Brought into the limelight by actor Michael J. Fox, Parkinson's disease affects the body’s ability to control movement.
The most prominent signs of Parkinson's disease result from damage to brain cells that produce a neurochemical called dopamine. Dopamine helps people have smooth, coordinated muscle movements by relaying messages to the parts of the brain that control mobility.
Damage to dopamine-producing cells can cause symptoms, such as tremors, stiffness, slowness and trouble with walking and balance.
"Signs and symptoms can start very gradually and often be mistaken for ‘normal aging’. A family member might be the first to notice an occasional shaking or tremor of the hands, slowing or shuffling of walking, or decreased facial expression," says Jori Fleisher, MD, a neurologist who specializes in movement disorders at Rush University Medical Center.
The damage to brain cells is not limited to those producing dopamine. Other symptoms such as depression, anxiety, cognitive impairment, constipation, drops in blood pressure and fatigue result from damage to other brain regions and are the focus of more recent research.
Unlocking the mysteries of Parkinson's disease
At present, Parkinson's disease is a chronic disease with no known cure. While symptoms can be managed with medication, surgical treatments and other forms of therapy, they continue to worsen over time.
"For decades, Rush has been a leader in studying the causes of Parkinson’s, the many related symptoms and treatments to address each of these,” Fleisher says.
The good news? Fleisher predicts that in the next decade there will be significant breakthroughs in treating Parkinson's disease and slowing the progression of the disease.
In fact, according to the National Institute of Neurological Disorders and Stroke, current advances in Parkinson's research have already raised realistic hopes of being able to halt the progression of the disease, restore lost function and even prevent it entirely.
While the timeframe for this is hard to predict — it could be within five to 10 years — one thing is certain: Hope is on the horizon. Here, Fleisher shares six things to know about Parkinson's disease.
Early detection may improve future treatments
One of the big pushes in Parkinson's research today is detecting the disease before characteristic movement symptoms, like tremors, surface.
Research suggests that dopamine begins to decline more than a decade before any neurological symptoms appear and that damage to other nervous system regions may occur even earlier. Very early signs of Parkinson's disease that may appear before evident motor deterioration include the following:
- Loss of sense of smell (or, anosmia) which begins about four to six years before movement dysfunction.
- Chronic constipation, which can begin up to 12 years before motor symptoms.
- Physically acting out dreams at night, a sleep disorder that is known as rapid eye movement (REM) sleep behavior disorder, can begin up to decades before any motor symptoms.
While these symptoms do not always signify Parkinson's disease, people should discuss these issues with a physician. By studying groups of people with early signs, researchers are developing treatments that target different parts of the brain that could slow, or even halt, the progression of the disease.
"Our goal is to find ways to prevent people from developing the symptoms that impact a person’s function and quality of life, and we're getting to a point where that is an achievable goal," Fleisher says.
Standard treatments are being tweaked
Since the late 1960s, levodopa (a medication that the brain converts to dopamine) has been the most effective treatment for addressing motor symptoms of Parkinson's disease. The problem for some patients is that levodopa does not provide the constant flow of dopamine necessary for smooth function throughout the day.
"Patients' symptoms may be well-controlled, and they may function well for many years once the right medication or combination is chosen. However, as time goes on and Parkinson’s progresses, the brain makes less and less dopamine. This translates to needing more medication or more frequent doses of medication, and as the medications wear off, the symptoms return," Fleisher says.
"It is hard for people with Parkinson’s and their care partners to live a normal life when symptoms are unpredictable and each day is different from the next."
In the past year alone, two new treatments have been approved that provide people with a more steady flow of medication — closer to how the brain normally works — to decrease fluctuations. This is a huge milestone for people living with Parkinson’s, and many more treatments are in the pipeline.
Surgical intervention decreases fluctuations and soothes symptoms
People who respond well to medications but struggle with fluctuations throughout the day may be eligible for deep brain stimulation (DBS), a surgical treatment in which a neurostimulator delivers tiny electrical signals to areas of the brain that control movement.
"DBS changes the electrical activity of the brain, like a pacemaker. People can experience significant improvement in their stiffness, tremor and slowness with this treatment," Fleisher says. "Although DBS isn’t right for everyone with Parkinson’s, it can be a life-changing improvement for many."
While DBS rarely means that a person will be able to completely stop all medications, it is a good option for otherwise healthy people who have periods where their medications aren't working.
In the past several years, Rush has been a pioneer for a new option called MR-guided focused ultrasound that can help ease medication-refractory hand tremor.
This outpatient procedure enables a neurosurgeon to precisely target the spot in your brain that controls the tremor — in a single session, without incisions or anesthesia. The surgeon uses sound waves (ultrasonic energy) to create a tiny scar in the brain, producing a therapeutic effect.
While it doesn't treat the underlying disease or slow disease progression, focused ultrasound has been shown to significantly improve quality of life. Easing hand tremor restores people's ability to write, eat and drink and do other tasks that had become difficult or impossible.
Exercise can improve function
In addition to its well-known effects of slowing down cognitive decline and boosting heart and lung function, exercise can help improve gait, balance, tremor, flexibility, grip strength and motor coordination in people with Parkinson's disease. Past and ongoing studies at Rush and other institutions are also looking at how exercise — including aerobic exercise — may, in fact, slow the progression of the disease.
Beneficial exercises include treadmill training, biking, dance, tai chi, yoga, and strength and flexibility training. Fleisher is a leader in research on karate for Parkinson's disease, and participants in this study have experienced improvement of their symptoms.
"People ask what they can do to slow down how quickly Parkinson’s is progressing, or how they can reduce their risk of Parkinson’s dementia. The answer to both: exercise. I recommend 150 minutes of moderately strenuous exercise each week, particularly aerobic exercise, to all of my patients and their families.”
“If someone is already doing that much — great! Add in a new form of exercise or increase the intensity — keep challenging yourself. If someone is pretty inactive, start small."
"Find any activity that you enjoy and that you’ll keep doing — ideally with a partner or friend to keep you accountable — and get moving. Every bit counts," Fleisher says. "The benefits are tremendous, both now and in your future, and there are few side effects."
Managing your mood is crucial
Living with a chronic, progressive disease can take a serious emotional toll on patients and their loved ones. Depression and anxiety are common symptoms of Parkinson’s disease, with up to 60% of people who have the disease experiencing mild or moderate depressive symptoms.
"Depression is one of the biggest culprits stealing quality of life for people with Parkinson's disease," Fleisher says. "We often spend so much time talking about the more obvious symptoms — like tremor or falls — but if we don’t address mood, we’re missing a big piece of the puzzle. Depression and anxiety in Parkinson’s are related to chemical changes in the brain — just like tremor and muscle stiffness. We have effective treatments for all of these symptoms and should be using them to help people with Parkinson’s live their fullest lives.”
Many patients benefit from psychological counseling, cognitive-behavioral therapy, and/or taking medications to help improve their mood. Support groups — such as the group hosted by Rush Oak Park Hospital the second Saturday of each month — can also help people with Parkinson's disease learn how to thrive despite their diagnosis.
“Social isolation is a big problem for people with Parkinson’s, and connecting with others who ‘get it’, in a space where they can leave any Parkinson’s stigma at the door, is very powerful”, Fleisher says. Finding your Parkinson’s community could be in one or more support groups, exercise classes or even social media platforms.
Don’t forget the care partners
Care partners and family members of people with Parkinson’s face high rates of caregiver strain, depression and social isolation, too.
“While the appointment might be booked for the person with Parkinson’s, it’s just as important that our care partners are educated, empowered and encouraged to care for their own physical and mental health, and connected to other people navigating similar challenges,” Fleisher says.
For that reason, Fleisher's team leads the first national, entirely virtual research study to help care partners of people with Parkinson’s and changes in their thinking or memory. The study, called PERSEVERE, has been designed by and for care partners and is enrolling in all 50 states and US territories.
For more information, visit redcap.link/PERSEVERE1
