April is Parkinson’s Awareness Month: Know the Signs!

According to the National Parkinson’s Foundation, over 50,000 new cases of Parkinson’s Disease are diagnosed each year.  Dr. Ryan Walsh is a neurologist at the Cleveland Clinic Ruvo Center for Brain Health and says there are early signs.

“There are early symptoms that may be related to the development of Parkinson’s Disease, for example, the loss of smell, although not specific to Parkinson’s Disease, is a prominent feature of the disease.”

The other early signs are anxiety and depression.

There is no one test to give you a 100% diagnosis, so the goal is to treat patients before they develop tremors.

Walsh says, “If you can slow it down here, rather than trying to slow it down later, you may actually have more of an impact on the disease.”

According to the Parkinson’s Foundation, almost 200 years after Parkinson’s was first discovered and after many new discoveries about the biology of the disease, a diagnosis still depends on identifying the core features — tremor, slowness and stiffness — described by James Parkinson.

The diagnosis of Parkinson’s does not come from a test, but instead requires a careful medical history and a physical examination to detect the cardinal signs of the disease, including the one Walsh mentions:

  • Resting Tremor: In the early stages of the disease, about 70 percent of people experience a slight tremor in the hand or foot on one side of the body, or less commonly in the jaw or face. A typical onset is tremor in one finger. The tremor consists of a shaking or oscillating movement, and usually appears when a person’s muscles are relaxed, or at rest, hence the term “resting tremor.”
  • The affected body part trembles when it is not performing an action. Typically, the fingers or hand will tremble when folded in the lap, or when the arm is held loosely at the side, i.e., when the limb is at rest. The tremor usually ceases when a person begins an action. Some people with PD have noticed that they can stop a hand tremor by keeping the hand in motion or in a flexed grip. The tremor of PD can be exacerbated by stress or excitement, sometimes attracting unwanted notice. The tremor often spreads to the other side of the body as the disease progresses, but usually remains most apparent on the initially affected side. Although tremor is the most noticeable outward sign of the disease, not all people with PD will develop tremor.
  • Bradykinesia: Bradykinesia means “slow movement.” A defining feature of Parkinson’s, bradykinesia also describes a general reduction of spontaneous movement, which can give the appearance of abnormal stillness and a decrease in facial expressivity. Bradykinesia causes difficulty with repetitive movements, such as finger tapping. Due to bradykinesia, a person with Parkinson’s may have difficulty performing everyday functions,such as buttoning a shirt, cutting food or brushing his or her teeth. People who experience bradykinesia may walk with short, shuffling steps. The reduction in movement and the limited range of movement caused by bradykinesia can affect a person’s speech, which may become quieter and less distinct as Parkinson’s progresses.
  • Rigidity: Rigidity causes stiffness and inflexibility of the limbs, neck and trunk. Muscles normally stretch when they move, and then relax when they are at rest. In Parkinson’s rigidity, the muscle tone of an affected limb is always stiff and does not relax, sometimes contributing to a decreased range of motion. People with PD most commonly experience tightness of the neck, shoulder and leg. A person with rigidity and bradykinesia tends to not swing his or her arms when walking. Rigidity can be uncomfortable or even painful.
  • Postural Instability: One of the most important signs of Parkinson’s is postural instability, a tendency to be unstable when standing upright. A person with posturalinstability has lost some of the reflexes needed for maintaining an upright posture, and may topple backwards if jostled even slightly. Some develop a dangerous tendency to sway backwards when rising from a chair, standing or turning. This problem is called retropulsion and may result in a backwards fall. People with balance problems may have particular difficulty when pivoting or making turns or quick movements. Doctors test postural stability by using the “pull test.” During this test, the neurologist gives a moderately forceful backwards tug on the standing individual and observes how well the person recovers. The normal response is a quick backwards step to prevent a fall; but many people with Parkinson’s are unable to recover, and would tumble backwards if the neurologist were not right there to catch him or her.

Secondary Motor Symptoms

In addition to the cardinal signs of Parkinson’s, there are many other motor symptoms associated with the disease.

  • Freezing: Freezing of gait is an important sign of PD that is not explained by rigidity or bradykinesia. People who experience freezing will normally hesitate before stepping forward. They feel as if their feet are glued to the floor. Often, freezing is temporary, and a person can enter a normal stride once he or she gets past the first step. Freezing can occur in very specific situations, such as when starting to walk, when pivoting, when crossing a threshold or doorway, and when approaching a chair. For reasons unknown, freezing rarely happens on stairs. Various types of cues, such as an exaggerated first step, can help with freezing. Some individuals have severe freezing, in which they simply cannot take a step. Freezing is a potentially serious problem in Parkinson’s disease, as it may increase a person’s risk of falling forward.
  • Micrographia: This term is the name for a shrinkage in handwriting that progresses the more a person with Parkinson’s writes. This occurs as a result of bradykinesia, which causes difficulty with repetitive actions. Drooling and excess saliva result from reduced swallowing movements.
  • Mask-like Expression: This expression, found in Parkinson’s, meaning a person’s face may appear less expressive than usual, can occur because of decreased unconscious facial movements. The flexed posture of PD may result from a combination of rigidity and bradykinesia.
  • Unwanted Accelerations: It is worth noting that some people with Parkinson’s experience movements that are too quick, not too slow. These unwanted accelerations are especially troublesome in speech and movement. People with excessively fast speech, tachyphemia, produce a rapid stammering that is hard to understand. Those who experience festination, an uncontrollable acceleration in gait, may be at increased risk for falls.

Additional secondary motor symptoms include those below, but not all people with Parkinson’s will experience all of these.  

  • Stooped posture, a tendency to lean forward
  • Dystonia
  • Impaired fine motor dexterity and motor coordination
  • Impaired gross motor coordination
  • Poverty of movement (decreased arm swing)
  • Akathisia
  • Speech problems, such as softness of voice or slurred speech caused by lack of muscle control
  • Difficulty swallowing
  • Sexual dysfunction
  • Cramping
  • Drooling

Nonmotor Symptoms

Most people with Parkinson’s experience nonmotor symptoms, those that do not involve movement, coordination, physical tasks or mobility. While a person’s family and friends may not be able to see them, these “invisible” symptoms can actually be more troublesome for some people than the motor impairments of PD.

Early Symptoms

Many researchers believe that nonmotor symptoms may precede motor symptoms — and a Parkinson’s diagnosis — by years. The most recognizable early symptoms include:

  • loss of sense of smell, constipation
  • REM behavior disorder (a sleep disorder)
  • mood disorders
  • orthostatic hypotension (low blood pressure when standing up).

If a person has one or more of these symptoms, it does not necessarily mean that individual will develop Parkinson’s, but these markers are helping scientists to better understand the disease process.

Other Nonmotor Symptoms

Some of these important and distressing symptoms include:

  • sleep disturbances
  • constipation
  • bladder problems
  • sexual problems
  • excessive saliva
  • weight loss or gain
  • vision and dental problems
  • fatigue and loss of energy.
  • depression
  • fear and anxiety
  • skin problems
  • cognitive issues, such as memory difficulties, slowed thinking, confusion and in some cases, dementia
  •  medication side effects, such as impulsive behaviors


TODAY’S LATEST PARKINSON’S DISEASE NEWS FROM REUTERS HEALTH

(Reuters Health) – People with diabetes may have a heightened risk of developing Parkinson’s disease, especially at a relatively young age, a new study finds.

Published in the journal Diabetes Care, the study adds to recent research linking diabetes to Parkinson’s disease.

But neither this report nor the earlier ones prove that diabetes, itself, raises a person’s risk of Parkinson’s — a disorder in which movement-regulating brain cells gradually become disabled or die.

Instead, researchers suspect that it’s more likely diabetes and Parkinson’s share some common underlying causes.

The new study looked at health insurance claims from more than one million Taiwanese adults — including a little over 600,000 with diabetes.

Researchers found that over nine years, people with diabetes were more likely to be diagnosed with Parkinson’s disease. They were diagnosed at a rate of 3.6 cases per 10,000 people each year, versus 2.1 per 10,000 among people without diabetes.

When the researchers factored in age, sex and certain other health conditions, they found that diabetes was still linked to an increased risk of Parkinson’s — especially at a relatively young age.

Among women in their 40s and 50s, those with diabetes had twice the risk of Parkinson’s that diabetes-free women did.

The same was true among men in their 20s and 30s, though that was based on only a handful of Parkinson’s cases: there were four cases among young men with diabetes, and two among those without diabetes.

Exactly what it all means is unclear, according to Drs. Yu Sun and Chung-Yi Li, who led the study.

But on average, people develop Parkinson’s diagnosis around age 60, the researchers noted in an email to Reuters Health.

“Our findings tend to suggest a relationship between diabetes and early-onset Parkinson’s disease,” said Sun and Li, who are based at En Chu Kong Hospital and National Cheng Kung University in Taiwan.

That’s in line with a study of Danish adults published last year, the researchers noted. (See Reuters Health story of April 15, 2011).

Still, it’s impossible to say for sure that diabetes, itself, is to blame.

One reason is that the current study had limited information, according to Sun and Li.

“Because our study was based on claims data,” they said, “it lacks information on some of the known risk factors for Parkinson’s disease, such as pesticide exposure.”

Researchers have speculated on the potential reasons for the diabetes-Parkinson’s link, and they suspect there might be certain biological mechanisms that contribute to both conditions.

One possibility is chronic, low-level inflammation throughout the body, which is suspected of contributing to a number of chronic diseases by damaging cells. There might also be a common genetic susceptibility to both diabetes and Parkinson’s.

But even if people with diabetes have a relatively elevated risk of Parkinson’s, it’s still a low risk, Sun and Li pointed out.

In this study, there were fewer than four cases per 10,000 diabetic adults each year.

A recent U.S. study found a similar pattern: Of 21,600 older adults with diabetes, 0.8 percent were diagnosed with Parkinson’s over 15 years. That compared with 0.5 percent of people who were diabetes-free at the study’s start.

The researchers on that study said that people with diabetes should simply continue to do the things already recommended for their overall health — like eating a well-balanced diet and getting regular exercise.

Sun and Li agreed with that advice. “There is no need for patients with diabetes to worry too much about the development of Parkinson’s disease,” they said.

More studies are needed, the researchers said, to understand why diabetes is related to a higher Parkinson’s risk — and what, if anything, can be done about it.

Diabetes arises when the body can no longer properly use the blood-sugar-regulating hormone insulin. Parkinson’s occurs when movement-regulating cells in the brain die off or become disabled, leading to symptoms like tremors, rigidity in the joints, slowed movement and balance problems.

Researchers say it’s possible that something about diabetes — like a problem regulating insulin — might somehow contribute to Parkinson’s. But that remains unproven.

SOURCE: bit.ly/HdmwiU Diabetes Care, online March 19, 2012.

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