What you need to know about Parkinson’s disease

Parkinson’s disease is a progressive condition that damages the brain. It is part of a group of diseases called neurodegenerative diseases and is the second most common neurodegenerative disease in the UK, affecting one in every 1,000 adults. 

The disease itself is not fatal; however, the progressive effects it has on your body can lead to poor health. 

Here, we will explore what causes Parkinson’s disease, who is at risk, how it progresses, and how it is diagnosed and treated.

Who is at risk of Parkinson’s disease?

The biggest risk factor for Parkinson’s disease is age, with most cases occurring in those aged 50 and over, and the risk increasing with advancing age. 

Your sex also has a role to play as those born male are more likely to develop Parkinson’s disease than those born female. Around 58% of people with Parkinson’s disease are men, compared to 42% who are women. 

Where you live affects your risk of developing Parkinson’s disease too. More people who live in the countryside develop the disease, which is thought to be due to longer life expectancies in these areas and increased exposure to pesticides from farming.

While most cases of Parkinson’s disease are sporadic, which means there is no family history of the disease, around 15 cases in every 100 are familial. This means that they are caused by flaws in your genes that can be passed down through the generations, resulting in a family history of Parkinson’s disease.  

How Parkinson’s disease affects your brain

Research continues into exactly what destroys brain cells in Parkinson’s disease. Currently, it is thought that a protein called alpha-synuclein becomes misshapen and builds up in nerve cells in structures called Lewy bodies. This ultimately leads to the death of nerve cells. 

Nerve cells in different parts of the brain die as a result of Parkinson’s disease, resulting in different symptoms depending on which part of the brain is affected. 

One area of the brain predominantly affected by Parkinson’s disease is the substantia nigra in the centre of your brain. Here, nerve cells containing dopamine start to die off. This part of the brain is responsible for balance, fine movements and dexterity. 

Other brain areas affected include the olfactory bulb, which controls your sense of smell; the vagus nerve, which regulates digestion; the limbic system, which controls emotions and mood; the pedunculopontine nucleus, which controls posture and movement from one place to another; and the frontal lobe, which is involved in memory and thinking.  

Symptoms of Parkinson’s disease 

Early symptoms of Parkinson’s disease often include back pain, neck pain and muscle pain. You may find it harder to bend, balance and walk, and consequently, experience more falls or near-falls. Your walk may become slower and more shuffle-like.

Parkinson’s disease also causes changes to your fine movements. You may notice tremors in your hands and find that your handwriting becomes less legible and/or smaller. You may struggle to do up buttons and zips, open jars and use a knife and fork.

Your sense of smell may reduce and you or others may notice that your speech becomes slurred. You may find it harder to turn in bed, which can disrupt your sleep. Parkinson’s disease also affects your gut, leading to constipation. You may also find swallowing more difficult. 

As Parkinson’s disease progresses, these symptoms worsen and you may also develop anxiety and depression as non-motor symptoms of the disease.

In more advanced stages of the disease, blood pressure can become erratic and memory problems and hallucinations can occur. 

Diagnosing Parkinson’s disease

Parkinson’s disease is diagnosed through a full clinical examination, which involves taking your family and personal medical history, discussing all of your symptoms in detail, such as day-to-day tasks that you struggle with, and performing a physical examination. 

Depending on the results of this examination, your doctor may then recommend a DaTSCAN. This involves being injected with a safe amount of a radioactive substance called DaTSCAN, which is taken up by certain parts of your brain. Before you are injected with DaTSCAN, you will be given potassium iodide tablets to prevent DaTSCAN from being taken up by your thyroid gland. 

DaTSCAN gives off gamma radiation, which can be detected by a gamma camera. Images of your brain will be captured with this camera — this takes around 45 minutes. These images will help your doctor determine whether or not you have Parkinson’s disease.

Treating Parkinson’s disease

Medications

The first line of treatment for Parkinson’s disease is a drug called rasagiline. This is taken daily to treat the motor (movement-related) symptoms of Parkinson’s disease. It reduces the breakdown of a chemical called dopamine, which is released by dopamine-producing nerve cells in the brain — these nerve cells die off in Parkinson’s disease. 

As the disease progresses, you will be given the drug levodopa. This is also taken daily and treats the motor symptoms of Parkinson’s disease. It is a building block for dopamine and, therefore, helps dopamine-producing nerve cells make more dopamine. You may also be given the drug ropeninol, which mimics dopamine and, therefore, reduces motor symptoms. 

Some of these medications can be given as patches instead of as tablets if swallowing becomes difficult. 

Drug treatments for Parkinson’s disease are very effective and can help you maintain your quality of life. 

Surgery

For younger patients who are otherwise in good health and for whom drug treatments have eventually stopped working, deep brain stimulation (DBS) may be recommended. 

This involves surgery to implant a device called a pulse generator under the skin on your chest or abdomen. Wires from this device are then inserted into certain parts of your brain to stimulate them. 

DBS does not cure Parkinson’s disease or slow down its progression. However, if drug treatments are no longer effective, it may help improve your motor symptoms. 

Living with Parkinson’s disease

If you have been diagnosed with Parkinson’s disease, you can effectively manage your symptoms with drug treatments, particularly in the early stages. It is, however, also important to follow a healthy, balanced diet, exercise regularly and maintain your connections with friends and family. This is important for both your physical and mental health. 

Parkinson’s disease does not have a significant impact on your life expectancy. On average, it reduces life expectancy by about one year. With early and continued treatment of the disease and management of its symptoms, you can lead a full and active life. 

You can find support and a wealth of further information about Parkinson’s disease and living with the condition from Parkinson’s UK (Parkinson’s Disease Society).