Imagine waking up one morning and discovering that you are having tremors and may find that it takes longer to walk across the room to get dressed. It would be very unnerving to say the least, especially if it continued to get worse. Is it just old age? Well, maybe, but it could be the first signs of a very common illness known as Parkinson’s Disease.
What is Parkinson’s Disease?
Parkinson’s disease is a progressive neurological disorder that affects the nerves responsible for muscle tension and movement. Parkinson’s Disease (PD) is characterized by tremor, muscle rigidity, slow movements, and postural abnormalities. It is the result of the death of cells in one of the movement centers of the brain.
PD has been identified as a disease for over 200 years. Currently, it affects approximately half a million men and women in the United States, with as many as 50,000 new cases appearing every year. It most often afflicts people in their late 50’s or early 60’s. About 15% of the American population between the ages of 65-74 will get PD to some degree, and the figures rise to about 30% of those between 75-84. It progressively advances in patients, deteriorating their ability to control the speed, consistency, and smoothness of their bodily motions.
The mechanics of how this illness works have been the subject of much research for many years. It is not fully understood, but much has been learned. There is an area of the brain called the “substantia nigra” (black substance) that is one of the primary movement control centers of the brain. PD appears to cause nerve cells (neurons) in the substantia nigra to degenerate and eventually die. Normally, these specialized cells release a chemical called dopamine that transmits neurological signals between the substantia nigra and the “corpus striatum,” another part of the brain associated with muscular movement. Under normal conditions, this process enables the muscles to operate in a smooth, controlled fashion. When these cells begin to die, less dopamine is produced, and muscular movement deteriorates. The dying cells also develop a unique substance called “Lewy bodies,” which can be used to help identify PD. The loss of dopamine producing cells is a natural result of aging in everyone, but PD patients may lose over 50% of the neurons in the substantia nigra.
What Causes Parkinson’s Disease?
Despite a huge amount of research over the years, scientists are still not sure what the exact cause of PD is. The leading theories speculate that there is most likely both an environmental and a genetic link to PD, but the specifics are as of yet unknown. Some believe PD may be caused by exposure to a genetic or environmental factor early in life that worsens over time until symptoms begin to appear. Makes ya’ think twice about what we may be exposing our children to, doesn’t it?
Statistics show a slight (5%) increase in the risk of contracting PD if you have a first-degree relative, such as parent, child, or sibling, who has the disease. In light of that fact, much of the research has focused on families who have more than one member with the illness. These families are rare, so studies such as these are precious to researchers. This line of research has revealed a bit more about the genetic puzzle. They have discovered that many PD patients have an abnormality in a certain protein (alpha-synuclein) that accumulates in their dying brain cells. Another clue points to a breakdown of systems that dispose of unwanted proteins in the bodies of PD patients. These two factors appear to be common to all PD sufferers.
There are also some clues about the connection of environmental factors with PD. Studies over the years have shown that statistically there is a slightly higher of incidence of PD in people who have had unusual exposure to herbicides and pesticides. People who live in a rural area, drink well water, or are involved in farming also have a slightly higher risk for PD. That is all we know. No specific substance or substances have been implicated.
Another clue was uncovered recently when it was discovered that a chemical called MPTP, a byproduct of the manufacture of some illegal narcotic drugs, causes PD like symptoms in people who ingest it. The symptoms appear almost immediately, within hours, and are permanent. Studies indicate MPTP works through free radical damage, and this has stimulated some research into possible treatments for PD that focus on using antioxidants to fight free radicals.
There are some medications that can trigger PD symptoms as well, if they are taken at higher than normal dosages for extended periods of time. The main culprits are two drugs given for psychiatric disorders, haloperidol (Haldol) and chlorpromazine (Thorazine). Other medications include metoclopramide (Reglan), prescribed for nausea, and valproate (Depakene), an epilepsy drug.
Other risk factors for PD include gender (more men get PD than women), and reduced estrogen levels. Studies have shown that menopausal women are at a greater risk than non-menopausal women.
What Are the Symptoms of Parkinson’s Disease?
These are the common primary symptoms:
Tremors: The most well known symptom of PD is tremors. They may begin on one side of the body at a time, and usually first appear in the hands or even only in one finger. The classic PD tremor is called the “pill-rolling tremor,” because it is a back and forth movement that resembles the rolling of a pill between the thumb and forefinger, usually occurring about three times per second. Tremors in the legs are also common.
Bradykinesia: This is the clinical name for ‘’slow movement.” PD patients may find that they slow down or sometimes even freeze-up (akinesia) during familiar movements such as walking, eating, or combing their hair.
Shuffling gait: This occurs in many patients as a reaction to changes in balance and posture. The gait (festination) is often adopted to avoid falling.
Muscle rigidity: As the movement function of the brain deteriorates, people with PD tend to lose their ability to move smoothly. Movement becomes stiff and jerky.
Masked face: Patients often lose most of their facial expressions, and also experience decreased eye blinking.
Monotone speech: Many folks will begin to lose the inflections in their voice and speak in a monotone.
Some secondary symptoms include:
- Rapid, unclear speech
- Difficulty sleeping, such as insomnia, restlessness, and nightmares
- Emotional changes such as irritability, fear, and paranoia.
- Changes in handwriting, such as letters becoming smaller from left to right (micrographia)
- Difficulty swallowing, often found in the latter stages of the illness.
- Dementia: A small percentage of PD patients develop this complication that affects memory and reasoning skills. It often starts out as slowed thought processes, and difficulty concentrating.
What Treatments Are Available for Parkinson’s Disease?
There is no cure for PD, but there are a slew of mainstream options that include numerable medications and surgeries. Let’s talk about a few of these options.
- The standard of treatment for PD since the 1960’s has been Levodopa, a natural substance found in plants and animals. It is a precursor to dopamine, and is converted into dopamine by neurons in the brain. The discovery of Levodopa was a breakthrough for scientists because they thought that supplementing PD patients with dopamine would help, but because of its structure, dopamine was not absorbable by the brain. There is a tissue known as the blood-brain barrier which screens out many substances to protect the brain. While dopamine cannot cross that barrier, Levodopa is of a different structure, and it can pass through the blood-brain barrier. In more recent times, a drug called carbidopa has been added to the Levodopa to make it more efficient. It helps Levodopa to convert more dopamine in the brain, where it is most needed for PD patients, rather than in other parts of the body. Carbidopa also reduces some of the side effects of this therapy. This has been and is today the preferred medication for the treatment of PD. The main drawback to this course of treatment is that it only treats the symptoms, and is not able to stop the disease from progressing. Therefore, after the disease reaches a certain stage, these drugs stop being as effective. Some of the side effects can be significant as well, such as hallucinations and hypotension (low blood pressure) when standing, causing many patients to have dizzy spells.
- In the last few years, some very interesting research has been done which focuses on the importance of a low protein diet in treating PD, especially in conjunction with Levodopa therapy. One doctor recommends limiting the amount of protein patients consume during breakfast and lunch to no more than 7 grams. Dinner should be the heavy protein meal of the day. Studies using this plan have shown very encouraging results, with many patients experiencing marked improvement in their symptoms especially during the main waking hours.
- I’d like to mention one surgical option just to let you know what’s available out there. I am not recommending this. In my mind the possible side effects are too risky. But it is one of the more recent innovations. It is called deep brain stimulation. An electronic transmitter, much like a pacemaker, is implanted into the chest. Then tiny electrodes are surgically inserted deep within the brain into a section that controls many major motor functions called the “subthalamic nucleus.” Use of these devices has shown improvement in the symptoms of some patients. And now for the rest of the story…Some of the possible side effects are brain hemorrhaging, stroke-like problems, infection, subsequent surgeries to replace parts if they wear out, possible increase of thinking and memory problems, and surgical replacement of the battery every few years. I’m just not sure it’s worth it. I guess that is a personal decision we would each have to make.
- From the natural point of view, one of the more popular therapies is Coenzyme Q10. Researchers have discovered that this substance can help to slow the progression of PD symptoms, especially in the early stages of the disease. CoQ10 is produced by mitochondria, the energy producing structures within our cells. Its purpose is to transport electrons during cellular respiration, which is how cells get energy from oxygen. Most PD patients have insufficient levels of CoQ10 in their bodies. This is a natural product with no known side effects.