More than a million people suffer from Parkinson’s disease (PD), including 16,000 in Tennessee. Yet few of us know much about PD other than the fact that Michael J. Fox has it.
WellTuned spoke with Dr. Ghiath Almasri, medical director at BlueCross BlueShield of Tennessee, to get the facts.
What is Parkinson’s disease?
Dr. Almasri: Parkinson’s is a degenerative disease that happens when certain brain cells die. Those cells produce a substance called dopamine. This is a neurotransmitter that helps control many activities in the body including movement and coordination. The chronic neurologic condition is named after Dr. James Parkinson, who first described it in 1817.
What are the symptoms of Parkinson’s disease?
Dr. Almasri: You need 2 of these 4 symptoms to diagnose PD:
1. Resting tremor
A resting tremor occurs when a muscle is relaxed rather than in action. Resting tremors happen when your hand, arm or leg shakes without activity. This is in contrast to an action tremor, which happens only when you attempt to complete a task. Resting tremors often worsen with stress, anxiety or activities that need concentration.
2. Slow movement (bradykinesia)
Bradykinesia, or slowness of movement, is a symptom you must have (along with a tremor or rigidity) for a Parkinson’s diagnosis. You may see this slowness in:
- Physical actions in general
- Fewer automatic movements (ex. blinking less)
- Difficulty initiating movements (ex. trouble getting up out of a chair)
- Abnormal stillness
- Decrease in facial expression
Together, this overall slowness can cause difficulty performing daily tasks. This can include tasks such as buttoning clothes, cutting food or brushing your teeth.
3. Rigidity
Another cardinal symptom of PD is stiffness beyond what happens normally with age. This tightness of the limbs occurs on one or both sides of the body and can cause:
- Decreased range of motion
- Pain in the muscles or joints
- Reduced arm swing when walking
- Rigidity of the trunk
- Facial masking (stiffness of facial muscles that makes it hard for others to interpret mood)
- Poor sleep quality
4. Balance problems
People with Parkinson’s often experience postural instability, or difficulty balancing, especially while walking. They’re also more likely to experience falls as a result.
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Other symptoms
Additional movement symptoms include:
- Dizziness or fainting
- Drooling
- Dyskinesia: writhing, twisting or turning in place
- Dystonia: curled, clenched toes or a painful cramped foot
- Stooped posture: caused by the brain no longer reminding the body to sit/stand up straight
Non-movement symptoms include:
- Small handwriting
- Changes to sense of smell
- Soft speech
- Lightheadedness
- Constipation
- Dementia
- Depression
- Difficulty swallowing [link to article when live]
How common is Parkinson’s disease?
Dr. Almasri: More people in the U.S. have Parkinson’s than multiple sclerosis, muscular dystrophy and Lou Gehrig’s disease combined. Men are 1.5 times more likely to have Parkinson’s than women. In Tennessee, more than 16,000 people have been diagnosed.
What are the risk factors of Parkinson’s disease?
Dr. Almasri: We don’t know what causes Parkinson’s, so age is the only risk factor, and it’s an indirect one. Most people are diagnosed in their 60s, with some as early as age 40. Michael J. Fox was diagnosed early — in his 30s. And he’s done a lot to promote PD research, which is why he’s often known as the face of Parkinson’s.
While diagnosis doesn’t typically happen until later in life, the brain-cell death that causes PD actually starts early in adulthood. Most people won’t notice symptoms until 80% of those cells are gone. As a progressive disease, PD can start in the fingers on one side of your body, extend to your arms/hands, and then move to your other leg or hand. It can be 15 years before it shows up as a full-blown disease.
How do you treat Parkinson’s disease?
Dr. Almasri: First, let’s address one thing most people don’t know, which is that Parkinson’s itself isn’t fatal. People may die of complications of Parkinson’s — falling and breaking a hip, difficulty swallowing which leads to pneumonia. But PD isn’t the actual cause of death, which is why symptom management is so important.
When it comes to treatment, since we have no way to reverse or cure PD yet, we management Parkinson’s through:
1. Medications
Medications prevent the breakdown of dopamine in the body. The most effective are carbidopa and levodopa, which convert into a dopamine substitute. The problem is they have to be delivered inside the brain, which has a blood-brain barrier that’s highly protective. So one medicine acts as a carrier to get inside, and the other acts as the dopamine replacement.
The drawback of this treatment is that the medicine is very short-acting — only 2-3 hours. So the patient has to take it many times a day. Plus, it’s less effective over time and causes side effects.
2. Deep-brain stimulation
Another treatment is surgical placement of a deep brain stimulator. Think of it like a pacemaker for the heart where leads connect to a modulator which goes up and down to suppress tremors.
Is there anything people can do to prevent Parkinson’s disease?
Dr. Almasri: Because we don’t yet know the cause of Parkinson’s, prevention is still a bit of a mystery.
Yet, people who want to prevent Parkinson’s can take the same steps we suggest for people with PD to manage the disease. That includes movement, which is proven to help quite a bit with symptoms.
Decrease the symptoms of PD with:
- Daily exercise
- Proper diet
- Cognitive stimulation
- Maintenance of mental well-being
When to seek help for mental health
Get more information about specific health terms, topics and conditions to better manage your health on bcbst.com. BlueCross BlueShield of Tennessee members can access wellness-related discounts on fitness products, gym memberships, healthy eating and more through Blue365®. BCBST members can also find tools and resources to help improve health and well-being by logging into BlueAccess and going to the Managing Your Health tab.