Written by: Roberto León Barriera, medical student at the University of Puerto Rico Medical Sciences Campus
Parkinson’s Disease is a neurodegenerative disorder that causes people to lose the ability to regulate their movements. This disease develops slowly, and the first sign is often a slight tremor of the hand, with eventual development of slow and stiff movements. In the United States, over one million people have Parkinson’s Disease and approximately 60,000 new cases are diagnosed each year. Current estimates indicate that over 25,000 people in Puerto Rico suffer from Parkinson’s Disease. Unfortunately, these numbers do not account for the many cases that go undiagnosed and untreated.As this condition progresses, everyday tasks such as getting dressed, drinking coffee, eating, or cooking become very difficult or impossible. While the specific cause of Parkinson’s is unknown, there are treatment alternatives that may improve symptoms and allow for a better quality of life.
The signs and symptoms of Parkinson’s Disease vary as the disease progresses. The clinical progression of Parkinson’s is divided into five stages:
- Stage I: Symptoms are mild and do not interfere with daily activities. These include: slight tremors, changes in posture, walking, and facial expressions.
- Stage II: Tremors continue to get worse and muscle rigidity appears. Daily tasks may begin to become difficult.
- Stage III: This is considered the mid-stage in the course of the disease. There may be loss of balance and slow movements. Daily activities such as getting dressed or eating are impaired.
- Stage IV: Symptoms are severe and very limiting. Patients require a walker to move about. Help is needed for all daily activities.
- Stage V: Motor symptoms are most severe. Patients may need a wheelchair or become bedridden, suffer from dementia, hallucinations, and delusions. Constant care is required during this stage.
This staging focuses mainly on motor symptoms. However, other non-motor symptoms such as depression, sleep disturbances, urinary incontinence, and sexual dysfunction may occur.
Essentially, what happens in Parkinson’s is the death of dopamine-producing neurons in the brain’s substantia nigra. Dopamine is one of the many neurotransmitters we have in the body. Neurotransmitters are chemical messengers that allow the transmission of signals through neurons (brain cells) in the brain, as well as the rest of the body. One of the functions of dopamine is to help in the initiation of an action, allowing smooth and coordinated movements. As the neurons in the substantia nigrabegin to die, tremors and slow movements begin to appear. As the amount of dopamine continues to decrease, people are left unable to control their movements normally. This lack of control leads to difficulty with everyday activities and can be very frustrating and disabling.
It is vital to seek the care of a neurologist if you begin having tremors or any of the previous symptoms. Statistics have shown that people who seek the care of a neurologist experience better outcomes, have a lower risk for complications, have a better quality of life, and even live longer. To prepare for your appointment, write down all the symptoms you are experiencing, list your medications, and write down any questions you may have for your doctor. Your doctor will ask you many questions, but some important ones you should be prepared to answer are:
- When did your symptoms begin?
- Are your symptoms present all the time or do they go away and come back?
- Does anything make your symptoms better or worse?
If you do have Parkinson’s, your doctor will likely give you a prescription for carbidopa-levodopa, which is a chemical that is converted to dopamine when it crosses into your brain. Levodopa is currently the most effective medication to treat Parkinson’s disease. However, after years of taking levodopa, its effects tend to become less reliable. At this point, your neurologist may give you a prescription for other medications to help improve your symptoms. In advanced cases of Parkinson’s that are unresponsive to treatment, your doctor may consider a surgical procedure known as Deep Brain Stimulation. In this procedure, an electrode is implanted into a specific part of your brain and is connected to a generator that is implanted in your chest. This generator sends electrical impulses to your brain and can reduce medication fluctuations, rigidity, tremors, and improve movement. It is important to note that this procedure is not for everyone, has some serious complications such as hemorrhage, and will not stop the condition from advancing.
Parkinson’s can be a very difficult situation for patients and their families to manage. Every Parkinson’s patient has different needs and will require varying amounts of help from their family members. It is important for families to know that there are several organizations that provide education, support, and help to Parkinson’s patients and their families in Puerto Rico. One of these organizations is the Puerto Rican Association of Parkinson, with their main offices located in Carolina. Their phone number is 787-768-5565 and their website can be accessed here. If you are the caregiver of a Parkinson’s patient, obtaining information and education on the condition will allow you to better care for your loved one.
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Parkinson's Disease. Mayo Clinic. (2015). Retrieved February 28, 2016, from http://www.mayoclinic.org/diseases-conditions/parkinsons-disease/basics/preparing-for-your-appointment/con-20028488
What is Parkinson's Disease. Parkinson's Disease Foundation. (2016). Retrieved February 28, 2016, from http://www.pdf.org/about_pd
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