Parkinson's disease

Parkinson’s disease is a progressive condition characterized by a gradual loss of neurons that normally produce the neurotransmitter dopamine, leading to problems with movement control and non-movement-related symptoms.

Parkinson's disease overview
Parkinson’s disease is a long-term and progressive brain disease that most commonly affects those over the age of 60.1 People with Parkinson’s disease have difficulty controlling their body movements, and symptoms become worse as the condition progresses. Ultimately, Parkinson’s disease impairs the individual’s ability to function in daily life situations.

The symptoms of Parkinson’s disease result from a loss of neurons in the brain that affect movement control, as well as other areas, such as mood, sleep and thought. The exact cause of the neuron loss is still unknown, but it is believed to involve a combination of genetic, environmental and ageing factors.2

Symptoms
Parkinson disease is a progressive disorder and, over time, new symptoms appear and existing symptoms slowly become more severe. However, it is not a terminal illness – people can live for some 15 to 25 years from the point of diagnosis – which makes it a long-term (chronic) condition.3

Symptoms of Parkinson’s disease can be categorized into motor and non-motor symptoms and complications.

Motor symptoms - The classic symptoms of Parkinson’s disease – so-called ‘motor’ (movement-related) symptoms – include tremor, slowness of movement, muscle stiffness, and balance problems.

Non-motor symptoms -  They accompany all stages of Parkinson’s disease and substantially impact patients’ quality of life, as for example, sudden drop in blood pressure when standing, mood disorders, sleep disorders, sensory problems, loss of sense of smell, constipation and cognitive issues e.g. memory difficulties, slowed thinking, confusion and cases dementia.4,5

Complications - After several years of treatment, complications can begin to appear.6 These may include ‘fluctuations’, when individuals alternate between periods of good symptom control and poor symptom control.

All of these symptoms add considerably to the disease burden.

Epidemiology and burden
Parkinson's disease is one of the most common neurological (nerve cell) disorders. It affects approximately 6 million men and women worldwide.

Parkinson’s disease usually develops in people in their late 50s and early 60s,1 though rarer forms of the disease can develop before the age of 40.9 

Because the risk of developing Parkinson’s disease increases with age, the fact that more people are now living into old age means that the overall number of people with Parkinson’s disease is also rising.10

Diagnosis and care
People who are concerned that they – or their loved ones – are experiencing symptoms of Parkinson’s disease should see their doctor for help and advice. Parkinson’s disease is diagnosed using medical history, clinical examination, and response to treatment; there is currently no reliable biochemical, imaging or genetic test that provides a definitive diagnosis.11,12 In addition, there are numerous assessment scales that can be used to identify the symptoms, and severity, of the disease.

At present, there is no cure for Parkinson’s disease, but treatments for symptoms are available and research continues. Although current Parkinson’s treatments cannot stop the progression, they can temporarily control and relief symptoms and improve quality of life for those with Parkinson’s and their caregivers.

Treatment for Parkinson’s disease normally involves drug therapy and, in some cases, surgery. In addition to this, physical exercise, diet, complementary therapies, emotional support and strong relationships all play important roles. Understanding Parkinson’s disease, relating to the new situation in life, and learning to accept new goals and challenges, are almost as important as practical management of the disease.

References

  1. Weintraub D, Comella CL, Horn S. Parkinson's disease-Part 1: Pathophysiology, symptoms, burden, diagnosis, and assessment. Am J Manag Care. 2008; 14(2 Suppl):S40-8.
  2. Schapira AHV The management of Parkinson’s disease - what is new? Eur J Neurol 2011;18(Suppl 1):1-2.
  3. Poewe W, Mahlknecht The clinical progression of Parkinson's disease. Park and Rel Dis 2009;15(Suppl 4):S28-S32.
  4. Chaudhuri KR, Ondo W. Handbook of Movement Disorders. London: Current Medicine Group, 2009.
  5. Goldman JG, Postuma R. Premotor and nonmotor features of Parkinson’s disease. Curr Opin Neurol 2014; 27 (4): 434-441.
  6. Kalia LV, Lang AE. Parkinson’s disease. Lancet 2015; 386 (9996): 896–912.
  7. The Global Burden of Disease Study 2016, Lancet.com. 2017. Available at https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32154-2/fulltext. Accessed November 2018.
  8. Kowal SL, Dall TM, Chakrabarti R, et al. The current and projected economic burden of Parkinson’s disease in the United States. Mov Disord 2013; 28 (3): 311-318.
  9. de Lau LML, Breteler Monique MB. Epidemiology of Parkinson's disease. Lancet Neurology, 2006;5(6):525-535.
  10. Dorsey ER, Constantinescu R, Thompson JP, et al. Projected number of people with Parkinson disease in the most populous nations, 2005 through 2030. Neurology 2007;68(5):384-386.
  11. Jankovic J. Parkinson’s disease: clinical features and diagnosis. J Neurol Neurosurg Psychiatry 2008; 79: 368–376.
  12. Williams DR, Litvan I. Parkinsonian syndromes. Continuum (Minneap Minn) 2013; 19 (5): 1189–1212.
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