What is Parkinson’s Disease?

Parkinson's disease afflicted elderly person.

Parkinson’s disease is an age-related progressive neurodegenerative disorder, and the second most common after Alzheimer’s disease. Therefore, it also ranks second to Alzheimer’s disease in its impact on society and the economic burden that sufferers and their caregivers might experience. It starts late in life and is diagnosed in fractionally less than 1% of individuals over the age of 65. Similar to Alzheimer’s disease, the number of Parkinson’s disease cases is expected to increase considerably over the next few decades. Alzheimer’s dementia and Parkinson’s disease are considered to be among the top 15 conditions with the most substantial impact to society and families.

The disease symptoms are typically associated with peculiar changes in movement, also called motor deficits (which include body tremors, slowed movement, muscle rigidity, and an irregular, shuffling posture), but also by an array of symptoms not associated with movement deficits, including fatigue of unknown origin, sleep disorders, generalized pain, depression, anxiety and higher levels of distress than seen in healthy elderly people. These combinations of symptoms often occur simultaneously in the same patient. Because many of the symptoms used in the clinical diagnosis of Parkinson’s disease also occur in other disorders, the diagnosis of the condition is not as straightforward as one might imagine. Many but not all of these “lookalike” diseases may also be associated with neurodegeneration and therefore complicate a clear diagnosis of Parkinson’s disease.

For many years, Parkinson’s disease has been considered by scientists and clinicians as a sporadic or idiopathic (meaning of unknown origin) disease. The latest findings suggest that Parkinson’s disease is not only a complex motor disorder but a systemic (body-wide) disease. This view is supported by the fact that we now know that in Parkinson’s patients, non-motor symptoms such as loss of smell, constipation, and sleep disturbances often precede the movement changes.

Can Parkinson’s disease be prevented? Well, that depends. We currently know too little to provide a definitive answer to that question. Despite much research into the causes of the disease, the strongest risk factors are seen to be age, race, and sex (men more often get Parkinson’s than women). Other potential risk factors include a history of working with pesticides, herbicides and other chemicals used in agriculture and industry, living in urban areas for most of one’s life, and industrial and/or urban metal exposure.

In the brain, Parkinson’s disease is characterized by a selective loss of specific types of brain cells – called dopaminergic neurons – in a part of the brain associated with movement control. This area, called the substantia nigra is primarily impacted by the loss of brain cells. But as can be imagined due to the diversity of symptoms seen in these patients, other brain structures have been documented to be involved as well. The beginnings of these changes in the brain likely start decades before any motor symptoms characteristic of the disease are seen in a patient. It is estimated that 5 to 15 years usually elapse, and 60%–80% of these dopaminergic neurons are lost, before symptoms emerge. Symptomatic therapies (medication) aim to bolster the activity of these lost neurons, and allow patients to live with the disease for decades.

Because patients are less able to work and oftentimes require care and treatment, Parkinson’s disease may put a financial burden on themselves and their caregivers. One government agency’s projection of the economic impact of the disease shows that the annual indirect cost of Parkinson’s disease (such as reduced or lost employment) is approximately $10,000 per patient, with additional medical expenses amounting to nearly $13,000 per patient per year. These numbers translate to an estimated societal cost in the US alone, of over $14 billion per year.

The increased disability and symptoms in advanced stages of the disease will require a caregiver who can assist with some activities of daily living in the life of a Parkinson’s disease patient. As such, caregivers play a key role in helping Parkinson’s disease patients to maintain an acceptable quality of life and some independence. Such a role role is more often than not assumed by a relative, partner or close friend. As the disease follows its natural course, such care frequently becomes the caregiver’s main activity.

As a complement to medical treatment, educational resources such as BlushBrain and many other excellent programs allow patients and their caregivers to acquire knowledge and skills relating to the disease and empower them become more involved in its management. This in itself may improve the quality of life for both.