PARKINSON’S DISEASE

Geeta Mohan
 Parkinson’s Disease

• Parkinson's disease (PD) is a long-term degenerative

disorder of the central nervous system that mainly
affects the motor system
• Parkinson's disease (PD) is a neurodegenerative
disorder that affects predominately dopamine-
producing (“dopaminergic”) neurons in a specific
area of the brain called substantia nigra
• It is a movement disorder of middle and old age that
affects 1% of the elderly population
• It is 2.5 times more prevalent in males than females
Parkinson’s Disease
Parkinson’s Disease

• In 2015, PD affected 6.2 million people and resulted in

about 117,400 deaths globally. Parkinson's disease
typically occurs in people over the age of 60, of which
about one percent are affected. Males are more often
affected than females.
• More than 10 million people worldwide are living with PD.
• 7 million people are estimated to be afflicted with
Parkinson's disease in India.
• The prevalence of the disease ranges from 41 people per
100,000 in the fourth decade of life to more than 1,900
people per 100,000 among those 80 and older.
• When it is seen in people before the age of 50, it is called
young-onset PD. The average life expectancy following
diagnosis is between 7 and 14 years. The disease is
named after the English doctor James Parkinson, who
published the first detailed description in An Essay on the
Shaking Palsy, in 1817
 Parkinson’s Disease

Symptoms
• Symptoms generally develop slowly over years. The
progression of symptoms is often a bit different from one
person to another due to the diversity of the disease.
•
• The initial symptoms are mild- slight stiffness or tremor of the
fingers Early in the disease, the most obvious
are shaking, limb rigidity, slowness of movement
(bradykinesia), and difficulty with walking , Gait and balance
problems .Tremor is pronounced during inactivity

• Thinking and behavioral problems may also

occur. Dementia becomes common in the advanced stages of
the disease. Depression, anxiety and pain are also common,
occurring in more than a third of people with PD. Other
symptoms include sensory, sleep, emotional problems and
mask –like face. The main motor symptoms are collectively
called "parkinsonism", or a "parkinsonian syndrome".
Parkinson’s Disease
 Parkinson’s Disease

Pathophysiology : Dopamine acts as a messenger

between the substantia nigra and the corpus striatum
in the brain - to produce smooth, controlled
movements. Most symptoms of Parkinson's disease are
caused by a lack of dopamine due to the loss of
dopamine-producing cells in the substantia nigra.
When dopamine is too low, ineffective communication
between the substantia nigra and corpus striatum
occur, and movement is impaired. It seems that by the
time clinical manifestations occur, approximately 85%
of dopaminergic neurons are lost. It is not clear why
these dopaminergic cells deteriorate but scientists
suspect it is due to a combination of genetic and
environmental factors.
Parkinson’s Disease

• The acetylcholine then serves as a chemical messenger,

traveling across the synapse to activate receptors on the
muscle cells, causing them to contract.
• Dopamine becomes increasingly deficient in Parkinson’s
disease, allowing excess levels of acetylcholine to
accumulate.
• Acetylcholine plays a significant role in the processes of
cognitive function. In the central nervous system,
acetylcholine helps with attention, arousal, reward and
sensation among other functions. In the normal midbrain,
there is a balance between dopamine and acetylcholine. The
loss of dopamine tilts the balance toward too much
acetylcholine, which also contributes to motor symptoms.
• The imbalance between cholinergic activity and
dopaminergic activity in the striatum causes a variety of
neurological disorders including PD
Parkinson’s Disease
Parkinson’s Disease
Parkinson’s Disease
Parkinson’s Disease
 Parkinson’s Disease

• The exact cause of Parkinson's disease is unknown,

although research points to a combination of genetics and
environmental factors
• In the past 10 years, researchers have identified a number
of rare instances where Parkinson's disease appears to be
caused by a single genetic mutation. In these cases, the
mutated gene is passed from generation to generation,
resulting in a great number of Parkinson's disease cases
within an extended family. Mutations in the LRRK2 gene are
the greatest genetic contributor to Parkinson's disease
discovered to date.
• Some studies suggest that genes play a role in the
development of Parkinson’s. An estimated 15 percent of
people with Parkinson’s have a family history of the
condition.
 Parkinson’s Disease

• There’s also some evidence that environment can play a role.

Exposure to certain chemicals has been suggested as a possible
link to Parkinson’s disease. These include pesticides such as
insecticides, herbicides, and fungicides
• Other factors – brain infections, stroke, tumors, traumatic brain
injury and neuro toxins.
• Research suggests that certain occupations may put a person at
greater risk for developing Parkinson’s. In particular, Parkinson’s
disease may be more likely for people who have jobs in welding,
agriculture, and industrial work and those exposed to toxic
chemicals.
• Clumps of specific substances within brain cells are microscopic
markers of Parkinson's disease. These are called Lewy bodies,
and researchers believe these Lewy bodies hold an important
clue to the cause of Parkinson's disease.
Parkinson’s Disease

Parkinson's signs and symptoms may include:

• Tremor. A tremor, or shaking, usually begins in a limb, often your hand or
fingers. You may notice a back-and-forth rubbing of your thumb and forefinger,
known as a pill-rolling tremor. One characteristic of Parkinson's disease is a
tremor of your hand when it is relaxed (at rest).
• Slowed movement (bradykinesia). Over time, Parkinson's disease may reduce
your ability to move and slow your movement, making simple tasks difficult and
time-consuming. Your steps may become shorter when you walk, or you may
find it difficult to get out of a chair. Also, you may drag your feet as you try to
walk, making it difficult to move.
• Rigid muscles. Muscle stiffness may occur in any part of your body. The stiff
muscles can limit your range of motion and cause you pain.
• Impaired posture and balance. Your posture may become stooped, or you may
have balance problems as a result of Parkinson's disease.
• Loss of automatic movements. In Parkinson's disease, you may have a
decreased ability to perform unconscious movements, including blinking,
smiling or swinging your arms when you walk.
• Speech changes. You may have speech problems as a result of Parkinson's
disease. You may speak softly, quickly, slur or hesitate before talking. Your
speech may be more of a monotone rather than with the usual inflections.
• Writing changes. It may become hard to write, and your writing may appear
small.
Parkinson’s Disease
Complications
• Thinking difficulties. You may experience cognitive problems
(dementia) and thinking difficulties, which usually occur in the later
stages of Parkinson's disease.
• Depression and emotional changes. People with Parkinson's disease
may experience depression.
• Experience other emotional changes. such as fear, anxiety or loss of
motivation.
• Swallowing problems. Person may develop difficulties with
swallowing as the condition progresses. Saliva may accumulate in
the mouth due to slowed swallowing, leading to drooling.
• Sleep problems and sleep disorders. People with Parkinson's disease
often have sleep problems, including waking up frequently
throughout the night, waking up early or falling asleep during the day.
• People may also experience rapid eye movement sleep behavior
disorder, which involves acting out your dreams.
• Bladder problems. Parkinson's disease may cause bladder problems,
including being unable to control urine or having difficulty urinating.
• Constipation. Many people with Parkinson's disease develop
constipation, mainly due to a slower digestive tract.
Parkinson’s Disease

• They may also experience:

• Blood pressure changes. May feel dizzy or lightheaded
when they stand due to a sudden drop in blood pressure
• Smell dysfunction. You may experience problems with
your sense of smell. You may have difficulty identifying
certain odors or the difference between odors.
• Fatigue. Many people with Parkinson's disease lose
energy and experience fatigue, and the cause isn't
always known.
• Pain. Many people with Parkinson's disease experience
pain, either in specific areas of their bodies or
throughout their bodies.
• Sexual dysfunction. Some people with Parkinson's
disease notice a decrease in sexual desire
Parkinson’s Disease

Prevention of PD
• Because the cause of Parkinson's is unknown, proven ways
to prevent the disease also remain a mystery. However,
some research has shown that caffeine — which is found in
coffee, tea and cola — may reduce the risk of developing
Parkinson's disease. Green tea also may reduce the risk of
developing Parkinson's disease.
• Some research has shown that regular aerobic exercise may
reduce the risk of Parkinson's disease
• Research has shown that people who eat more fruits and
vegetables, high-fiber foods, fish, and omega-3 rich oils
(sometimes known as the Mediterranean diet) and who eat
less red meat and dairy may have some protection against
Parkinson
Parkinson’s Disease Diagnosis and Treatment

Diagnosis of Parkinson's disease based on medical

history, a review of signs and symptoms, and a
neurological and physical examination.
• Blood tests, to rule out other conditions that may be
causing the symptoms.
• Imaging tests — such as MRI, ultrasound of the brain
Treatment : Parkinson's disease can't be cured, but
medications can help control the symptoms
Doctor may prescribe carbidopa-levodopa (is a natural
chemical that passes into the brain and is converted to
dopamine), a Parkinson's disease medication.
Lifestyle changes, especially ongoing aerobic exercise,
in some cases, physio therapy that focuses on balance
and stretching also is important.
Parkinson’s Disease

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