Management of Your Parkinson's

Original Editor - User:Greg Walding User:Katherine McBeth Top Contributors - Greg Walding, Kim Jackson and Lucinda hampton

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This information is not intended to replace your healthcare professional. Please make sure you seek medical advice if you are experiencing any symptoms of Parkinson's.

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Overview

Parkinson's is a progressive neurodegenerative disorder of the central nervous system. It is the most common disorder of the basal ganglia and the second most common neurodegenerative condition worldwide, after Alzheimer's. The main area of basal ganglia dysfunction appears to stem from the loss of dopamine-producing cells in the substantia nigra, causing difficulty in the initiation of movement.

There are approximately 6.3 million with Parkinson's worldwide. Global diagnosis ranges from 12 to 230 per 100,000 per year. It is more regularly diagnosed in the elderly, affecting around 1% of people over 65 years of age. It can affect both males and females, but is slightly more common in males.

Causes

Parkinson's is caused by a loss of nerve cells in the substantia nigra, which is an area in the brain. Nerve cells in the substantia nigra are responsible for producing a chemical called dopamine. Dopamine acts as a messenger between the areas of the brain and nervous system that helps co-ordinate and control body movements. The volume of dopamine in the brain can decrease if these cells die or become damaged. This means the part of the brain controlling movement cannot work as well as normal, causing movements to become slow and abnormal. The loss of nerve cells is a slow process. The symptoms of Parkinson's usually only start to develop when around 80% of the nerve cells in the substantia nigra have been lost.

The exact reason why this occurs is currently unknown. However, researchers strongly believe that it is a combination of age, environmental factors and genetics that cause the dopamine-producing nerve cells to degenerate.

Prevention

evidence-based advice on preventative measures

Symptoms

People with Parkinson's present with a range of symptoms affecting function, activity, participation and quality of life. Symptoms can differ from person to person and in the same person over time.

Key motor symptoms of Parkinson's are:

• Slowness at initiation of and during movement (Bradykinesia) - may be demonstrated through difficulty with planning, initiating, executing and performing sequential and simultaneous tasks, loss of fine motor control.
• Reduced movement amplitude (Hypokinesia) - typically observed in facial expression, arm swing during walking, writing, but can be present in any movement.
• Rigidity
• Tremor - usually becoming inhibited when initiating movement
• Postural instability or "stooped posture" - this not seen at diagnosis but later on in the course of the disease. This can cause balance deficits and create a risk of falls.
• Shuffling walking pattern - short and close steps
• Freezing whilst walking - reduced ability to prepare and sustain movement

Non-motor symptoms:

• Sleep disorders
• Fatigue and weight loss or gain
• Autonomic disturbances including bladder and sexual dysfunction, excessive sweating
• Depression, anxiety, cognitive disorders
• Altered pain sensation and other sensory abnormalities
  

Diagnosis

No tests can conclusively show that you have Parkinson's. The diagnosis of Parkinson's is commonly based on motor symptoms such as muscle stiffness (rigidity), tremor at rest and slowness of movement. Other symptoms such as depression, falls and sleep disturbances aid the diagnostic decision-making process.

If your doctor does suspect Parkinson's, you will be referred to a specialist. This will either be a neurologist - specialising in brain and nervous system, or a geriatrician - specialising in conditions affecting elderly people.

Being informed that you have Parkinson's can be overwhelming and an emotional experience. It is important to feel supported by a care team and your family during this time. There are a number of support groups and charities that should provide some additional information and support. There are some listed at the bottom of this page.

Management

evidence-based exercises for the specific condition in terminology/language suitable to patients. be mindful that some patients may not have access to a gym or certain equipment

Self-Management

short and long-term management of condition. medication. general health and wellbeing e.g. nutrition and sleep.

More Information and Support

links or information on specialist services, charities, or organisations that may offer additional help and support