Parkinson's disease (patient information)

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 * Associate Editor(s)-In-Chief: Jinhui Wu, MD

Overview
Parkinson's disease (PD) is a chronic, progressive neurodegenerative movement disorder, which are the result of the loss of dopamine-producing brain cells. The cause of Parkinson's disease is unknown. Many researchers believe that a combination of several factors, such as free radicals, environmental toxins and genetic predisposition, is involved in the development of this disease. Parkinson's disease develops gradually, often starting with a barely noticeable tremor in just one hand. With time going on, patients may show symptoms as rigidity, masked face, slowness of movement (bradykinesia) and impaired balance, even dementia. Meidcal history, physical examination, neurological evaluation and head images may help exclude other diseases that may cause similar symptoms to Parkinson's disease. Treatment goal of Parkinson's disease is to relieve the symptoms. The main treatment opinion include medications and surgery. The prognosis varies from person to person. It depends on the start time of treatment, nursing and complications.

What are the symptoms of Parkinson's disease?
Symptoms of Parkinson's disease vary with each individual and the stage of Parkinson's disease. In the early course, Parkinson's disease does not have any symptoms. As the disease developes, people may notice one or more of the following symptoms:
 * Tremor: Tremor is one of the most common signs of Parkinson's disease. It often affects in a hand, arm, or leg. It occurs when the person is awake and sitting or standing still, and subsides when the person moves the affected body part.
 * Rigidity: Muscle stiffness often occurs in the limbs and neck. Later, the patient can not move an arm or leg normally and feel pain in the limb.
 * Masked face: This appearance is cause by loss of movement in the muscles in the face. Patients with Parkinson's disease may feel it difficult to speak and swallow.
 * Slowness of movement (bradykinesia) and impaired balance: In the later course of the disease, patients with Parkinson's disease are likely to take small steps and shuffle with the feet close together. They also have trouble in turning around and keeping balance. These abnormities may result in frequent falls.
 * Freezing
 * Constipation
 * Dementia: Patients may appear progressively memory loss, losing interest in things they previously enjoyed, difficulty communicating, reading or writing, difficulty with performing tasks. With time goes on, more signs such as withdrawing from social contact, personality changes and inappropriate behavior may be observed.

Who is at highest risk?
The cause of Parkinson's disease is unknown. Many researchers believe that a combination of several factors is involved in the development of this disease.
 * Free radicals
 * Aging
 * Environmental toxins
 * Genetic predisposition

When to seek urgent medical care?
Call your health care provider if symptoms of Parkinson's disaese develop.

Diagnosis

 * Meidcal history, physical examination and neurological evaluation: Tremor is usually the symptom that causes people to seek medical help.
 * Blood tests: These tests include the check of thyroid function, liver function, kidney function, glucose levels, even the presence of any toxins. The goal of the lab tests may help doctors exclude other diseases that may cause similar symptoms to Parkinson's disease.
 * Imaging studies such as head CT (computerized axial tomography) and MRI (magnetic resonance imaging): These images can also be used to help doctors exclude other brain diseases that may cause similar symptoms to Parkinson's disease, such as stroke or brain tumor.
 * Positron emission computerized tomography (PET): This image is only used in experiment. It may detect low levels of dopamine in the brain, a key feature of Parkinson's disease.

Treatment options
There is no cure for Parkinson's disease. The goal of treatment is to relieve the symptoms. The main treatment opinion include medication and surgery.
 * Taking regular exercise and eating a healthy, balanced diet.
 * Medictions:
 * L-dopa: Levodopa is considered as the "gold standard" of treatment for Parkinson's disease. This drug can increase the level of dopamine in the brain, helping nerve cells use to make dopamine to replenish the brain's dwindling supply.
 * Dopamine agonists such as bromocriptine, pramipexole, or ropinirole: These drugs may mimic the role of dopamine in the brain, causing the neurons to react as they would to dopamine. Also, they may delay the onset of levodopa's side effects.
 * Anti-depression drugs: Depression is common in people with Parkinson's disease. It is important to recognize and deal with this symptom to improve the life quality.
 * Control dementia: Dementia is a usual signs in the later course of Parkinson's disease. When you show signs such as loss memory, problem on solving, learning, and other mental functions, you need to see your doctor to get some medicines to treat dementia.


 * Surgery: Surgery for Parkinson's disease may be appropriate for those who do not respond to drugs. Deep brain stimulation (DBS) is a kind of surgery approved by the U.S. Food and Drug Administration. During this procedure, the surgeons put electrodes into the brain and connect to a pulse generator that can be externally programmed. DBS can reduce the need for levodopa and relieve symptoms such as tremor, slowness of movements, and gait problems.
 * Physical therapy or occupational therapy: These treatment may be used when the condition of Parkinson's disease gets worse. The patients may get some helpful advice from the therapists to improve their walking ability and reduce the risk of falling.

Diseases with similar symptoms

 * Parkinsonism
 * Hyperthyroidism
 * Stroke
 * Essential tremor
 * Dementia

Where to find medical care for Parkinson's disease?
Directions to Hospitals Treating Parkinson's disease

Prevention of Parkinson's disease
Because the cause is not clear now, the preventive measurement for Parkinson's disease is unknown.

What to expect (Outlook/Prognosis)?
The prognosis of Parkinson's disease varies from person to person. It depends on:
 * Whether the patient can be treated early
 * Whether the patient can get a good care or not
 * Whether the patient is accompanied with complications, such as pneumonia, dementia, falling injury or fracture.

Possible complications

 * Difficulty performing daily activities
 * Difficulty swallowing or eating
 * Disability (differs from person to person)
 * Injuries from falls
 * Pneumonia from breathing in (aspirating) saliva
 * Side effects of medications