disease is a progressive neurological disorder that impacts the nervous system and interferes with the functioning of the nerves. As a result, body parts controlled by nerves are affected, and their normal function is interrupted. It is most commonly found in patients older than 60.

The primary target of Parkinson's disease is a specific area of the human brain called the basal ganglia. The disorder causes deterioration of the basal ganglia and results in the loss of control over areas controlled by the part. How does this occur?

During the normal functioning of the body, the brain releases certain chemicals called neurotransmitters to monitor and control the communication of the neurons or brain cells. Dopamine is one such neurotransmitter, and it is essential to generate the 'fight or flight response of the body. It is responsible for bodily functions like movement, sleep, behaviour, attention and arousal.

Parkinson's disease causes a reduction in the dopamine levels released by the brain. In turn, the body lacks sufficient neurotransmitters to send electrical impulses to the body, resulting in delayed movements and loss of cognitive functions.

While Parkinson's can be controlled using medications, the disorder worsens with time. Hence, it is crucial to consult a doctor during the early stages and start treatment early.

When to Consult a Doctor?

Initial symptoms synonymous with Parkinson's disease may usually be mild. As a result, they may be challenging to detect and make it difficult to receive timely medical attention.

Here are some common signs that should convince patients to consult a doctor immediately.

  • Early symptoms

Tremors in the finger, hand or chin; minor loss of smell, inability to sleep, stiff muscles making it difficult to perform an unrestricted movement, constipation, constant dizziness or fainting episodes

  • Age

Parkinson's disease is common in elderly patients, especially individuals nearing sixty. For these patients, it is important to schedule regular medical check-ups to assess overall health and discover discrepancies to weed them out. Younger people can also choose regular health check-ups to detect Parkinson's disease or other ailments.

Diagnosis

The symptoms of Parkinson's disease can overlap with multiple other conditions, making it difficult for neurologists to make a diagnosis with symptoms alone. Although there is no specific test to detect Parkinson's disease, neurologists employ several tests to rule out other disorders.

Some of the tests utilised are as follows.

  • Lab tests

In some cases, the neurologist may ask for a blood sample to rule out other conditions like abnormal thyroid hormone levels or liver damage.

  • Imaging tests

Standard tests like MRI or CT scans help rule out additional conditions like strokes or brain tumours to confirm the diagnosis. Sometimes, neurologists may ask for a dopamine transporter (DAT) scan to identify the amount of dopamine in the body and diagnose Parkinson's disease.

Along with these tests, a neurologist analyses the patient's symptoms, medical history and neurological and physical examinations to confirm Parkinson's disease.

Treatment

Parkinson's disease is a chronic condition that cannot be cured completely. However, it can be managed with regular neurologist consultations and self-care. Here are some ways to manage the disease.

  • Homecare

For individuals with Parkinson's disease, it is essential to remain physically active by engaging in exercises like running and stretching to gain more flexibility and balance. Activity is also believed to increase muscle strength and improve coordination between body parts. Additionally, getting uninterrupted sleep and avoiding caffeine, tobacco, and alcohol is vital.

  • Medication

Neurologists prescribe carbidopa-levodopa during the initial stages to confirm the diagnosis. If a patient's condition is improved after taking this medication for a few days, the diagnosis of Parkinson's disease is confirmed. Neurologists may further prescribe levodopa and carbidopa to increase dopamine production in the brain to manage the condition.

  • Surgical Treatment

While neurologists attempt to manage the disorder using medications, they may suggest surgery if the previous treatment is ineffective. The standard surgical method employed is deep brain stimulation, where the surgeons implant an artificial device into the patient’s brain. This device aims to provide an electrical current directly to some regions of the brain and compensate for the lack of dopamine production.

  • Alternative management

The research on Parkinson's has allowed for the development of a new method called Duopa. Though it is not a widely used procedure, it involves a gel of carbidopa-levodopa to be directly delivered to the intestine to reduce the absorption and ensure the maximum amount of the mixture reaches the brain. The surgical process is conducted by creating an incision in the abdomen through which a tube is inserted. The tube acts as a pump to deliver Duopa to the intestine directly.

Risks and Complications if Left Untreated

Being a progressive disease, Parkinson's worsens with time. If it is detected near the onset, it can be controlled through medication and physical therapy. If none of these methods work, surgery is also viable.

However, untreated Parkinson's disease can ultimately deteriorate the brain within ten to fifteen years and cease all brain functions. It can also lower the patient's life expectancy and cause early death due to a complete shutdown of the brain. Unmanaged Parkinson's is also known to cause health hazards like pneumonia, choking and severe injuries.

The intensity of Parkinson's disease is usually denoted by the Hoehn and Yahr scale. It represents the stages of Parkinson's on a scale of 1 to 5. The initial stage denotes the early onset of Parkinson's, two and three points mean mid-stage, and the last two indicate severe Parkinson's.

Additional Information

What is the difference between Parkinson's disease and Parkinsonism?

Parkinsonism is the umbrella term covering ailments that have symptoms similar to Parkinson's disease. The condition covers five types of conditions, namely:

1. Idiopathic Parkinsonism

Parkinson's disease, also known as idiopathic Parkinsonism, is the most common disorder. It is characterised by the loss of nerve function in body parts caused due to a reduction in dopamine. Since dopamine helps provide electrical signals to enable motility and other functions of the body, Parkinson's is synonymous with symptoms like delayed responses, loss of balance, impaired senses and stiff muscles that restrict movement.

2. Vascular Parkinsonism

This type of Parkinsonism is known to cause damage to the part of the brain controlling the motility of the body. The reason for this damage is usually tiny strokes that damage the nerve function of a specific portion of the brain. The symptoms resemble that of idiopathic Parkinsonism but the cause here is different. While idiopathic Parkinsonism occurs due to a gradual loss or damage of nerve cells that impact dopamine production, vascular Parkinsonism can be credited to small strokes that build up damage over time and affect cognitive function.

The blood vessels in the brain are responsible for ensuring no interruption in blood flow to the region that controls the body’s motor skills. However, small strokes cause damage to these vessels and affect the flow of blood to the deep centres of the brain. Alternatively, vascular Parkinsonism can also occur due to constricted blood vessels or the formation of fatty plaques in the arteries.

3. Drug-Induced Parkinsonism

Among all the types, drug-induced Parkinsonism is the only one that does not occur due to a natural disruption in the body. It is a non-degenerative type that arises due to the effects of drugs that block dopamine production.

Overall, it is similar to idiopathic Parkinsonism in terms of symptoms. However, a neurosurgeon can address it more quickly by reducing the dosage of the drug causing the condition.

4. Multiple System Atrophy (MSA)

MSA impacts two systems – one that controls movement and the other that controls actions like blood pressure and digestion. It is a progressive disorder similar to Parkinson's and gradually reduces the functioning of the nerve cells in the spinal cord and brain.

5. Progressive Supranuclear Palsy (PSP)

Hailed as an uncommon brain disorder, PSP results in significant problems caused due to loss of control in body movements, coordination and clear thinking. It is a progressive disease that causes loss of balance and difficulty in managing eye movement. Left untreated for a long time, PSP can cause severe pneumonia and lead to swallowing problems that can contribute to choking.
 

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Frequently Asked Questions

Parkinson's disease is caused due to a disruption in a specific region of the brain, called the basal ganglia, which controls the movement-related functions of the body. Parkinson's impacts the production of dopamine, a neurotransmitter that sends electrical impulses to specific body parts to ensure coordinated movement. In the absence of dopamine, it is common to see symptoms like delayed responses, muscle stiffness, impaired senses and loss of balance.

Parkinson's is only fatal if left untreated. Usually, it can be controlled with medications that compensate for reduced dopamine production in the brain. Left untreated, Parkinson's results in complete brain deterioration within ten to fifteen years, causing an early death.

Parkinson's and dementia are two separate disorders caused due to different reasons. However, studies have not ruled out the possibility that Parkinson's patients can acquire dementia. While the chances do not seem high, patients affected with Parkinson's for more than ten years are believed to be diagnosed with dementia.

Usually, Parkinson's may not show a lot of external symptoms. At most, one might witness slight tremors in his/her fingers or classic symptoms like nausea, constipation and muscle stiffness. It is crucial to visit a neurologist, who may subject him/her to physical and neurological exams and assess the medical history to make a diagnosis.