An estimated 1.1 million Americans are living with Parkinson’s disease (PD), making it the second most common neurodegenerative disease after Alzheimer’s. “Parkinson’s is a disease in which neurons are lost over time,” explains Katherine D. Amodeo, M.D., an assistant professor of neurology and a movement disorders specialist at New York Medical College. The disease mainly affects the neurons that produce the chemical dopamine, which is responsible for movement, but it can also influence other brain chemicals that may affect memory, mood, and other non-motor skills, she adds.
The biggest risk factor for PD is age: Most cases are not diagnosed until people are in their 60s or older, though around 10% to 20% can experience symptoms before age 50 or even as early as their 20s (the actor Michael J. Fox was diagnosed at just 29). Genetics may be responsible for 10% to 15% of cases, and it is diagnosed in men at a higher rate than in women. Research is also looking into how environmental factors such as pesticide exposure may affect risk, says Dr. Amodeo.
The symptoms of PD usually develop slowly. And while it may be the disease’s effects on physical movement that bring someone to a neurologist to get the diagnosis, PD affects more than dopamine and motor symptoms, says Stuart H. Isaacson M.D., director of the Parkinson’s Disease & Movement Disorders Center of Boca Raton. “It also affects other parts of the nervous system, including different brain areas, peripheral nerves, the autonomic nervous system, and the gut nervous system, and this can lead to a number of non-motor symptoms,” he says.
Motor symptoms include:
Tremor while at rest, typically starting in the hand, foot, or leg
Rigidity, tightness, or stiffness of the limbs or the torso
Slowed movement, which can present as slower walking, smaller handwriting, and masklike facial features
Lower voice
Balance problems
Gait changes such as swinging the arms differently and taking smaller, slower steps
Non-motor symptoms may include:
Loss of smell
Constipation
Low standing blood pressure
Cognitive changes, such as taking longer to come up with a word
Acting out dreams
Hallucinations
Insomnia
Depression and anxiety
Fatigue
“Being faced with a Parkinson’s diagnosis can be very daunting, but most people with the disease live full, active lives,” says Dr. Isaacson, who adds that most Parkinson’s patients will not require a walker or a wheelchair and most do not develop cognitive impairment. “With the right treatment and support, you can live a good long life with Parkinson’s,” says Dr. Amodeo.
What treatments are available?
While there’s no cure yet for Parkinson’s disease, there are several effective ways to treat the symptoms, and many promising drugs are in the pipeline that may push back the symptoms even further, says Dr. Isaacson. “We have found that a comprehensive approach to identify and treat both motor and non-motor symptoms, combined with regular exercise and other wellness activities, is the best strategy for long-term management of PD,” he says.
New methods for older meds
Right now the standard treatment for motor symptoms is to replace the dopamine lost by patients’ brains, mainly through the use of a drug called levodopa. “In the past year, the FDA has approved three new medications for PD,” Dr. Isaacson says. “One is a longer-acting pill that replaces dopamine, and two are subcutaneous wearable devices, similar to an insulin pump for a person with diabetes, that deliver medication just beneath the skin for people who have fluctuations in how their medications help improve their motor symptoms.” With the wearable devices, patients can have steadier control of motor symptoms.
Treating the whole body
The FDA has approved several meds to treat common non-motor symptoms in people with PD, including an atypical antipsychotic for hallucinations and delusions, an alpha and beta–adrenergic agonist for low blood pressure symptoms, and an acetylcholinesterase inhibitor for dementia. For severe motor symptoms, a surgical procedure called deep brain stimulation may be recommended.
Hope for the future
“It’s a very exciting time—we think we’re going to have major breakthroughs in the next few years to better treat the symptoms and try to slow the progression of PD,” says Dr. Isaacson, who adds that though massive funding cuts for medical research are a big concern, he believes Parkinson’s research will continue. “Many of the drug programs are being funded by pharmaceutical companies, by private foundations such as the Michael J. Fox Foundation, and by people living with Parkinson’s and their families,” he says. In fact, research funded by the Michael J. Fox Foundation has recently discovered a biomarker that can identify people at high risk for Parkinson’s years before they exhibit symptoms, paving the way for early treatment and potentially even prevention.
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