Parkinson’s disease (PD) is a disorder that progresses gradually and affects the nervous system. A hardly light tremor in one hand may be one of the first symptom of Parkinson’s.

An estimated 1 crore people in the world (i.e., approximately 0.3% of the world population) and 1% of those above 60 years are found to be affected with PD. In India, there highly variable rates from 33 to 76 per 100,000 prevalence rate depending on different parts in India.

What are the symptoms of Parkinson’s disease?

Symptoms often begin on one side of the body and tend to remain worse on that side, even development of symptoms on both sides of the limbs. Common symptoms of Parkinson’s disease include:

• Muscle rigidity – may be painful and restrict the range of motion.
• Tremors – These are rhythmic shaking, often in the hand or fingers.
• Slowed movement (Bradykinesia) – Gradual slowing slowing down of movement making simple tasks difficult and time-consuming.
• Changes in walking pattern, balance and posture – Posture may become stooped, and loss of balance may increase risk of falls
• Changes in speech and handwriting – Slurred speech and difficulty in writing
• Orthostatic hypotension (a drop in blood pressure when standing, resulting in lightheadedness or fainting)

Age-bracket of PD:

The average age of diagnosis is 60. However, about 4% of those with Parkinson’s disease are diagnosed before age 50, and some people are also diagnosed before age 40, known as “young-onset” Parkinson’s disease.

What are the causes and risk factors of Parkinson’s disease?

Parkinson’ disease happens due to gradual break down or death of certain nerve cells (neurons) in the brain.

These neurons produce a chemical messenger (dopamine) responsible for regular brain activity and decrease in this causes a irregular movement and other symptoms of PD. The Symptoms of Parkinson’s disease usually only start to develop when around 50% of the nerve cell activity have been lost.

Certain factors increase the risk of developing PD, such as:

• Genetics – Passing of faulty genes in the family may trigger the disease
• Environmental factors – It is suggested that pesticides and herbicides use in farming and or industrial pollution may contribute to PD.
• Sex- Men are more likely to develop PD than women
• The symptoms of PD may be seen due to certain other causes such as:
  
  • medications – these symptoms usually stop once medications is stopped
  • other progressive brain conditions
  • cerebrovascular disease – when series of small strokes cause several brain cell death

How is Parkinson’s disease diagnosed?

The doctor often diagnoses Parkinson’s based on a physical exam, and if any 2 of the following signs are present, the doctor may investigate for PD.

• Tremor or shaking
• Slow movement (called bradykinesia)
• Stiff or rigid arms, legs, or trunk
• Balance problems or frequent falls

There aren’t any specific tests to confirm PD diagnosis and the doctor refers the patient to a specialist trained in nervous system conditions (neurologist).

Tests:

• A specific single-photon emission computerized tomography (SPECT) scan called a dopamine transporter (DAT) scan may be suggested but symptoms and results of a neurological exam that ultimately determine the correct diagnosis.
• Doctors may also suggest blood test to rule other conditions that may cause symptoms. 
• A Parkinson’s disease medicine (carbidopa-levodopa) is given and improvement in symptoms is confirmation of the diagnosis of PD.

What are the treatment options for Parkinson’s disease?

Although there is no cure for Parkinson’s disease, medicines can help control the symptoms significantly and help people to live a normal life.

Medications:

• To help manage symptoms and problems with walking, movement and tremor, medicines may increase, or substitute dopamine may be prescribed.
• There are wide range of medications that can be prescribed to manage the levels of dopamine and control symptoms.

Surgery:

Deep brain stimulation (DBS) – offered to people with advanced Parkinson’s disease who have unstable responses to medications.

Supportive therapies:

These may help improve ease some of the symptoms and complications of Parkinson’s disease, such as pain, fatigue and depression and improve the quality of life. Some of them are:

• Physiotherapy
• Massage
• Tai chi
• Yoga
• Alexander technique
• Pet therapy
• Relaxation techniques

Lifestyle and home remedies:

Healthy eating –

Some foods help ease the symptoms of PD. For example, constipation, a common trait of PD, can be avoided by eating foods high in fiber and drinking plenty of fluids.

Exercising – Increases muscle strength, flexibility, and balance along with improvement in general well-being and avoiding depression or anxiety.

What can be done to improve balance and avoid falls?

• Try not to move very quickly.
• The heel should be aimed first to the floor first while walking.
• Stop and check posture if a person’s feet are shuffling.
• Look in front, not directly down, while walking.
• In the later stages of the disease, the risk of falls may increase.

Ways to avoid falls –

• Make a U-turn instead of pivoting the body over the feet.
• Distribute your weight evenly between both feet, and don’t lean.
• Avoid carrying things while walking
• Avoid walking backward.

What are the medication guidelines for Parkinson’s Disease?

There are some general guidelines for taking Parkinson’s medication as complying the treatment regimen will help in managing the disease in a better way.

• Don’t split pills or pull capsules apart (unless on doctor’s instructions)
• Drinking 6 to 10 glasses of water a day.
• Regular physical activity helps in digesting and absorbing medication (please confirm with doctor).
• Know the names of medications and always keep a list of the treatment regimen details with you.
• Take medications exactly as doctor prescribes them.
• Don’t stop taking or changing medicines before consulting the doctor.
• Keep a medication calendar and note every time you take a dose.
• Don’t panic if you miss a dose at the scheduled time and take it as soon as you remember. If it’s almost time for the next dose, skip the missed dose and return to your regular medication schedule.
• Don’t keep outdated or expired drugs.
• Don’t share your medications with others.
• While travelling, take extra medicine with you and keep it in the carry-on luggage, not in a checked bag.
• Refill your prescriptions before you are completely out of medicine.