Show 1490: Could It Be Parkinson's? Symptoms People Often Miss

Neurological conditions have been increasing over the past several decades, but none more quickly than Parkinson disease. What is this disorder, and what is driving the increase? We’ll discuss symptoms people often miss and find out about treatments.

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What Is Parkinson Disease?

This movement disorder is named after the doctor who first described it in a publication in 1817. As we mentioned, it has become more common in recent years, so you may not be surprised to learn of numerous celebrities who have or have had Parkinson disease (PD). Michael J. Fox may be one of the best known because he has worked so hard to gain recognition that PD can affect people in their 30s and 40s. Of course, like most degenerative conditions, it is more common as people age. Parkinson disease is characterized by a relative lack of dopamine. The areas of the brain that would normally produce this crucial neurotransmitter stop making it, for reasons that are not completely understood.

What Dopamine Does

We need dopamine for proper functioning with regard to movement, mood, sleep, attention and memory. This explains why some people with PD may experience cognitive challenges or depression. The FDA approved levodopa (AKA L-dopa) in 1970. It is still a mainstay of treatment for Parkinson disease, often with carbidopa. This therapy is more helpful for movement symptoms than for the other aspects of Parkinson disease, however.

Symptoms People Often Miss

In the past, it wasn’t possible to tell how much dopamine the brain might be making. A person might search for years to get the appropriate diagnosis because symptoms people often miss weren’t noticed.

People do think of tremor as a primary symptom of Parkinson disease, but they may confuse it with essential tremor. The tremor of PD occurs when the person is at rest. For example, the hands may shake while lying in the person’s lap. Essential tremor is completely different and occurs while the person is active, such as applying make-up or putting on earrings.

Another common symptom of PD is slower motion. It may take longer to cook a meal or get dressed. That is because we need dopamine to move. However, under some circumstances, slow-moving people can move remarkably quickly. Joe has noticed this with a tennis partner, and other people have seen it in emergencies.

New technology called DAT spect scan (for dopamine tags) makes it possible to tell if the brain is producing dopamine. The doctor may also order a MRI to make sure that the problem is with the dopamine area of the brain and not caused by a stroke or a tumor. After a diagnosis is established, the doctor may ask the patient to perform toe-tapping and finger-tapping exercises to assess how they are doing.

How Do Doctors Treat Parkinson Disease?

When we asked our guest, Dr. Nina Browner, what is at the top of her prescription pad for PD patients, she told us it is not a treatment but a conversation. Understanding the person and what is important to them is crucial in guiding the treatment. For example, one of her patients likes to run with his grown sons. This is their way of connecting. For this patient, treatment to maintain mobility is key.

High-Intensity Exercise for PD

Research, specifically the SPARKS 3 study, has shown that after 17 minutes of vigorous exercise, the brain produces more dopamine. Consequently, the recommendation is to exercise beyond 17 minutes and then stretch to loosen the muscles. For best results, people with PD need much more exercise than other individuals; 30 minutes three times a day provides a good baseline. For even greater efficacy, people might increase their activity up to 150 minutes a day. They can benefit from a wide range of activities, ranging from bicycling to boxing, from tai chi chuan to ping pong, Zumba or dancing. The social aspects of ping pong and Zumba might be especially helpful.

Beyond Movement to Symptoms People Often Miss

Levodopa, the prescription drug used to replace the missing dopamine, helps improve movement but it does little or nothing for the symptoms people often miss. Dr. Browner may refer patients for other treatments, such as speech therapy. Digestive difficulties (especially constipation) are very common, although people may not necessarily associate them with Parkinson disease. Patients frequently need help dealing with that.

Another area that can pose challenges is sleep. People with PD may be prone to something called REM sleep behavior disorder. As a result, instead of being immobilized during a dream as most of us are, they may act out their dreams, kicking, punching or leaping out of bed. Needless to say, this can result in injury for either the patient or their bed partner. The doctor may prescribe clonazepam for some of these sleep difficulties.

Cutting Edge Treatments

People with Parkinson disease may benefit from a treatment known as deep brain stimulation. This surgical procedure implants wires into the part of the brain most affected by PD. The battery to power the stimulation remains outside the body so that it can be changed when necessary. Those who undergo this procedure often benefit for an extended time.

Another nonpharmacological treatment is focused ultrasound. This acts similar to surgery, but it uses sound instead of a scalpel. You can hear more about this treatment in Show 1462: Using Focused Ultrasound Against Parkinson Disease and Tremor.

This Week's Guest

Nina Browner, MD, is the Bryson Distinguished Professor of Neurology at the UNC School of Medicine and Director of the UNC Parkinson Foundation Center of Excellence. A nationally recognized expert in Parkinson's disease and movement disorders, she leads clinical, research and educational programs dedicated to improving care for people living with neurological disease.

[caption id="attachment_141696" align="alignnone" width="240"] Dr. Nina Browner, Bryson Distinguished Professor of Neurology at the UNC School of Medicine
Photo credit: UNC Health[/caption]