Parkinsons

Parkinson’s disease (PD) is a progressive condition caused by reduced levels of a chemical called dopamine in the brain. This can cause tremor, slowness of movement and rigidity of muscles.

Parkinson’s is a chronic and advancing neurological condition. Clinical presentation is considered to result from the increasing deterioration and death of dopamine-producing neurons located within the basal ganglia situated at the base of the forebrain. The resulting shortage of dopamine is believed to be one of the major factors in the development and progression of Parkinson’s symptoms. The basal ganglia play a key role in well-learnt, voluntary and semi-automatic motor skills and movement. The dopamine they produce also supports cognitive skills such as, attentional and executive abilities, motivation, mood and visual perception. Further changes in associated brain regions and in other neurotransmitters are also believed to be involved in Parkinson’s.

Parkinson’s progresses into a highly complex condition with most people experiencing physical, cognitive and emotional symptoms. The results affect a breadth of activities and limit participation in everyday life.
Currently, no conclusive scan or test can diagnose Parkinson’s. Physical examination and self-reporting would determine, through clinical evaluation, a diagnosis. Typical motor symptoms seen in Parkinson’s are also present in a variety of associated, but distinct, Parkinsonian disorders. These include conditions such as Lewy body dementia, multiple system atrophy and progressive supranuclear palsy (PSP). These have a distinct prognosis and therefore require different approaches to those used for Parkinson’s.

‘Parkinson’s is a common neurodegenerative disorder and the average age at diagnosis is older than 60 years. The incidence and prevalence of Parkinson’s in the UK has recently been reviewed and as a result in late 2017 it was estimated that around 145,000 people in the UK have been diagnosed with the condition; that’s about one in 350 adults in the UK. And, Parkinson’s diagnoses are set to rise by nearly a fifth by 2025’ (Parkinson’s UK 2017).

The main motor symptoms of Parkinson’s are:

• Akinesia: poverty of movement
• Bradykinesia: slowness of movement
• Hypokinesia: reduced scaling of movements, affecting many motor activities, including balance, co-ordination, speech, swallowing, handwriting, and facial expression
• Rigidity: raised and sustained high muscle tone and stiffness
• Rest tremor: involuntary fine movements, which usually begin in one hand or leg. This symptom only affects about 70 per cent of people with Parkinson’s
• Postural instability

Non-motor symptoms include:

• Autonomic failure: for example, a sudden fall in blood pressure on rising from lying or sitting, extreme sweating or episodes of feeling very hot or very cold
• Continence problems, including, constipation, urine urgency and nocturia
• Sexual health issues: for example, erectile dysfunction or reduced libido
• Fatigue
• Pain
• Sleep disturbances, including insomnia and/or disturbing dreams
• Cognitive impairments are seen in approximately 75% of people with Parkinson’s
• Visual hallucinations
• Dementia