There is no cure for Parkinson’s disease, but medications can significantly improve symptoms. Occasionally, doctors can also use surgery and deep brain stimulation (DBS) to regulate certain regions of the brain.
The most important medicines are levodopa, a type of dopamine replacement therapy. Other medicines that reduce tremor and stiffness include trihexyphenidyl, benztropine mesylate, and biperiden HCL.
A delicate balance of neurotransmitters helps coordinate the millions of nerve and muscle cells involved in movement. When these neurons start to degenerate and produce less dopamine, the symptoms of Parkinson’s disease appear. Symptoms may include tremor (rhythmic shaking), rigidity or stiff muscles, and slowness of movement. They often start in one area of the body and spread over time.
Parkinson’s can also cause non-motor symptoms, including memory problems, depression, fatigue, sleep disturbances and sexual dysfunction. In some cases, the symptoms can become very serious and even life-threatening. These emergencies often arise from medical or surgical treatment, but they can also be caused by a combination of factors such as the progression of the disease and side effects from medication.
X-rays and scans may be used to help diagnose PD, but there is no definitive test for the condition. A trial of the medicines levodopa (L-dopa) may be given to see if they ease the symptoms. If your doctor suspects PD, they will look for the following signs:
Rigidity or stiffness (involuntary tightening of the muscles). You may notice this in your legs, arms and neck. This can lead to postural instability, which can result in falls or a stooped posture. It can also cause difficulty swallowing and drooling.
You may lose the ability to perform unconscious movements, such as blinking or swinging your arms when you walk. You might have a slurred speech, or your writing may seem small and cramped due to lost muscle control. Some people with PD have trouble with their sense of smell and develop constipation. Others have problems with their blood pressure and may feel dizzy or light-headed when they stand.
Often, the first sign of PD is a small tremor or slowness in starting movement. The symptoms also include muscle rigidity, a soft voice, slow and shuffling walk and postural instability (unsteady posture). In the late stages of the disease, the person can no longer stand unassisted. He or she may need a wheelchair and can suffer from depression, dementia and hallucinations.
There are several tests that can help diagnose PD. A blood test, CT scan and MRI can give your doctor an idea of how severe your condition is and can rule out other disorders that cause similar symptoms. A brain scan called a DaTscan can see if misfolded alpha-synuclein proteins are present. These are the proteins involved in PD. But it isn’t clear how this test can prove a diagnosis of Parkinson’s disease.
Your doctor will likely do a trial test of medicines to see how well they ease your symptoms. Levodopa is the medicine that has been the most commonly used for PD. It can’t be used as a cure, but it replaces or boosts the brain’s depleted dopamine levels. Your doctor may also suggest a psychiatric evaluation and a physical therapy program to help with balance and mobility problems.
Research into PD is focused on finding ways to prevent, detect and treat the disease in its early stages before it causes significant problems. A healthy diet, regular exercise and physical therapy can delay the onset of symptoms. There are also medicines that can ease the most troublesome symptoms and a surgery that can offer significant improvement in some people.
Symptoms of Parkinson’s Disease progress slowly and can vary from person to person. In the early stages, a person may need little or no assistance and can live independently. As the disease progresses, the symptoms worsen and become more difficult to control. Eventually, they will interfere with daily activities and quality of life. The severity of the symptoms can be measured using a scale created in 1967 by two experts Margaret Hoehn and Melvin Yahr, or the Unified Parkinson’s disease rating scale (UPDRS).
A variety of medications are used to treat PD. These include drugs that stimulate the remaining cells in the basal ganglia to produce more dopamine (levodopa medications), and drugs that block the brain’s natural reabsorption of dopamine by inhibiting acetylcholine production (anticholinergic medications).
It is important for a person with PD to see their healthcare provider regularly, especially when they start taking medication. This will allow the healthcare provider to adjust the doses of the medications based on the person’s response and to monitor for any possible side effects.
Other treatment options include physical therapy to improve balance, movement and flexibility, and speech and language therapy to help with problems such as slurred or soft speech and swallowing difficulties. Dietary changes can help with gastrointestinal and urinary issues, including constipation, a loss of sense of smell, and sleep disorders, such as periodic limb movement disorder (PLMD), rapid eye movement disorder and restless legs syndrome.
For some people, surgery can be a good option to reduce tremors and other movement-related symptoms. This includes deep brain stimulation surgery, where a small electrode is placed in the part of the brain that controls movements.
Many people with PD take pills or a combination of medicines to manage their symptoms. It may take time to find the right medicine, dosage and schedule to ease your specific symptoms. Some medications can affect your mood, so it is important to talk with your doctor about any changes in feelings you are having.
Medications for Parkinson’s disease work best when they are used as prescribed and for the duration of treatment. Keeping in touch with your doctor and following their advice about diet, exercise and stress management will also help. It is also helpful to join a support group.
Levodopa (Duopa, Rytary, Sinemet) is the most common medication used to treat Parkinson’s. It works by replacing the natural chemical dopamine that is lost in the brains of people with PD. Dopamine is a chemical that sends signals to control movement. Levodopa is the most effective medication at reducing tremor, stiffness and slowness of movement. Its side effects include nausea, vomiting, confusion and hallucinations.
Other drugs that can be taken with levodopa to reduce the side effects include monoamine oxidase-B inhibitors, such as safinamide (Xadago), selegiline (Eldepryl, Zelapar)and rasagiline (Azilect). These block brain chemicals that break down dopamine, so more of it is available to work with levodopa. They also slow down the rate at which your body breaks down levodopa, making it last longer.
Anticholinergic medications are also used to reduce tremors in some people with Parkinson’s. These are drugs that block the action of a chemical called acetylcholine. They may cause dry mouth, constipation, and depression. Examples are benztropine (Banesomeprazole) and trihexyphenidyl (Artane, Gocovri ER, Symmetrel). These medications can also cause drowsiness, dizziness or light-headedness, constipation, nausea, confusion and hallucinations.
In some people, surgery can help decrease tremors and stiffness. This type of surgery is called deep brain stimulation (DBS). It involves placing electrodes in the deep parts of the brain that control movement. These electrodes are connected to a battery-powered electrical device in the chest wall. When the doctor turns on this device, it sends painless electric impulses to specific areas of the brain that cause symptoms. The impulses help to reduce the tremors and rigidity by interrupting the abnormal brain signals.
Surgery may also be used to treat non-motor symptoms such as depression, hallucinations and sleep problems. In addition, spinal surgery is sometimes needed to correct back problems that can occur in PD, such as pseudarthrosis and junctional kyphosis. It is important for people with PD to continue taking their PD medication through anesthesia and into the immediate postoperative period. They should talk to their neurologist and the healthcare professional who oversees their PD care about this issue before considering surgery.
Parkinson’s disease happens when nerve cells in a part of the brain called the substantia nigra start to die or lose their ability to work. These cells produce a chemical called dopamine, which helps regulate the brain and nervous system’s ability to control movements. When these cells are damaged, it causes a lack of dopamine, which can lead to a variety of symptoms including tremor, slowness of movement and rigidity.
There are several different kinds of surgery for PD, but only a few have been shown to improve symptoms. Ablative surgery for PD involves locating, targeting and then destroying the tissue that is causing tremors or other symptoms. One of the most common ablative procedures is known as pallidotomy, which involves the targeted destruction of a small area in the globus pallidus in the brain.
Parkinson’s disease symptoms vary widely. The most common treatment is a medicine called levodopa. It helps ease movement problems by boosting levels of dopamine in the brain.
Other symptoms of PD include trouble swallowing, a soft voice, and cramped or small handwriting. These non-motor symptoms may start years or even decades before motor symptoms appear.
Tremor is the main symptom of Parkinson’s Disease, and it happens when nerve cells in an area of the brain called the basal ganglia die or become impaired. These nerve cells produce an important brain chemical known as dopamine that controls movement. When the cells in this area die or become impaired, dopamine production drops, which leads to symptoms like muscle rigidity, resting tremor, slowness of starting movement and postural instability (poor posture and balance).
The first tremors may be barely noticeable, but they will get worse over time. They can affect one hand or both, but they usually begin in the fingers. They can be aggravated by stress, fatigue, lack of sleep and some medications. They also tend to be more prominent when the person is at rest, such as sitting or lying down.
Other symptoms of Parkinson’s Disease include a stooped or hunched over posture and a slower, shuffling walk. It’s common to drag the feet when walking or to have trouble turning. The face can become mask-like in expression and speech may be soft or slurred. Many people also start to drool.
People with Parkinson’s Disease have a higher risk of dementia, which can develop as the disease progresses. This is partly because the tremors can be misinterpreted as signs of dementia, but it’s also because the underlying brain changes that cause the tremors may accelerate the rate at which the person gets dementia.
In addition to taking medication, exercise and a healthy diet can help control tremors. Some patients find that a particular food or substance makes their tremors worse, so it’s a good idea to keep a diary of when the tremors occur and what seems to make them better.
The most effective treatment for tremor is levodopa, which helps replace the missing dopamine in the brain. About 75 percent of people with Parkinson’s respond to this medication. It is often given with a drug called carbidopa, which delays the breakdown of levodopa at the blood-brain barrier. Other medications that help with tremors are dopamine agonists, such as bromocriptine and pramipexole, or anticholinergics, such as ropinirole and trihexyphenidyl, which block acetylcholine.
A main symptom of Parkinson’s disease is stiffness, or spasticity. This is caused by a lack of dopamine, the chemical that helps nerve cells coordinate movement. The brain normally makes dopamine in a delicate balance with other chemicals, such as acetylcholine and serotonin. Without enough dopamine, a person can develop tremors (trembling in the hands, arms and legs); slow movements; rigidity or stiffness of muscles and joints; and balance problems.
Another symptom is trouble swallowing (dysphagia). This happens because the throat muscle loses its ability to control the movement of air and food. Over time, this can increase the risk of problems like pneumonia or choking.
Stiffness may also lead to a hunched over posture. People with this symptom often have difficulty standing or walking, and they may fall more easily. Falls are a major problem because the body doesn’t have the normal reflexes to catch them. This can cause serious injuries. In severe cases, people can become fearful of leaving their homes because they don’t know what might trigger muscle spasms in public places.
Medications can help relieve the symptoms of Parkinson’s disease. Typically, doctors prescribe drugs that stimulate the remaining neurons to produce more dopamine in the substantia nigra or block the release of acetylcholine from nerve cells. These medications can help alleviate some of the most common symptoms, but they won’t alter the rate at which the disease progresses.
It’s important to take medication at the correct times each day and to ask questions if you’re unsure about anything your doctor says. It’s also a good idea to bring someone with you to your appointments so they can ask questions and keep track of what’s said.
There’s no cure for Parkinson’s, but medicine and surgery can help manage symptoms. A healthy diet, exercise, speech and physical therapy can also promote independence. In some cases, doctors recommend deep brain stimulation (DBS), a procedure in which electrodes are placed in the deep parts of the brain that control movement. A generator connected to these electrodes sends out pulses that can reduce the severity of some of the most serious symptoms.
The most well-known Parkinson’s Disease symptom is difficulty walking. It happens because of the slow movement and stiffness, which causes a person to take smaller steps and move their arms less than usual when they walk. The slowed movement also leads to a hunched over or stooped posture and can cause the person to fall or have balance problems. It can also affect the way they speak, as their voice becomes soft and breathy or they slur their words. They may also find it hard to write, resulting in cramped or small handwriting.
People with PD often have other symptoms that aren’t connected to muscle movement or stiffness, but rather to the autonomic nervous system, such as bladder problems or constipation. They may also have sleep problems, depression or memory difficulties. Some research suggests that non-motor symptoms can occur years or even decades before motor symptoms.
During the early stages of Parkinson’s, a person may not notice any symptoms at all or they may only experience them on one side of their body. This stage is known as stage 1 Parkinson’s. As the disease progresses, symptoms will gradually get worse.
Some PD medications can improve the condition and ease these symptoms. Some work by stimulating the remaining cells in the substantia nigra to produce more dopamine (levodopa medications), while others reduce the amount of acetylcholine released by these neurons (anticholinergic medications). It is important that people with PD continue taking their medication, but they should also talk to their doctor about whether the symptoms are getting worse or becoming more frequent.
Other PD symptoms include:
Tremors that happen while the muscles are at rest (resting tremors).
Rigidity or stiffness, which is more common as the disease progresses. This can be a constant feeling of rigidity, or it can appear as jerky movements that are called cogwheel or lead-pipe rigidity.
Loss of automatic movements, such as blinking or swinging the arms when they walk.
Trouble swallowing, which can cause drooling.
Do you feel down or depressed more often? Does your mood change easily? Do you lose interest in hobbies or socializing? These are common non-motor symptoms of Parkinson’s. They are often less noticed than tremors and rigidity. You can get medicine to help improve your mood. Talk with your doctor.
Parkinson’s disease is a progressive brain disorder. It begins in a small area of the brain called the basal ganglia. Nerve cells in this area produce dopamine, a chemical messenger that helps coordinate the millions of nerve and muscle cells involved in movement. When dopamine is reduced, the symptoms of PD occur. They include tremor (trembling of the hands, arms, legs and jaw); stiffness or bradykinesia; slowness of movement; and impaired balance and coordination.
Levodopa, a drug developed more than 30 years ago, is the mainstay of Parkinson’s treatment. It can pass through the blood-brain barrier to help replace dopamine. However, enzymes in the body break down levodopa before it reaches the brain, so it is usually combined with another medication known as carbidopa, which delays the breakdown and increases the amount of dopamine that reaches the brain. Other medications used in PD include dopamine agonists such as bromocriptine and pramipexole, and anticholinergics, such as benztropine and trihexyphenidyl, which block the parasympathetic nervous system and can help with rigidity.
Aside from drugs, a healthy diet and exercise can help manage the symptoms of PD. Depression and emotional changes are also part of PD, especially in the early stages. Treatment with antidepressants and/or anxiolytic medicines can improve these symptoms.
Doctors do not know what causes PD, but they believe that it develops when nerve cells in the basal ganglia become damaged or die. Genetic factors, oxidative damage, environmental toxins and accelerated aging are all linked to the condition. A mutation in one gene is responsible for five percent of inherited cases of Parkinson’s, but the majority of cases are due to unknown causes. Symptoms of PD can be improved with medication, surgery and therapy. The condition can be prevented or delayed by exercising, eating well and getting enough sleep.
Parkinson’s disease treatment includes medicines to improve movement and non-movement symptoms. Other treatments, such as exercise, a healthy diet and good sleep, can also help.
Always take your medication as directed. Your doctor may need to change the dose or type of your medications over time. It’s important to see a neurologist regularly for proper management of your medication.
Levodopa, a medication that increases dopamine levels in the brain, can help reduce tremors and stiffness. It is usually given in combination with another drug called carbidopa to minimize side effects. However, it can also cause involuntary movements that are sometimes difficult to control. These symptoms are known as dyskinesia. Some experts recommend delaying the start of this medication until the tremors or other symptoms begin to interfere with a person’s quality of life. However, it does not slow the progression of Parkinson’s disease, so it is best to start treatment as early as possible.
In addition to a levodopa-carbidopa regimen, doctors can use other medications to control Parkinson’s symptoms. These drugs include dopamine agonists, amantadine, COMT inhibitors and anticholinergics. They may also prescribe a variety of other tests to diagnose the disease. These tests may include blood work, imaging tests and nerve tests. A health care professional will then examine the patient and recommend a treatment plan.
The most common therapy for PD is the use of levodopa, an amino acid that’s converted to dopamine in the brain. This medication relieves tremors and stiffness and improves walking, balance and movement. It can also help with other symptoms such as depression, anxiety and sleep problems. However, it can cause a number of other side effects, such as nausea, hallucinations and confusion. Taking the medicine with food can help prevent these side effects.
If a person doesn’t respond to levodopa and carbidopa, their doctor may recommend surgery. There are three surgical procedures that can help people with PD: ablative surgery, stimulation surgery and neural grafting or tissue transplants. However, not all patients are suitable candidates for these treatments.
A person with PD should also try to get regular exercise, maintain a healthy diet and avoid smoking. They should also talk to their healthcare provider about support groups. These groups can offer practical information about the condition and a place to find other people who have similar concerns. In addition, they can provide emotional support. Antidepressant medicines can also help ease the depression that sometimes occurs in people with PD.
Medications can improve the shaking (tremors) and movement problems associated with Parkinson’s disease. They can also help with a slowness of movements that is known as bradykinesia and the problem with balance and falls. Symptoms may improve as the drug is taken longer and more regularly, but the medication will lose its effectiveness over time. Regular follow-up appointments with a specialist are important, and the care plan will be reviewed as needed.
The most commonly used medication for Parkinson’s disease is levodopa, a chemical that is converted to dopamine in the brain. It is available in pill form and in a combined medication with carbidopa, which reduces side effects such as nausea. The combination is known by the brand name of Sinemet, and it is very effective in controlling motor symptoms.
Other medications are available to treat specific symptoms, such as problems with balance and falls, or swallowing difficulties (dysphagia). These include anticholinergic drugs that help to increase the amount of dopamine in the brain, which helps reduce some tremors and stiffness. These medicines include trihexyphenidyl, benztropine, orphenadrine, and procyclidine. They can cause many side effects, including dry mouth and blurred vision, constipation, nausea, difficulty emptying the bladder, and increased sweating.
Medication can control most of the symptoms of Parkinson’s disease, but it does not stop or reverse the disease’s progression. Research is under way to find treatments that slow or change the progression of the disease. These new medications are called neuroprotective, and they aim to block the aggregation of a protein that causes Parkinson’s disease, Lewy bodies.
Surgery is rarely used to treat Parkinson’s disease, but it can be helpful in some cases. The surgery can be ablative or destructive, or it can involve stimulation or transplantation of neural cells. Surgical procedures can be helpful when a patient’s symptoms do not respond to medications or if the medications cause unpleasant side effects. Currently, three types of surgical treatment are available for Parkinson’s disease: ablative surgery, stimulation surgery, and neural graft or tissue transplants.
The goal of this therapy is to stimulate certain areas of the brain with electrical impulses. The pulses help to control abnormal brain activity and improve the function of affected nerve cells. The procedure has helped many people with Parkinson’s Disease.
This is a surgical procedure that involves placing electrodes in the brain. It is used when medications aren’t effective or cause side effects. It also can reduce the number of involuntary movements (dyskinesias) and tremors. The surgery is available in some specialist neuroscience centres around the UK.
Patients are evaluated by a multidisciplinary team of doctors and nurses to determine if deep brain stimulation is the right treatment option. The evaluation includes a videotape of the patient doing various movement tasks while on and off medication. A neurologist, neuropsychologist and neurosurgeon will evaluate the information. Unlike other surgical options (pallidotomy or thalamotomy), DBS is reversible and can be turned off or on as needed.
A neurologist and neurosurgeon will use MRI or CT scans to locate the area of the brain that is responsible for your symptoms. The surgeon then uses the images to map the location of a target in the brain. After numbing the scalp, the surgeon makes an incision on the top of your head and removes a strip of hair. A stereotactic frame is then attached to the head. The surgeon then inserts a small box-shaped localizing device into the frame. Markers on the device show up on the MRI or CT scans, helping the surgeon to pinpoint the exact three-dimensional coordinates within your brain where the electrode will be placed.
After the neurologist and neurosurgeon are satisfied with the location of the electrode, they will test it by sending impulses through the brain lead. The lead will be connected to a battery-powered stimulator implanted under the skin in your chest. The insulated wire connecting the electrode and the generator will be a few inches below your collarbone.
You will return to the doctor’s office periodically to adjust your DBS settings. There are a few possible complications of the surgery, including infection and reactions to the anesthesia. The most serious risk is that the DBS electrode may move or dislodge from its original position in your brain.
Neural grafting or tissue transplants involve a surgical procedure in which neurons are placed into the brain to replace lost ones. It is a promising therapy because conventional medications are effective in alleviating tremors and rigidity but do not address the degeneration that leads to Parkinson’s Disease (PD). The aim of neural grafting is to prevent or slow the progression of the disease and improve motor symptoms. In addition, it may increase the number of surviving dopaminergic cells in the nigrostriatal pathway. There are several different types of cell sources that can be used in neural grafting. However, it is important to select the right cell type for a specific patient. Some cell types are more promising than others for treating PD, and it is also important to consider the potential side effects of each treatment.
One of the most promising treatments for PD is to transplant cells that will produce dopamine in the putamen. These cells can be derived from embryonic mesencephalic (mES) cells, embryonic stem cells, or human pluripotent stem cells. In the case of mES cells, the transplanted dopaminergic neurons are derived from precursor cells that also generate neurons in the central nervous system of adult mammals. These cells are called nigrostriatal dopaminergic neurons and produce dopamine in the nigrostriatal pathway.
Another option for treating PD is to transplant neurons originating from the adrenal gland. These cells are referred to as chromaffin cells and produce neurotransmitters that are chemically similar to those made by dopamine neurons. This type of cell is known to be resistant to oxidative stress and has been found to produce dopamine in the nigrostriatal region in mice.
The cellular grafts have the potential to stimulate growth of new neurons in the host brain and to reduce the scar that inhibits axon regeneration. Furthermore, grafted neurons can release growth-promoting chemicals that neutralize the unfavorable environment of mature CNS tissues. Moreover, axons that regenerate through the graft may penetrate only a short distance on reentry into the mature brain and thus bypass the unfavorable environment.
Parkinson’s disease affects the nervous system and parts of the body that control movement. Symptoms start gradually and worsen over time.
Mutations in certain genes increase a person’s risk of developing PD or cause it outright. This form of the condition is sometimes referred to as familial Parkinson’s disease.
Several other conditions cause symptoms similar to those of PD, but the underlying biology is different. These include dementia with Lewy bodies, corticobasal degeneration, progressive supranuclear palsy and multiple system atrophy.
Approximately 20 percent of people with Parkinson’s disease have a different condition called atypical parkinsonism, which includes Progressive Supranuclear Palsy (PSP), Corticobasal Degeneration (CBD) and Dementia with Lewy Bodies (DLB). Atypical parkinsonism is associated with a loss of nerve cells in the part of the brain that controls movement. As the brain cells die, dopamine production decreases, and the parts of the body that control movement become slow and jerky.
It’s difficult to make a diagnosis early on because the signs and symptoms can look very similar to other health problems or normal aging. A doctor will want to watch your symptoms over time and do a health history and a neurological exam. A blood test or a brain scan may be done to help find the cause of the problem but is not necessary.
The onset of atypical parkinsonism can be earlier than PD, even in the 40s, and it can progress more rapidly than PD. It’s also more likely to affect women than PD.
In atypical parkinsonism, there’s a high rate of drug resistance and more psychiatric symptoms such as hallucinations and orthostatic hypotension (dropping). Atypical parkinsonisms can be treated with the same medications used for PD, such as levodopa, and medicines to treat dementia or psychosis, such as donepezil (Alzheimer’s disease) and quetiapine (Seroquel). Botulinum toxin injections (BOTOX) may help reduce eye muscle twitching.
Atypical Parkinsonian disorders are more likely to develop in older people. People diagnosed with atypical Parkinsonism tend to live longer than those diagnosed with PD. However, life expectancy varies from person to person. It depends on your overall health, and how much the atypical disorder affects your ability to move, think, and sleep.
In Parkinson’s disease, a specific area of the brain deteriorates, leading to loss of dopamine-producing cells. Dopamine is a neurotransmitter that helps control movement and balance. Without enough dopamine, you can develop symptoms such as tremors; stiffness or rigidity of the muscles; slow movements (bradykinesia); and trouble walking, moving, and balancing. The condition also can cause non-motor symptoms such as sleep problems, depression, fatigue and constipation. Symptoms begin gradually, and they usually get worse over time.
People with Parkinson’s may also have difficulty thinking, writing and talking. Because the condition causes changes in mood, some people may become less social or withdraw from friends and family.
Doctors can’t cure PD, but medications are available to help reduce the severity of movement and non-movement symptoms. Most people with PD are diagnosed through physical examination and medical history. No blood test or brain scan can be used to diagnose PD. However, a number of tests can be done to confirm the diagnosis.
Medications can significantly lessen the symptoms of PD, and many people are able to continue working and living independently for years. In addition to medication, a multidisciplinary team of allied health professionals can assist with strategies that minimize the impact of symptoms on daily life.
The course of PD is different for everyone, so it’s important to see an experienced neurologist who can manage your medications. Your neurologist will consider your symptoms, the progression of the disease and your physical tolerances when deciding on the type, dose and combinations of drugs to prescribe. They will also review your medications periodically to ensure they are continuing to be effective. This can help reduce the risk of side effects such as uncontrolled writhing movements, called dyskinesias, which can occur when medication wears off.
Progressive supranuclear palsy (also known as Steele-Richardson-Olszewski syndrome after the family names of three scientists who defined it) is one of the rarer forms of Parkinson’s disease. It usually affects people in late middle age or older. Its symptoms are similar to those of Parkinson’s, but more noticeable problems with the movement of the eyes, especially trouble shifting the gaze downward, tend to be a telltale sign of PSP. In addition, speech becomes slurred and swallowing solid foods and liquids may become difficult. The progression of PSP is gradual.
Symptoms of PSP differ from those of other Parkinson-plus disorders, such as asymmetric parkinsonism, corticobasal syndrome and alien limb disorder, because the signature characteristic of PSP is the accumulation of tau protein in brain cells rather than alpha-synuclein. It is not clear what causes this degeneration. However, it is believed to be a result of cellular damage from free radicals. These are reactive molecules produced continuously by the body during normal metabolism. Normally, the body has built-in ways to clear them away from cells.
In PSP, clumps of tau accumulate in nerve cells that control movement and thought (the basal ganglia). These clumps disrupt cell function, causing the areas of the brain that control movements and thinking to deteriorate.
People with PSP often have changes in their mood and personality, which can lead to them being mistaken for depression or other conditions that cause similar symptoms. The most accurate diagnosis is made by a neurological exam and diagnostic tests, including brain imaging. Medicines that raise the level of dopamine, such as levodopa, can reduce some movement symptoms but they are less effective than in Parkinson’s disease.
The signs and symptoms of Parkinson’s are the result of gradual loss of nerve cells in a part of your brain called the basal ganglia, which controls movement. Over time, the cells degenerate, and their loss leads to a reduction in the production of a natural brain chemical called dopamine. Scientists do not know what causes this decline. However, age and genetics are known to be risk factors for Parkinson’s. People with a parent or sibling who has the disease have twice the chance of developing it themselves.
Corticobasal degeneration is a slow-progressing disease that may cause problems with your speech, movement and memory. You may have a difficult time using utensils and buttoning your shirt, and you might have trouble with your balance or uncoordinated walking gait. You might also experience muscle spasms or twitches (dystonia), and have difficulty completing tasks like walking or swallowing. Symptoms typically begin on one side of the body or in your face, and they spread to other parts of the body over time.
Symptoms of this condition may get worse over time and interfere with your daily life, but you can usually maintain a good quality of life with medications. The drugs that help with the disease are called levodopa and dopamine agonists, and they stimulate the remaining neurons in the substantia nigra to produce dopamine. They also inhibit the production of a brain chemical that blocks dopamine, called acetylcholine.
Some people with this disorder experience hallucinations (seeing, hearing or feeling something that is not there) or delusions (becoming convinced about something that is not true). These symptoms can be very distressing and affect how well you function at work and at home. They can also be difficult to treat, and your doctor will need to monitor you carefully to ensure that you are receiving the correct dosage of medication.
The loss of dopamine results in the movement disorders seen in Parkinson’s disease: tremor; rigidity of the limbs and face; slowness of movement; and impaired balance and coordination. The underlying cause of the disease remains unknown, although it’s believed that genetic factors and oxidative damage are involved. Some studies suggest that inherited mutations in certain genes may increase a person’s risk of developing the condition; environmental causes, such as exposure to farming chemicals (including pesticides and herbicides), traffic pollution or working with heavy metals and solvents (like Agent Orange during the Vietnam War), have also been suggested as potential causes.
Symptoms of PD vary widely between individuals and progress differently in each person. There is no blood test or brain scan that can be used to diagnose the disorder, so doctors use a physical examination and symptoms reported by the patient to make a diagnosis. Movement disorder specialists can offer advice and support to help reduce PD symptoms and assist with daily tasks.
While there is no cure, medications can often dramatically improve a person’s PD symptoms. Levodopa is the most common treatment. It is most effective when it’s taken with a medication called carbidopa, which delays its breakdown and increases the amount available at the brain’s blood-brain barrier. Other medications include dopamine agonists, which mimic the action of dopamine; and anticholinergics, which block the parasympathetic nervous system to help control the rigidity of muscles.
Those diagnosed with PD should be offered early access to a multidisciplinary team of health professionals, including doctors, physiotherapists, occupational therapists, speech therapists, dietitians and specialist nurses. These teams can assess a person’s needs and help them plan for the future, and provide education and training on how to manage PD and its symptoms.