Parkinson’s is a neurological disorder first known as Shaking Palsy but which later took its name from the English doctor who identified it in 1817: James Parkinson. Its symptoms appear slowly and it is often difficult to diagnose in the early stages. It usually affects people over 60 but it is not unheard of in younger people. Famous sufferers of Parkinson’s include Muhammad Ali and Michael J. Fox.
One of the characteristic signs of Parkinson’s is a tremor in any limb but usually the hand or arm. It can be seen when the hand is relaxed and is often noticeable as a movement between the thumb and forefinger, known as pill-rolling. Other early signs are stiffness and the slowing of movements plus difficulty in walking, with the loss of arm swing, accompanied by shuffling and shorter steps. People often find they freeze on the spot, unable to take a step forward. Increasing muscle stiffness, particularly trunk rotation, can also make it difficult to move. Even simple tasks like rolling over and getting out of bed or getting in and out of the car become difficult. Stiffness and muscle imbalance can also affect posture. Many people with Parkinson’s begin to stoop, which further complicates balance and walking.
Another distinguishable feature is loss of facial expression, with reduced blinking and smiling due to changes in muscle function and stiffness; the face can take on a mask-like appearance. People with Parkinson’s may find problems not only with movement but also with speech, which can become soft and/or slurred; it is not uncommon for hesitation before speaking and the loss of inflection in the tone: everything is said at one level, with no expression. This can make talking to people problematic as tone and facial expression are two things that we use when trying to gauge a person’s mood and intention. We often say one thing but our tone and expression indicate something completely different. As the disease progresses, changes in a person’s thinking processes can be noticed and, in the advanced stages, dementia is common.
What causes Parkinson’s?
Parkinson’s is a neural disease that affects the brain but its cause remains unknown. Most of the symptoms are caused by loss of neurons that produce dopamine, a neural chemical messenger. The decrease in dopamine causes abnormal brain activity and the result is the symptoms that combine to identify the disease.
What are the risk factors?
Age is one of the most common risk factors; it usually affects people over the age of 60 and is more common in men than women. It is not thought to run in families but there is some evidence that if there are several people in a family suffering from Parkinson’s, the risk of developing the disease increases. Also, exposure to pesticides and toxins may increase the risk. Recent research has also started to look at the link between head trauma and Parkinson’s; several boxers and footballers have developed the disease but more research is needed.
How is it treated?
There is no cure so treatment focuses on managing the symptoms with medication. Because of the varying symptoms and presentation of the disease, finding the right medication regime can often be trial and error and, even when the right combination is found, it can stop being effective, virtually overnight.
Exercise is important but, like medication, one size does not fit all. Introducing exercise during the early stages of the disease has been shown to be effective in slowing its progression. The best and often under-utilized therapies are speech therapy and physiotherapy. Physiotherapists are trained in the art of movement and function. They assess posture and movement and design programmes that cater for individual needs, based on symptoms and presentation.
If you suspect that you or somebody close to you has signs of Parkinson’s, the first step would be to consult your primary healthcare provider. Remember, even if symptoms are mild, ask about physiotherapy; the earlier one receives intervention and exercise advice, the greater the chance of slowing down the deterioration of movement and function.
