Parkinson’s disease

Parkinson’s disease, also known as Morbus Parkinson or shaking palsy, is a brain disease. It particularly affects older people and restricts mobility. Its causes have not yet been fully clarified.

The illness is incurable. Once diagnosed, many people still lead a largely independent life, because the illness only progresses slowly and its symptoms can be alleviated by effective treatment. They are primarily treated with drugs.

Parkinson’s can become evident in very different ways. Typical symptoms are:

• Impaired movement (akinesia): movements become slower in general. For example, walking becomes very hesitant; shorter, shuffling steps are typical. It is difficult to get moving – the first walking step, in particular, is unsuccessful. It also becomes more difficult to stop movements, for example to stand still quickly. The swinging of the arms when walking gradually vanishes. Actions that require more skill, such as tying one’s shoes, become more difficult. The facial muscles become less mobile, which makes the face seem mask-like. Swallowing becomes difficult and talking becomes quiet and monotonous.
• Muscle stiffness (rigor): the arms, legs and neck, in particular, can be permanently stiff and tense. The arms and legs can only move against resistance and with the help of another person, or not move at all, and then become even stiffer. The extreme tension often causes muscle pain.
• Trembling while at rest: sufferers typically tremble, particularly their hands. This makes their handwriting smaller and less legible. The trembling lessens when in motion.

The symptoms are often more pronounced on one side. Other possible symptoms include, for example, bladder and digestive disorders, circulatory problems, increased sebum production in the skin, and depression.

The disease sub-divides into different types. The most common is so-called idiopathic Parkinson’s disease. Idiopathic means that no cause can be found.

Dopamine, in particular, plays a major role in Parkinson’s disease. One of the things this chemical messenger does is to send electrical impulses from the brain to the muscles via the nerves. This is how movement is controlled. With Parkinson’s disease this link is disturbed, as nerve cells in the brain that produce the messenger dopamine are damaged. So the damage to these cells impairs the ability to begin or coordinate movements. As a result there can be balance problems which increase the risk of falls and broken bones.

Inflammations, tumors, and drugs such as psychopharmaceuticals can also cause similar symptoms. Parkinson’s symptoms can also be the result of other nervous system conditions such as dementia. 

Around one to 2 people in 1,000 are affected by Parkinson’s disease. It usually occurs after the age of 50. In old age the disease is far more common – above the age of 70 around 20 in 1,000 people are affected. Men are slightly more often affected than women.

How the disease progresses varies widely. Often many years go by between the first Parkinson’s indications and a diagnosis.

If a person’s handwriting changes or their fine motor skills deteriorate, these may be the first indications of Parkinson’s disease. With many people, their facial expression becomes more fixed, some people lose their sense of rhythm, or their arms stop swinging when they walk. There are often problems of constipation, loss of sleep, or mood swings. Some people lose some or all of their sense of smell.

The spread of symptoms usually happens very slowly. In its early stage, drugs can usually very much alleviate, or even completely eliminate, the symptoms.

However, the advance of the disease continues to damage the brain cells so that the symptoms grow once more after around 5 to 10 years. The effect of the drugs is then no longer sufficient, or it fluctuates a lot. The symptoms then alternate between normal mobility and great immobility. This alternating is referred to as off and on phases.

When the disease progresses, there may be further symptoms – for example, dangling arms, smacking of the lips, or jerky movements. Other symptoms such as speech disorders, memory problems, bladder disorders, hallucinations and depression are possible. Some sufferers develop dementia.

In its late stage people with Parkinson’s need help with many everyday activities. Help is required with eating and drinking, standing up and walking, getting dressed and personal hygiene. 

Physical examinations and a detailed consultation about symptoms and previous medical history are required to produce a diagnosis. Loved ones can help by being involved in the discussion, because they notice symptoms or limitations that patients themselves do not always notice. As well as the general physical examination, the doctor tests the reflexes, sensitivity – for example to pain or pressure – and mobility. They test, for example, whether the joints can be moved normally or whether the muscles provide resistance.

The so-called L-dopa test can help in the definitive diagnosis. After the patient has taken the L-dopa (Levodopa) drug, the doctor checks whether the symptoms have abated. If there is a rapid improvement, it indicates Parkinson’s.

In its early stage in particular, Parkinson’s disease cannot easily be distinguished from other conditions. So it is useful to observe patients over a longer period of time. In particular, a CT (computed tomography) or MRI (magnetic resonance imagery) scan can be done to rule out other conditions.

If the symptoms are not troublesome in the disease’s early stage, no treatment is yet needed in some cases. If the symptoms get worse, drugs can help to mitigate the symptoms. But though the drugs can compensate for the lack of dopamine, the progress of the disease cannot be halted. So over time their effect is no longer sufficient, and the type and dosage of the medication needs to be adjusted continually. A medical pump can be used to administer drugs steadily. It either dispenses the drug beneath the skin or straight into the small intestine.

If the symptoms cannot be sufficiently improved using drugs, deep brain stimulation is possible. This involves an operation in which electrodes are implanted into certain areas of the brain. They constantly emit electrical impulses, thus influencing muscle activity.

The limited mobility causes a decrease in muscle strength. So everyday movements and activities are exercised in the course of supportive ergotherapy. Mobility exercises and sports are intended to help compensate for the loss of muscle strength, and to improve mobility and coordination. If the voice becomes quieter and speech less clear, speech therapy can also be considered.

For more detailed information, for example, when a brain pacemaker is a useful treatment, go to gesundheitsinformation.de.

Parkinson’s disease affects many areas of life – work, partners, family, and leisure activities. Even if everyday life is changed little in the early stage of the illness, many sufferers are worried about becoming dependent and needing care as time goes by. But it is certainly possible to cope well with the disease for a long time with no major impairments.

Nonetheless, it is a good idea to prepare for the time when more and more support is needed. Most people do better in dealing with their condition if they do not withdraw, but rather try to interact with others from the beginning. Good medical support is also important, as are the involvement of family, friends and acquaintances if help is required with everyday living.

For many of those affected, staying active for as long as possible has a positive effect. In doing so, it is important to recognize one’s own limits and to keep aligning one’s physical mobility, everyday and working activities with one’s capabilities.

How do people live everyday life with their Parkinson’s disease? Read about people’s experiences on gesundheitsinformation.de.