most common condition today is the one first recognized in 1817 by James Parkinson. At present there is no cure, but treatments do exist and are available.

While experts agree symptoms are due to a deficiency of the brain chemical, dopamine, they are uncertain as to why the nerve cells containing dopamine die. Parkinson's disease is not contagious.

The incidence of Parkinsonism increases with age and is uncommon in people younger than forty. Although it is not a regular feature, intellectual impairment may occur in the later stages of the disease.

Parkinson's disease affects both men and women across all ethnic groups and is a serious health problem in the United States. The National Parkinson Foundation, Inc. (NPF) estimates that up to 1.5 million Americans have the disease and that approximately 60,000 new cases are diagnosed each year. VA medical centers treat at least 40,000 Parkinson’s disease patients every year.

The Symptoms and Appearance

Slowness of movement

This is the most disabling symptom. Initially, it often begins in one arm with a loss of manual

dexterity. The slowness makes it difficult to get out of a chair or turn in bed. Fine movements such as buttoning clothing, handwriting, and using a fork or knife may become difficult.

Later, the person appears to be in slow motion and if not treated may become virtually frozen like a statue. Because of the enormous energy it takes to overcome slowness, the person with Parkinson's disease often complains of being "weak" although there is no true muscular weakness.

Tremor

Tremor or shaking occurs in about two-thirds of people with Parkinsonism and is often the most visible and obvious sign of the disease. While the Parkinson tremor usually affects the hands and feet it sometimes involves the lips, tongue, and jaw. The tremor is more visible while at rest or while walking and will usually stop during movement of the hand.

Muscle stiffness

Stiffness combined with slowness may cause aching muscles and joints, especially in the shoulders. This is sometimes misinterpreted as "arthritis" or "bursitis."

Masked face

An often confusing characteristic of the disease is the presence of a "masked face," showing little or no emotion through facial expression. Blinking and spontaneous eye movements are less frequent, giving rise to a staring expression. This can be misinterpreted as lack of interest or depression.

Walking difficulties

The gait may be slow with short steps. A person with Parkinsonism may also intermittently freeze as if the feet were stuck to the floor. Freezing occurs especially when approaching doorways or if forced to hurry. There is a propensity to bend the trunk forward and to walk with out swinging the arms. It is common to have difficulties with balance.

Speech problems

About one half of all individuals with Parkinson's disease develop difficulty with their speech. The most common problem is a soft or fading voice. Communication can be complicated further by a fast mumbling speech with uncontrollable repetitions of tNovember 5, 2007 difficulties

Some individuals experience difficulty eating because their ability to swallow has become impaired. Food may collect in the mouth or the back of the throat resulting in choking or coughing. Friends and family members may wish to become familiar with the Heimlich Maneuver in the event of a choking episode. A physician or other health professional can explain this procedure.

Troubling inconsistencies

It is important to note that an individual's symptoms may vary from moment-to-moment and day-to-day. Symptoms may be nonexistent one minute only to suddenly reappear for no clear reason. These variations can be due to the disease or medications. Such fluctuations will often confuse or frustrate caregiver, family, and friends who are unaware of the fickle nature of this disease.

How is the disease treated?

There is presently no cure or prevention of Parkinson's disease. However, the symptoms can be substantially or sometimes completely alleviated with medications, especially during the earlier stages. Patients need to establish a strong relationship with their physician to maintain effective and comfortable levels of medication.

No treatment may be necessary for some patients with mild symptoms associated with the early stages of the disease.

 

Deep Brain Stimulation

 

Deep Brain Stimulation (DBS) is a primary concentration of research at the Northwest PADRECC.

This procedure involves implanting a very thin electrode into the brain. The implant uses small electrical pulses from a device similar to a cardiac pacemaker to stimulate the brain and block brain signals that cause Parkinson’s symptoms. DBS may be used to improve motor function and relieve tremors.

Deep Brain Stimulation is now being offered to all qualifying patients. Some of the basic criteria required to qualify includes:

• A Diagnosis of Idiopathic Parkinson’s Disease
• Have run out of medication therapy options.
• Persistent disabling symptoms such as troubling dyskinesias or disabling “off” periods at least three hours a day despite medication therapy.
• Have never had previous Parkinson’s Disease surgery.
• Do not have any other implanted stimulation or electronically-controlled devices.
• Have not developed any dementia problems.
  
  

For more information, contact Susan O’Connor at (503) 721-1091

Behavioral Health and Clinical Neurosciences Section
Phone: 503-721-1091
FAX: 503-402-2961
email: nwpadrecc@va.gov