Parkinson's disease is a progressive neurodegenerative disease in which dopamine-producing cells in the area of the brain that controls movement (substantia nigra) gradually die. It affects 1-2% of people over age 65; there are approximately 200,000 patients in our country.
There is no definitive treatment; however, with medications and other treatments, symptoms can be largely controlled.
Symptoms
Usually over age 60, slowly progressive. Symptoms start unilaterally and spread over time.
Motor symptoms (TRAP):
- Tremor (shaking): At rest, usually one hand at start
- Rigidity (stiffness): Muscle stiffness, difficulty with movements
- Akinesia/bradykinesia: Slow movement, difficulty moving
- Postural instability: Balance disorder, fall risk
Other motor:
- Decreased facial expression (masked face)
- Small handwriting (micrographia)
- Voice softening, lowering
- Swallowing difficulty
- Drooling
- Small steps, shuffling gait
- "Freezing" (inability to move suddenly while walking)
- Stooped posture
Non-motor (often before motor symptoms):
- Loss of smell
- Constipation
- REM sleep behavior disorder (acting out dreams)
- Depression, anxiety
- Cognitive problems, later dementia
- Urinary problems
- Low blood pressure (on standing up)
- Erectile dysfunction
- Extreme fatigue
- Skin problems (seborrheic dermatitis)
- Apathy
- Hallucinations (in advanced stages)
Stages (Hoehn and Yahr)
- Stage 1: Unilateral symptoms
- Stage 2: Bilateral, balance preserved
- Stage 3: Mild balance disorder
- Stage 4: Severe, walking with help
- Stage 5: Bedridden or wheelchair-dependent
Causes
The exact cause is unknown. A combination of genetic and environmental factors:
Genetic:
- Gene mutations such as SNCA, LRRK2, PARKIN, PINK1
- Family history increases risk (15%)
Environmental:
- Pesticide, herbicide exposure
- Some heavy metals
- History of head trauma
- Rural life, well water
Risk Factors
- Age (over 60)
- Being male (1.5 times more common)
- Family history
- Agricultural occupational exposure
- Head trauma
- Genetic mutations
Protective factors (observational):
- Caffeine consumption
- Smoking (debated)
- Regular exercise
- NSAID use (limited evidence)
Complications
- Falls, fractures
- Aspiration pneumonia due to swallowing difficulty
- Malnutrition
- Sleep disturbances
- Cognitive decline, dementia (Parkinson's disease dementia)
- Depression
- Psychosis (drug side effect or disease)
- Drug side effects (dyskinesia)
- Loss of independence
- Social isolation
When to See a Doctor
- Tremor at rest
- Slowing of movements
- Smaller handwriting
- Gait changes
- Decreased facial expression
- Voice changes
- Unexplained balance problems, falls
- Changes noticed by family
Diagnosis and Treatment
Diagnosis:
- Clinical examination (neurology)
- Detailed history
- UPDRS score
- Levodopa response (supports diagnosis)
- DAT-SPECT (dopamine transporter imaging)
- MRI (differential diagnosis)
- Blood tests (differential diagnosis)
Treatment:
1. Medication:
*Levodopa (gold standard):*
- Most effective drug
- Combined with carbidopa or benserazide
- Side effects: dyskinesia (long-term), nausea, blood pressure drop
- Effect "wears off" over time (motor fluctuations)
*Dopamine agonists:*
- Pramipexole, ropinirole, rotigotine
- First choice in young patients
- Side effects: compulsive behaviors (gambling, shopping), sleep attacks
*MAO-B inhibitors:*
- Selegiline, rasagiline, safinamide
*COMT inhibitors:*
- Entacapone, opicapone
- Prolong levodopa effect
*Amantadine:*
- For dyskinesia
*Anticholinergics:*
- Only if tremor-dominant, in younger patients
- Many side effects
2. Surgery:
- Deep Brain Stimulation (DBS):
- In advanced patients
- Electrode into subthalamic nucleus or GPi
- Can provide significant benefit
- Focused ultrasound
3. Pump treatments:
- Levodopa intestinal gel pump (Duodopa)
- Apomorphine pump
4. Rehabilitation:
- Physiotherapy (gait, balance)
- Speech therapy (LSVT-LOUD)
- Occupational therapy
- Exercise (boxing, tai chi, yoga - proven benefit)
5. Treatment of accompanying conditions:
- Depression: SSRIs, SNRIs
- Sleep disturbances
- Constipation
- Hallucinations: pimavanserin, quetiapine
Lifestyle and Prevention
Prevention:
There is no definitive prevention method; however:
- Regular exercise (strongest protective factor)
- Healthy nutrition
- Avoid head trauma
- Avoid toxin exposure
- Adequate vitamin D, omega-3
- Coffee consumption (moderate)
- Manage stress
Lifestyle (after diagnosis):
- Regular exercise (very important, slows disease progression)
- Mediterranean-style diet
- Adequate protein (adjusted with levodopa timing)
- Plenty of water
- High-fiber foods (prevent constipation)
- Swallowing exercises
- Fall prevention: anti-slip carpets, grab bars
- Take medications regularly
- Family and social support
- Join Parkinson's patient groups
- Professional follow-up (neurology, physiotherapy)