Parkinson`s disease

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Overview

Parkinson’s disease is a brain disorder that causes unintended or uncontrollable movements, such as shaking, stiffness, and difficulty with balance and coordination.

Symptoms usually begin gradually and worsen over time. As the disease progresses, people may have difficulty walking and talking. They may also have mental and behavioral changes, sleep problems, depression, memory difficulties, and fatigue.

Older woman and her caregiverWhile virtually anyone could be at risk for developing Parkinson’s, some research studies suggest this disease affects more men than women. It’s unclear why, but studies are underway to understand factors that may increase a person’s risk. One clear risk is age: Although most people with Parkinson’s first develop the disease after age 60, about 5% to 10% experience onset before the age of 50. Early-onset forms of Parkinson’s are often, but not always, inherited, and some forms have been linked to specific gene mutations.

Symptoms

Parkinson’s has four main symptoms:

Tremor in hands, arms, legs, jaw, or head

Muscle stiffness, where muscle remains contracted for a long time

Slowness of movement

Impaired balance and coordination, sometimes leading to falls

Other symptoms may include:

Depression and other emotional changes

Difficulty swallowing, chewing, and speaking

Urinary problems or constipation

Skin problems

The symptoms of Parkinson’s and the rate of progression differ among individuals. Early symptoms of this disease are subtle and occur gradually. For example, people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly, or that their handwriting is slow and looks cramped or small. Friends or family members may be the first to notice changes in someone with early Parkinson’s. They may see that the person’s face lacks expression and animation, or that the person does not move an arm or leg normally.

People with Parkinson's disease often develop a parkinsonian gait that includes a tendency to lean forward; take small, quick steps; and reduce swinging their arms. They also may have trouble initiating or continuing movement.

Symptoms often begin on one side of the body or even in one limb on one side of the body. As the disease progresses, it eventually affects both sides. However, the symptoms may still be more severe on one side than on the other.

Many people with Parkinson’s disease note that prior to experiencing stiffness and tremor, they had sleep problems, constipation, loss of smell, and restless legs. While some of these symptoms may also occur with normal aging, talk with your doctor if these symptoms worsen or begin to interfere with daily living.


Causes

It's not known why the loss of nerve cells associated with Parkinson's disease occurs, although research is ongoing to identify potential causes.


Currently, it's believed a combination of genetic changes and environmental factors may be responsible for the condition.


Genetics

A number of genetic factors have been shown to increase a person's risk of developing Parkinson's disease, although exactly how these make some people more susceptible to the condition is unclear.


Parkinson's disease can run in families as a result of faulty genes being passed to a child by their parents. But it's rare for the disease to be inherited this way.


Environmental factors

Some researchers also feel environmental factors may increase a person's risk of developing Parkinson's disease.


It's been suggested that pesticides and herbicides used in farming and traffic or industrial pollution may contribute to the condition.


But the evidence linking environmental factors to Parkinson's disease is inconclusive.


Other causes of parkinsonism

"Parkinsonism" is the umbrella term used to describe the symptoms of tremors, muscle rigidity and slowness of movement.


Parkinson's disease is the most common type of parkinsonism, but there are also some rarer types where a specific cause can be identified.


These include parkinsonism caused by:


medication (drug-induced parkinsonism) – where symptoms develop after taking certain medications, such as some types of antipsychotic medication, and usually improve once the medication is stopped

other progressive brain conditions – such as progressive supranuclear palsy, multiple systems atrophy and corticobasal degeneration

cerebrovascular disease – where a series of small strokes cause several parts of the brain to die

Risk factors

It's a complex picture, but you may be more likely to get Parkinson's based on:


Age. Since it mostly affects people 60 and older, your risk goes up as the years go by.


Family history. If your parent, brother, or sister has it, you're a little more likely to get it.


Job. Some types of work, like farming or factory jobs, can cause you to have contact with chemicals linked to Parkinson's.


Race. It shows up more often in white people than other groups.


Serious head injury. If you hit your head hard enough to lose consciousness or forget things as a result of it, you may be more likely to get Parkinson's later in life.


Gender. Men get it more than women. Doctors aren't sure why.


Where you live. People in rural areas seem to get it more often, which may be tied to chemicals used in farming.

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Complications

Parkinson's disease is often accompanied by these additional problems, which may be treatable:


Thinking difficulties. You may experience cognitive problems (dementia) and thinking difficulties. These usually occur in the later stages of Parkinson's disease. Such cognitive problems aren't usually helped by medications.

Depression and emotional changes. You may experience depression, sometimes in the very early stages. Receiving treatment for depression can make it easier to handle the other challenges of Parkinson's disease.


You may also experience other emotional changes, such as fear, anxiety or loss of motivation. Health care providers may give you medication to treat these symptoms.


Swallowing problems. You may develop difficulties with swallowing as your condition progresses. Saliva may accumulate in your mouth due to slowed swallowing, leading to drooling.

Chewing and eating problems. Late-stage Parkinson's disease affects the muscles in the mouth, making chewing difficult. This can lead to choking and poor nutrition.

Sleep problems and sleep disorders. People with Parkinson's disease often have sleep problems, including waking up frequently throughout the night, waking up early or falling asleep during the day.


People may also experience rapid eye movement sleep behavior disorder, which involves acting out your dreams. Medications may improve your sleep.


Bladder problems. Parkinson's disease may cause bladder problems, including being unable to control urine or having difficulty in urinating.

Constipation. Many people with Parkinson's disease develop constipation, mainly due to a slower digestive tract.

You may also experience:


Blood pressure changes. You may feel dizzy or lightheaded when you stand due to a sudden drop in blood pressure (orthostatic hypotension).

Smell dysfunction. You may experience problems with your sense of smell. You may have difficulty identifying certain odors or the difference between odors.

Fatigue. Many people with Parkinson's disease lose energy and experience fatigue, especially later in the day. The cause isn't always known.

Pain. Some people with Parkinson's disease experience pain, either in specific areas of their bodies or throughout their bodies.

Sexual dysfunction. Some people with Parkinson's disease notice a decrease in sexual desire or performance.

Prevention

Some research has shown that regular aerobic exercise might reduce the risk of Parkinson's disease. Some other research has shown that people who consume caffeine — which is found in coffee, tea and cola — get Parkinson's disease less often than those who don't drink it.Since most causes of Parkinson's disease are unknown, there are no specific prevention techniques. Caffeine and green tea may lower your risk of developing Parkinson's disease. In addition, staying active and exercising may also lower your risk. Limiting dairy and red meat may also help.