Each year, April is designated as “Parkinson’s Disease Awareness Month” where people come together to raise awareness about this neurodegenerative brain disease. This month offers a unique opportunity for people to understand the disease and how it affects the world’s population as it is critical to educate on such a rampant condition, one that impacts an estimated 7 million individuals across the country.
While you may be aware of the well-known symptoms involved, there’s unfamiliar information about Parkinson’s that can help you learn it better. In an interview with HT Lifestyle, Dr Pankaj Agarwal, Senior Consultant – Neurology, Head, Movement Disorders Clinic and In-Charge, Deep Brain Stimulation (DBS) at Mumbai’s Program Global Hospital, shared, “Parkinson’s Disease is the degeneration of dopamine-producing cells in the substantia nigra, a small but crucial area located deep inside your brain, that is the root cause of PD.”
Symptoms:
Dr Pankaj Agarwal revealed, “In the human body, dopamine is a chemical that carries signals within the motor brain circuits and just because there isn’t enough dopamine in PD brains, symptoms like shaking, slowness, and stiffness develop.”
Dr Sonukumar Puri, MD Physician at Jain Multispeciality Hospital highlighted that Parkinson’s has motor and non motor symptoms. According to him, four primary motor symptoms of Parkinson’s disease include:
- Tremor – occurring at rest, the classic slow, rhythmic tremor of Parkinson’s disease typically starts in one hand, foot, or leg and eventually affects both sides of the body.
2. Rigidity – tightness or stiffness of the limbs or torso
3. Bradykinesia – slow movement, mask like facies
4. Postural instability – balance problems, tendency to list or fall backward (retropulsion)
He shared, “Observing two or more of these symptoms is the main way that physicians diagnose Parkinson’s. The voice may become softer. There may be a loss of the normal variation in volume and emotion in the voice, so that the individual may speak in a monotone. In more advanced Parkinson’s, speaking may become rapid, stuttering may occur. A common, early symptom of Parkinson’s disease is a decrease in the natural swing of one or both arms when walking. Later, steps may become slow and small and a shuffling gait (festination).”
He listed the non-motor symptoms of Parkinson’s disease that included:
1. Cognitive Changes – Particularly in more advanced Parkinson’s disease or in older people with the disease, problems with thinking, word finding, and judgment are common.
2. Depression and Anxiety – Depression and anxiety are fairly common non-motor symptoms of Parkinson’s. Reduced sensitivity to odours (hyposmia) or a loss of smell (anosmia) is often an early symptom of Parkinson’s. Eyes can experience diminished movement capabilities, , leading to a condition called “dry eye”. They experience easy fatiguability.
3. Gastrointestinal Issues – Constipation occurs frequently because Parkinson’s disease may slow the automatic movement of the digestive system and even side effects of medications may also contribute to constipation.
4. Light headedness – This symptom is related to the body’s inability to quickly regulate blood pressure, particularly when sitting up from a lying position or standing from a sitting position. When severe, light-headedness may cause blackouts or fainting.
5. Personality Changes – The disease can affect the brain in ways that cause modest personality changes over time and Parkinson’s medication can, in some instances, cause impulse control disorders (ICD). Psychosis is also common.
6. Sexual Concerns – Reductions in sexual desire, or libido, is another non-motor symptom of Parkinson’s disease that is often under-recognized. Sleep problems are commonly experienced by people with Parkinson. Excessive sweating is a relatively common sign of Parkinson’s, particularly if the disease is untreated.
7. Urinary Issues – Urinary frequency (the need to urinate often) and urinary urgency (the feeling that one must urinate right away, even if the bladder is not full) are other problems. Loss of weight is a common symptom, particularly in the later stages of the illness.
Treatment:
According to Dr Gunjan Bharadwaj, Founder/CEO of Innoplexus, “Experiencing Parkinson’s disease is not limited to dealing with occasional loss of balance and tremors. However, living with this condition does not mean the end of the world. The disease and its symptoms can be managed with the right medical intervention.”
He added, “Thanks to different forms of treatment and modern-day medicine, a person with Parkinson’s can cope with the condition and live a normal, long life. If you are experiencing or know someone who is diagnosed with Parkinson’s disease, it’s necessary that you seek help from support groups, spread awareness, and assist others learn about the condition better.”
Dr Pankaj Agarwal revealed, “If the treatment and medicine are taken regularly, it can give relief from symptoms, allowing PD sufferers to return to a practically normal life. Even in the late last stages, Deep Brain Stimulus (DBS) surgery can provide excellent relief from PD.” He listed the following ways in which PD can be managed:
● Diet- a well-balanced diet consisting of fiber and fluids, to reduce constipation.
● Physiotherapy can provide relief from muscle stiffness and joint pain through movement and exercise.
● Occupational therapy identifies difficulties in daily chores such as dressing up or walking to the nearby store, and appropriate training to manage these better.
● Speech and swallowing therapy to address speech problems and swallowing difficulties and correct them.
● Medications play a crucial role– like taking it on time and regularly to reduce all symptoms, and with regular follow-up with your doctor.
● Surgery (deep brain stimulation) to improve the quality of life in patients with advanced Parkinson’s disease where medications are no longer as effective or produce side effects.
● Regular follow-up with your doctor – As PD is progressive, patients need regular assessment by a movement disorder neurologist, who will fine-tune medications depending on the condition of the patient on follow-up evaluation. This is one of the most important aspects of managing the disease.
Myths and facts about Parkinson’s Disease:
Dr. Gunjan Bharadwaj shared the following facts –
#1 Parkinson’s is a progressive, incurable disease
Parkinson’s doesn’t have a cure as yet. However, there are several treatments, including Deep Brain Stimulation (DBS), medication, and lifestyle changes, that can potentially control symptoms and improve your quality of life. DBS has proved to be a breakthrough technology that eliminates the tremors and rigidity linked with Parkinson’s disease, empowering the individual to live a normal life.
#2 Each person with Parkinson’s shows different symptoms
The signs and symptoms among patients with Parkinson’s are vastly different for everyone. While symptoms like loss of balance, tremors, decreased mobility, stooped posture, and uncontrollable movements remain constant and common, the severity, progression, and frequency of dysfunctions are unique in every person.
#3 Researchers are still striving to find the cause of PD
Currently, the cause and cure of Parkinson’s are yet not known. But research shows that genetics, to some extent, play a key role in the development of the disease, as per the Parkinson’s Disease Foundation. Some studies, on the other hand, suggest that hereditary causes of this condition are rare. About 10 to 15 percent of people with Parkinson’s have a family history of it. Experts highlight that a combination of genetic and environmental factors is responsible for causing Parkinson’s disease.
#4 Non-motor symptoms of Parkinson’s are more adverse
Parkinson’s condition is mainly distinguished by four symptoms, including impaired coordination, tremors in the arms, legs, jaw, or hands, chronic muscle stiffness, and slow movement. Though a majority of people experience these symptoms, there are also non-motor symptoms that aren’t frequently associated with the disease. For example, many patients report mood disorders, constipation, fatigue, sleep disturbances, depression, anxiety, and urinary problems. These side effects greatly affect a person’s quality of life and impact their ability to carry out daily activities.
#5 Parkinson’s strikes more men than women
In the past few years, many studies have indicated that men are more susceptible to developing PD as compared to women. However, women have shown a faster progression and higher mortality rate due to the condition. While researchers have yet to confirm the reason behind this, some reports suggest that women are less at risk because of the potential protective impact of the female hormone estrogen on the nervous system.
Experiencing Parkinson’s disease is not limited to dealing with occasional loss of balance and tremors. However, living with this condition does not mean the end of the world. The disease and its symptoms can be managed with the right medical intervention.
Debunking certain myths and misconceptions surrounding Parkinson’s, Dr. Gunjan Bharadwaj highlighted –
Myth 1: Parkinson’s only causes movement-related (motor) symptoms
Fact: While it’s true that PD involves symptoms like shaking and tremors, slowness of movement, rigid muscles, and a flat or frozen expression, there’s more to it. In the past few years, non-motor symptoms have gotten attention from medical experts and researchers. In fact, for many patients, non-motor symptoms are more severe than motor symptoms. These symptoms include dementia, cognitive impairment, fatigue, anxiety and depression, and sleep problems.
Myth 2: Parkinson’s medications are toxic
Fact: Though the misconception that the medications available for Parkinson’s are toxic was debunked, it exists. Levodopa is the most common drug therapy for PD. It’s an effective drug that helps people with motor symptoms. But many patients wrongly assumed that over time, this drug makes the condition progress faster. The reality is, that as long as the medicine is being used in the right proportion and for the right duration, it is safe and beneficial for people with PD.
Myth 3: Parkinson’s intensifies and then fades away
Fact: Unlike other illnesses that can flare up and fade away eventually, Parkinson’s doesn’t function like that. The symptoms may be better or worse each day, but the condition as such is always progressing, although slowly.
The misconceptions around Parkinson’s disease can be dangerous for those trying to understand the diagnosis. Being able to differentiate between the facts and myths can help manage people living with Parkinson’s disease.
Dr Pankaj Agarwal pointed out the several myths and misconceptions around varied aspects of PD –
Myth 1: Parkinson’s only causes body movement-related (motor) problems’
Fact: ‘Patients with Parkinson’s disease may also experience non-motor symptoms such as depression, sleep disturbances, constipation, a lack of smell, urine incontinence, and dizziness on standing. These are serious ‘non-motor’ symptoms that need proper attention, treatment, and care along with the more obvious motor symptoms.
Myth 2: ‘‘All Parkinson’s patients have Hand Shaking’
Fact: Tremor is very common in PD, but 10-15% of patients may not have tremor at all. These patients may instead have slowness, stiffness of their body parts, walking difficulty and loss of balance as their main problems. Indeed each patient with PD has different symptoms and no two patients are alike.
Myth 3: ‘If I have Parkinson’s, I will definitely become disabled or die early’
Fact: Not true. PD is not a fatal disease, unlike a severe heart attack or stroke. Most patients with Parkinson’s if provided early and appropriate neurological care can lead near-normal lives with a near-normal lifespan and manageable symptoms.
Myth 4: ‘Parkinson’s is only seen in old people’
Fact: Although the majority of Parkinson’s disease patients are over 60 years old, but nowadays It is becoming increasingly common to have symptoms of Parkinson’s disease before the age of 40, Do not be surprised if you see someone with PD in their 30s or even in their 20s.
Myth 5: ‘Parkinson’s cannot runs in families as it is not hereditary’
Fact: While this may be true in the majority (80%+)of PD cases, at least 15-20 percent of Parkinson’s is now considered to be genetic in origin. Several genes are now well known to cause PD and cause it in many members of one family.
Myth 6: ‘There is no good treatment for Parkinson’s’
Fact: Many treatment options exist that allow patients with Parkinson’s disease to live better, or to live near their normal lives when properly treated by PD specialists such as movement disorders neurologists. Various forms of dopamine-altering medicines, physiotherapy, and lifestyle changes all play a big role. In certain individuals with advanced or severe illness, surgery (DBS) can successfully reduce symptoms while also maintaining a valuable quality of life for a long time.
Adding to the list of myths in Parkinson’s disease diagnosis, Dr Syed Moeed Zafer, Consultant Neurologist and Movement Disorders Specialist at Mumbai’s Masina Hospital, shared –
Myth #1 – Tremor means Parkinson’s disease:
Tremor is a symptom of Parkinson’s disease BUT can occur in many other diseases also-like Essential Tremor, Dystonic tremor and Enhanced physiological tremor.
Myth #2 – My family member has Parkinson’s disease so I may also develop the same:
Parkinson’s disease is commonly sporadic(occurring in only a single individual in family).Rarely it can be familial or inherited, hence the probability of a family member being affected in very less.
Myth #3 – MRI BRAIN can confirm the diagnosis of Parkinson’s disease:
Parkinson’s disease is a clinical diagnosis-made by your physician. MRI BRAIN if asked for is to rule out other diagnosis-it does not confirm Parkinson’s disease.
Myth #4 – No treatment for Parkinson’s disease:
Parkinson’s disease is not curable-BUT it is treatable and the symptoms can be very well controlled with medications and subsequently Device assisted therapies.
Myth #5 – Levodopa phobia – don’t use Levodopa otherwise it will lead to severe complications:
Levodopa is the best effective treatment for Parkinson’s disease-it can be used early if the patient has significant disabling symptoms. It is the dose of Levodopa and the duration of illness which have an impact on development of motor complications in Parkinson’s disease.
Myth #6 – Deep Brain Stimulation is not an effective treatment of Parkinson’s disease:
Deep Brain stimulation is an established and very effective treatment of Parkinson’s disease-in carefully selected patients at a stage when the symptoms become disabling and the response to medicines is limited.
Myth #7 – Stem cell therapy can cure Parkinson’s disease:
Stem cell therapy is at experimental stage-it is not an established treatment for Parkinson’s disease