Parkinson's disease is a progressive disorder of the nervous system that affects a person's movement. It develops gradually, sometimes starting with a barely noticeable tremor in just one hand. And while a tremor may be the most well-known sign of Parkinson's, the disorder also commonly causes stiffness or slowing of movements.
With April designated Parkinson's Awareness Month, and the Kingdor National Parkinson Foundation heightening the awareness of this progressive, debilitating condition, neurologist Dr. Edwin Demeritte says Parkinson's is a common disease; with the population living longer, there is a higher chance of people developing Parkinson's disease.
"The older you are, the more likely you will end up with Parkinson's disease," said Demeritte, who is also the medical director at Bahamas Neurological Center.
According to the doctor, Parkinson's disease typically occurs at the average age of 60, but he said there are people with Parkinson's who are younger than age 45; they are referred to as having juvenile Parkinson's. In many people who experience the early onset of Parkinson's, there is a family history of the illness. There are also chromosomal abnormalities that contribute to an increased incidence of Parkinson's disease. All ethnic groups are susceptible to Parkinson's disease.
While there aren't any numbers known on the people living with the disease in The Bahamas, Demeritte said in the United States, 50,000 Americans are diagnosed each year, with the male to female ratio being about two to one. He also said that there has been talk about it occurring less in people of African and Asian descent, but scientists are uncertain as to why.
"Here in The Bahamas nobody really knows the exact incidence, but our population over the years has been fairly long -- for women, it's about 79 years; for men, life expectancy is about 75 years," he said. He also said that nobody is certain as to the prevalence of the disease in the country as people tend to hide diseases.
Parkinson's disease stages
Parkinson's disease has five stages -- During stage one, a patient usually experiences mild symptoms that may inconvenience day-to-day tasks the patient would otherwise complete with ease. Typically, these symptoms include the presence of tremors or experiencing shaking in one of the limbs. Also during stage one, friends and family can usually detect changes in the Parkinson's patient including poor posture, loss of balance and abnormal facial expressions.
In stage two, the patient's symptoms are bilateral, affecting both limbs and both sides of the body. The patient usually encounters problems walking or maintaining balance, and the inability to complete normal physical tasks becomes more apparent. Stage three symptoms can be severe, and include the inability to walk straight or to stand. There is a noticeable slowing of physical movements in stage three.
The fourth stage of the disease is accompanied by severe symptoms of Parkinson's. Walking may still occur, but it is often limited, and rigidity and bradykinesia (slowed movement) are often visible. During this stage, most patients are unable to compete day-to-day tasks, and usually cannot live on their own. The tremors or shakiness that take over during the earlier stages however, may lessen or become non-existent for unknown reasons during this time.
In the fifth and final stage of Parkinson's disease the patient is usually unable to care for him or herself and may not be able to stand or walk. A patient at stage five usually requires constant one-on-one nursing care.
Tests and diagnosis
A neurologist diagnoses Parkinson's disease based on medical history, signs and symptoms and a neurological and physical examination. Tests may also be done to rule out other conditions that may be causing a person's symptoms. The doctor said Parkinson's disease can mimic other diseases, and if someone is having a tremor, there are many causes, and it does not have to be Parkinson's disease.
Treatment and cure
There is no cure for Parkinson's disease.
"The therapy right now is more symptomatic," said Demeritte. "People who have Parkinson's disease usually are quite mentally intact, so it's not as if they're not with you as is the case with someone with dementia. I tend to look at treatment as in different modalities -- one aspect you're trying to replace the dopamine, so you may have medications that replaces the dopamine that the body is lacking; or you have medications that may prolong the effect of the dopamine, or you get other medications that may mimic the dopamine," he said.
In the past, the neurologist said medical professionals treated Parkinson's by going into the area of the brain that causes the excessive tremor and that helps to coordinate movement. By cutting through some of the pathways, he said, they improved the tremors, rigidity and bradykinesia. These days, the medical professionals have moved away from that and are now looking at deep brain stimulators in which a stimulator (kind of like a pacemaker) is implanted to activate the correct brain pathways to inhibit the areas that are causing tremors or the slow movement or rigidity. He said exercise and music therapy are other aspects that seem to be effective.
The degenerative brain disorder was first described in 1817 by James Parkinson and was then known as the shaking palsy. In the early 1960s they discovered a fundamental defect in some of the brain cells that produce a chemical substance called dopamine, which is produced by specific brain cells located in the substantia nigra. Demeritte said that in the disease, as time goes by, the decreased production of the dopamine is typically slow. He said there are a number of theories as to what contributes to these nerve cells and not producing.
The neurologist said Parkinson's is a family disease that impacts everybody, not just the individual. People with Parkinson's need to be helped so that they can live a decent quality of life.
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