Dear Dr Makis
My husband has recently been diagnosed with Parkinson’s Disease. He has started walking a little slower and his hand shakes a little on occasions. The symptoms don’t really bother him to much but the diagnosis has worried us both. What exactly is Parkinson’s Disease and what can we expect of the future?
Mrs P
Dear reader,
Parkinson’s Disease, or PD for short, is a disorder of the nervous system. A small part of the
brain, called the substantia nigra, is mainly affected. This area of the brain sends messages down nerves in the spinal cord to help control the muscles of the body. Messages are passed between brain cells, nerves and muscles by chemicals called neurotransmitters. The brain cells in the substantia nigra produce dopamine, the main neurotransmitter.
If you have PD, a number of cells in the substantia nigra become damaged and die. The exact cause of this is not known. Over time, more and more cells become damaged and die. As cells are damaged, the amount of dopamine that is produced is reduced. A combination of the reduction of cells and a low level of dopamine in the cells in this part of the brain causes nerve messages to the muscles to become slowed and abnormal.
The risk of developing Parkinson's disease seems to involve genetic and environmental factors. Parkinson's disease can run in families as a result of faulty genes, However Parkinson's disease is not an inherited condition and there is currently no strong evidence to link any particular gene or chemical to Parkinson's disease.
PD mainly develops in people over the age of 50. It becomes more common with increasing age. About 5 in 1,000 people in their 60s and about 40 in 1,000 people in their 80s have PD. It affects men and women but is a little more common in men. Rarely, it develops in people under the age of 50. PD is not usually inherited and it can affect anyone. However, one type of PD, which appears in the small number of people who develop it before the age of 50, may be linked to inherited (genetic) factors. Several family members may be affected.
The three main symptoms pf PD are movement related and include slowness of movement, muscle stiffness and a tremor that occurs when resting. There are many other symptoms that can be caused by PD which affect parts of our body that are not associated with movement, these include mood changes, dizziness and balance issues, sweating and sleep problems.
The cells in the brain affected in PD are not in the 'thinking' parts of the brain and dementia is not a typical early feature of PD. However, if you have PD you have an increased risk of developing dementia. About half of people with Parkinson's disease develop dementia at some stage. If dementia occurs, it tends to develop in older people with PD (aged over 70). Early dementia in younger people with PD virtually never develops. It is thought that PD alone does not cause dementia; however, other age-related factors in addition to PD may increase the risk of dementia developing.
The symptoms of PD tend to become gradually worse over time. However, the speed of progression varies greatly from person to person. When symptoms first begin, you may not need treatment when symptoms are relatively mild. Most people with PD can expect to have some time of relatively mild symptoms. Then, when the symptoms become worse, they can expect several years of good or reasonable control of the symptoms with medication. However it is important to remember that everyone is different and it is difficult to predict for an individual how quickly the disease will progress. Some people may only be slightly disabled 20 years after PD first begins, whereas others may be very disabled after 10 years.
Treatment for PD is usually with medication which aims to improve the symptoms. There are many different medications that are uses and your doctor will decide which medication is most appropriate to take. Keeping active is also important, we know that physical activity , where possible, helps with the symptoms. Maintaining independence and social interactions help with the psychological aspects of this disease.
Keep positive and maintain your normal activities but adapt to any limitations you both may experience.
Dr Makis
Dr Makis offers medical advice via his monthly article in the Paphos Post newspaper. If you require personal medical advice, contact your own GP in the first instance. For further information about Veramedica Medical Center, please contact us.