What you need to know about Parkinson’s disease

Pradeep Bollu, MD

Neurology

Thanks to individuals like the celebrity Michael J. Fox and others sharing their stories, Parkinson’s disease is more widely recognized than ever. However, many still have unanswered questions about this complex neurological disease. Can you inherit Parkinson’s disease? Is it fatal? Is there some way to prevent it?

Pradeep Bollu, MD, neurologist, answered these and other questions about Parkinson’s disease.

What are the early signs of Parkinson’s disease?

“Tremor is often a predominant early symptom,” said Dr. Bollu. “It tends to be associated with the public image of the disease.”

However, other symptoms like slowness, stiffness, and postural instability may also be present. Tremor may be minimal, or you may not experience tremors at all. For some, the first symptom is a significant unexplained loss of balance leading to a fall. For others, a gradual change in handwriting with the letters becoming smaller and much more cramped may be a puzzling early sign.

Are there non-neurological symptoms of Parkinson’s disease?

“The disease involves far more than the motor system,” said Dr. Bollu. “In fact, many non-neurological symptoms are very common and may grow more pronounced with time.”

Other symptoms can include the following:

• Inability to smell
• Constipation and other intestinal issues
• Erectile dysfunction
• Difficulty sleeping
• Problems with mood and memory

Can you inherit Parkinson’s disease? Is it genetic?

“Most cases of are sporadic, not inherited,” said Dr. Bollu. “The exact cause for why Parkinson’s disease develops in some but not others is largely unknown, and we are still searching for a definitivecause.”

While there are occasional examples of an inherited Parkinson’s disease due to genetic mutations passed down through a family line, they make up only a tiny proportion of those diagnosed with the disease.

 Is Parkinson’s disease fatal?

“Parkinson’s disease, like many neurodegenerative diseases, causes the destruction of neuronal cells in and out of the brain,” said Dr. Bollu. “This results in a variety of consequences throughout the body.”

Rather than considering whether or not the disease is directly fatal, Dr. Bollu suggested looking at it in a slightly different way. The gradual loss of brain cells[PCB1] caused by the disease results in many different issues, including loss of motor function, cognition and memory difficulties, and dysfunction or breakdown of the part of the nervous system that regulates heart rate, blood pressure, gut movement and more.

As the disease advances, the affected person typically develops complications that will, eventually, result in their death.

How is Parkinson’s disease diagnosed?

“Parkinson’s disease is primarily a clinical diagnosis,” said Dr. Bollu. “This means that rather than relying on a specific test result, such as someone with a lump in their breast being tested for the presence of cancer cells or a tumor, the clinician in the case of Parkinson’s disease makes the diagnosis based on the patient’s symptoms and a clinical examination. Alternative explanations for those symptoms need to be excluded, as well.”

In certainsituations, a special type of CAT scan of the head, called a DAT scan, can also be used to help with the diagnosis. Recently skin biopsies have been utilized to support the diagnosis. In these cases, a small sample of skin is analyzed for the presence of specific abnormal proteins in the nerve tissue of the skin. These abnormal proteins are linked not just to Parkinson’s disease but to other movement disorders as well, so it works best as a supporting test for the clinical examination and doesn’t provide a precise diagnosis on its own.

How is Parkinson’s disease treated?

“Many of the older therapies for Parkinson’s disease focused on replenishing dopamine, which is lost when the disease targets the neurons that produce it,” said Dr. Bollu. “Often, these therapies involved medications like Sinemet (levodopa and carbidopa), entacapone, rasagiline, and other similar options.”

Deep brain stimulation has also become one of the standard therapies for the disease. This surgical procedure, which involves placing thin metal wires inside the brain that provides electrical stimulation, can help to ease motor system symptoms and even decrease medication needs in some patients. It doesn’t work for everyone, however, and so clinicians use a careful process with multiple steps that involve a treatment team of neurologists, neuropsychologists and neurosurgeons to decide if it’s right for the individual patient’s unique needs.

Clinicians will also often prescribe certain exercises or time in physical therapy as a way to help mitigate some of the troubling motor symptoms that you might be experiencing. This helps to decrease problems with loss of strength or mobility and can balance, flexibility, and retain more independence over time.

Is there anything you can do to prevent Parkinson’s disease?

“There is no specific action or way to prevent the development of Parkinson’s at this time,” said Dr. Bollu. “Our focus is mainly on looking for those symptoms and providing therapies to help with discomfort and interference in everyday life.”

The most common risk factors for developing Parkinson’s disease include advancing age (most cases are in those over 60, although early-onset Parkinson’s does occur), biological sex (men are more likely to develop Parkinson’s disease than women), and whether you have a family history of the disease.

Early treatment is key to staying more mobile and living longer with the disease, so contact your doctor if you notice any unexplained worrying symptoms.