Parkinson’s Disease: what you should know about the second most common degenerative disorder after Alzheimer’s

Over one million Americans are living with Parkinson’s Disease (PD), with 60,000 new cases diagnosed each year. Many people do not realize that Parkinson’s is the second most common degenerative neurological disorder after Alzheimer’s disease. A number of well-known individuals have been diagnosed with and lived with Parkinson’s, including boxer Muhammad Ali, singers Johnny Cash and Neil Diamond, and actors Robin Williams, Alan Alda and Michael J. Fox. Their diagnoses have helped to bring more awareness to this disorder.

What is Parkinson’s Disease?

Parkinson’s Disease is a progressive nervous system disorder that affects the part of the brain responsible for movement. According to the Parkinson’s Foundation, the disease primarily targets the neurons in the brain that produce dopamine. Dopamine is a chemical that sends signals throughout the brain affecting mood, movement and memory. If you have Parkinson’s, when these neurons die they produce less dopamine, which causes the movement problems typically identified with PD. People with Parkinson’s also lose the nerve endings that produce norepinephrine, the main chemical messenger of the sympathetic nervous system, which controls many automatic functions of the body, such as heart rate and blood pressure. The loss of norepinephrine might help explain some of the non-movement features of Parkinson’s, such as fatigue, and irregular blood pressure. Parkinson’s is usually diagnosed by identifying four concurrent signs: tremors, slowness of movement, rigid limbs, and difficulty walking.

Who gets Parkinson’s Disease?

Symptoms of PD are most likely to appear in individuals who are older than 60 years of age, however symptoms can start at 50 or younger. When the latter occurs, it’s referred to as ‘young-onset Parkinson’s disease’ (YOPD). Estimates vary, but about 10 percent of people with Parkinson’s may fall into this category. Actor Michael J. Fox was just 29 when he was diagnosed. Studies show that men are 1.5 times more likely than women to get Parkinson’s, although scientists are not able to explain why this is. In addition, the incidence of the disease is higher in industrialized countries, and in fact in the U.S., urban areas have a higher prevalence of and incidence of PD than rural areas. Also, in the U.S., studies show that Parkinson’s is substantially more common in white Americans of European background, than in other ethnic groups.

What causes Parkinson’s Disease?

The cause of Parkinson’s essentially remains largely unknown. However, theories for potential causes range from oxidative damage (an imbalance between free radicals and antioxidants in your body) and environmental toxins, to genetic factors and and accelerated aging.

• Genetic factors. In 2005, researchers discovered a single mutation in a Parkinson’s disease gene which is believed responsible for five percent of inherited cases. However, more research needs to be done to determine genetic causes for PD since 90 percent of cases have not identified a genetic marker.
• Traumatic brain injury (TBI). Having had a prior TBI or multiple head injuries has been associated with an increased likelihood of developing Parkinson’s.
• Exposure to toxins. Individuals in agricultural and industrial occupations seem to be at a greater risk for developing Parkinson’s, possibly due to exposure to environmental toxicants such as pesticides, solvents, metals, and other pollutants.

How does Parkinson’s disease affect daily life?

Since Parkinson’s is a progressive disease, it won’t impact daily life immediately. Instead, your routine will change over time and may be impacted by increasing difficulty in regular activities. Here are some of the ways PD can impact daily life.

• Speaking. Speech may be, soft, slurred, mumbled or monotone. Individuals with Parkinson’s might not be aware of their changes in speech patterns. The following speech disorders may impact those with PD:
• Hypophonia: when someone speaks in a very soft or quiet voice
• Dysarthria: affects the muscles needed to talk or produce clear speech.
• Tachyphemia: when a person produces fast or erratic bursts of speech, making him or her hard to understand

As a result of speech difficulties, some individuals may take less interest in socializing or communicating with others, but it’s important to try to stay socially active despite these feelings.

• Swallowing. About 80 percent of those with PD may develop swallowing disorders as the disease progresses (Suttrup et al., 2016). Problems with swallowing can lead to malnutrition or inhaling food into the lungs, or choking, so it’s important to consult a speech-language pathologist if you see these symptoms develop. Symptoms may include coughing when eating or drinking, difficulting clearing food from your throat, or watery eyes or runny nose after eating.
• Mobility. People living with Parkinson’s may find movement does not come as naturally as it once did. However, its critical to build a plan to keep moving into your daily schedule, but remember to do so safely. Taking regular walks, doing chores, or taking a class in movement at a community center can be ways to do this.
• Cognition. Since PD may impact the part of the brain that controls multitasking, planning and problem solving, individuals with the disease sometimes report feeling forgetful or slow to process thoughts. Some individuals with PD may develop dementia at later stages of the disease.
• Emotional side effects. Some studies have shown that the emotional effects of living with Parkinson’s can be equal or greater than the effects of motor or speech changes, potentially causing anxiety, depression, frustration, and apathy. Seeking counseling, finding a support group, and exercising regularly are some ways of dealing with emotional side effects.

How is Parkinson’s treated?

Parkinson’s can’t be cured, but medications, therapies, surgery, and lifestyle changes can help control symptoms. Always ask your own medical provider first, but many people with Parkinson’s find it helpful to consult a speech-language pathologist (SLP) who can help address speech, swallowing, and cognitive issues. Constant Therapy is a mobile app that your SLP may recommend for home, or work with you in clinic. Like other digital therapies, it provides tasks to practice speech and cognitive skills on your phone, Chromebook, or tablet.

• For individuals with PD who are working on cognitive skills, Constant Therapy tasks such as Alternate Symbol Matching, Auditory Command, and Word Problem provide exercises to target training in the areas of attention, memory, and reasoning skills.
• For individuals with PD who are working on voice or speech intelligibility, Constant Therapy tasks such as Repeat Words, Name Pictures, and Sentence Picture Description include a sound meter to cuq you to speak loudly. The app provides you with audio feedback so you can replay your recording and try again if needed.

You might also consider participating in a clinical trial. Clinical trials and their participants have helped make available new treatments in addition to improving the delivery methods of medications, thereby changing the lives of many affected with PD. Several clinical trial-matching tools can be found online. With treatment, the life expectancy of people with PD is similar to that of the general population. Scientists have found that early detection of the disease, prevention of motor symptom progression, and treatment of dementia can increase life expectancy. Where can I find additional resources?

• The Michael J. Fox Foundation
• The Parkinson’s Foundation
• The National Institutes Health – National Institutes on Aging (NIH-NIA): Parkinson’s Disease Overview
• American Association of Neurological Surgeons (AANS): Parkinson’s Disease

REFERENCES

• Treatment & Medication | American Parkinson Disease Assoc. (n.d.). Retrieved from http://www.apdaparkinson.org/what-is-parkinsons/treatment-medication.

• Yorkston, K. M. (2010). Management of motor speech disorders in children and adults. Austin, TX: Pro-Ed.

• Disease Society of Victoria. (n.d.). Anxiety, Depression and Emotional Changes :: Parkinson’s Victoria – We’re in this together. Retrieved from http://www.parkinsonsvic.org.au/parkinsons-and-you/anxiety-depression-and-emotional-changes/.

• Suttrup, I. & Warnecke, T. Dysphagia. (2016). Springer US, 31(1): 24-32. https://doi-org.ezproxy.neu.edu/10.1007/s00455-015-9671-9

• Downward, E. (2017). Symptoms – Speech Difficulties or Changes. Retrieved from parkinsonsdisease.net/symptoms/speech-difficulties-changes

• Chapey, R. (2008). Language intervention strategies in aphasia and related neurogenic communication disorders. Philadelphia: Wolters Kluwer, Lippincott Williams & Wilkins.

• Cognitive Impairment in Parkinson’s Disease. (n.d.). Retrieved from http://www.michaeljfox.org/understanding-parkinsons/living-with-pd/topic.php?cognitive-impairment

• Lanska, D. J. (1997, September 01). The geographic distribution of Parkinson’s disease mortality in the United States. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/9260859.