Parkinson's Disease: The Case for Earlier Detection

January 12, 2013
As populations continue to age, more families are being touched by Parkinson’s disease. Though the condition remains incurable, earlier detection and expert care are giving patients more effective treatment options and better life quality.
The global “graying” trend shows no signs of slowing down. While people are enjoying longer lifespans,  the aging trend has a downside, too: More adults are being diagnosed with Parkinson’s disease, the second most prevalent neuro-degenerative brain disorder after Alzheimer’s disease.

About one percent of senior adults in industrialized countries have Parkinson’s. Thailand’s rate is growing but remains lower – the Thai Red Cross Society estimates 0.42 percent of adults over 60 have Parkinson’s.
Past generations of Thais called Parkinson’s san-ni-bat-look-nok (‘shaking palsy’). While the disease has been around for centuries, it’s still somewhat mysterious. To better understand this serious health threat, Better Health turned to Dr. Oraporn Sitburana, a neurologist at Bumrungrad’s Neuroscience Center who specializes in treating patients with Parkinson’s and other movement disorders.   
“It’s important to see your doctor if you experience any Parkinson’s symptoms. Today there are more and better medications for reducing symptoms, as well as other treatments that may increase longevity and improve quality of life during     the disease’s later stages.”
Dr. Oraporn Sitburana


The onset of symptoms

According to Dr. Oraporn, the most common symptoms of Parkinson’s include slowness of movement, muscle rigidity, and resting tremors that lessen with movement. The onset of movement symptoms typically occurs after the patient’s supply of dopamine-generating cells has declined by about 60 percent. The loss of these cells, which are produced by the substantia nigra structure in the midbrain, deprives the patient of the neurotransmitter chemical that regulates body movement.

Parkinson’s research suggests that it takes from four to ten years of cell degeneration before a patient’s normal movements are affected. The decline in nerve cells eventually impacts a patient’s sense of smell, intestinal function, sleep quality and emotional well-being. Parkinson’s patients typically suffer chronic constipation, and emotional affects range from mood swings and depression to anxiety and obsessive/compulsive behaviors. The impact on sleep can be significant – some patients report episodes of shouting, kicking and trashing occurring during sleep.

Symptoms & diagnosis

Diagnosing Parkinson’s typically occurs after a patient begins noticing physical symptoms and decides to see their doctor. These initial symptoms may include slow movement, leg stiffness, decreased arm swing while walking, rigid body, slower or softer speech and small handwriting. Recognizing these symptoms is an important aspect of correctly diagnosing the disease.
Doctors also review the patient’s medical history and conduct a physical examination during the diagnostic process. Clinical tests and MRI scans are only able to identify disorders that are similar to Parkinson’s disease.

For example, the F-DOPA PET, a complex and expensive MRI brain scan, can reveal dopamine uptake abnormalities. Neurologists who specialize in Parkinson’s typically can identify the disease with an accuracy rate above 90 percent.

Earlier, better treatments

As with most medical conditions, patients can benefit greatly if Parkinson’s is diagnosed earlier, when treatment outcomes are better and less traumatic. Earlier detection and treatment enhances the impact of lifestyle changes, such as good nutrition and exercise habits, that boost quality of life and emotional well-being.
It’s important to see your doctor if you experience any Parkinson’s symptoms. Today there are more and better medications for reducing symptoms, as well as other treatments that may increase longevity and improve quality of life during the disease’s later stages.  
“Ongoing research studies
are showing positive signs            
for the future, including more
effective symptom-relief medications
with improved side effect profiles.”

Treatments and stages

For patients in the early and middle stages of Parkinson’s disease, most treatments involve medication that targets the neurotransmitters producing dopamine, as well as choline, adrenaline and serotonin. The most widely-used medicines include dopamine substrate, dopamine agonists and dopamine inactivation enzymes.
By the time the disease reaches its later stages, nerve cell damage is severe. Patients typically have great difficulty with everyday activities and rely more on family members and caregivers for help. A patient’s movements can be further impaired as a result of side effects and/or drug resistance due to long term use of medication. If medication loses effectiveness, doctors then consider additional treatment options such as deep brain stimulation, insertion of a subcutaneous apomorphine pump and intrajejunal duodopa infusions.

Developing treatments

While the search for a Parkinson’s cure continues, Dr. Oraporn notes that ongoing research studies are showing positive signs for the future, including more effective symptom-relief medications with improved side effect profiles. Research on alternative medication delivery methods – skin patches and below-the-skin inserts, among others – appears promising as well.

Greater resources are being allocated to research on early-stage Parkinson’s, the period prior to the onset of movement impairment symptoms. It’s hoped this will lead to remedies to slow disease progression, and perhaps to a Parkinson’s cure. Scientists continue to explore genetic, stem cell and other therapies; one such therapy being tested uses a virus as a courier to deliver neurotropic factor genes that can restore normal movement functions.

Senior society

In closing, Dr. Oraporn reflects on the implications of a graying nation: “Thailand is an aging society. Families need to be sure that seniors are properly taken care of. Having a loving, caring family makes a huge difference in living a happier and healthier senior life. It makes seniors stronger physically and mentally, they take better care of themselves, and they reduce the burden felt by their family.”

How does Parkinson’s affect the brain?

Parkinson’s disease is caused by the progressive degeneration of dopamine-producing nerve cells located in the substantia nigra structure of the brain-stem. These cells help control motor movement; their decline eventually leads to dysfunction of a patient’s body movements.

Recognizing signs and symptoms 

Nerve cell degeneration is a gradual process that eventually produces a variety of physical symptoms. When Parkinson’s disease is detected earlier, patients have more effective treatment options for reducing symptoms and enjoying a longer, better quality of life.
Consult your doctor if you experience any of the following Parrkinson’s symptoms:
  • Tremors;
  • Slow movement;
  • Muscle stiffness;
  • Soft, weak voice;
  • Lack of facial expressiveness;
  • Hunched or stooped posture;
  • Reduced sense of smell;
  • Chronic constipation;
  • Yelling or punching during sleep;
  • Small or cramped handwriting.
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