Mick Reedy, MD, Movement Disorders Specialist with IPMDC, is the author of this series on the basics of Parkinson’s.
Please click on the links to the right for more information on the topics listed.
Parkinson’s Disease
Parkinson’s Disease (PD) is a neurodegenerative disease of the nervous system that affects 1-2% of patients over the age of 60. Most cases are sporadic (happen for unclear reasons), and it is very uncommon for PD to run in the family. Symptoms of PD are thought to be due to a deficiency in a brain chemical called “dopamine.” Dopamine is like a “battery” for the brain. It allows people to move more freely. It is also as involved with mood, thinking/memory, decision-making, and numerous other functions. Every person’s Parkinson’s Disease affects them differently.
Diagnosis
Parkinson’s Disease is diagnosed when people have slowness, stiffness, and occasionally tremor (~30% of people with PD). By definition, people with PD have to have slowness (also called “bradykinesia”). This is tested by watching the speed and quickness of your movements (when you tap your fingers, open you hands, wave your hands, stomp your feet, and tap your toes). Those with PD do not move as quickly or fluidly as their peers. PD causes stiffness in either the neck, arms, or legs. This is tested when physicians passively move your necks, arms, and legs when you are seated at rest. Tremor is common, but not everyone has it. It is evaluated by watching your face, hands, and feet when you are at rest, holding your arms up, and reaching your fingers to a target.
Treatment
Because Parkinson’s Disease is thought to be a deficiency in dopamine, we have found that replacing dopamine with a precursor called levodopa is oftentimes helpful in treating slowness, stiffness, and tremor (if present). Levodopa is absorbed in the small intestines and makes its way to the brain where it is broken down into dopamine that the brain can use however it likes. Levodopa has many formulations that different physicians will use depending on your symptoms and responses to the medications. The most commonly prescribed formulation of levodopa is called Sinemet IR (carbidopa/levodopa). Carbidopa prevents the breakdown of levodopa in the blood which allows it to reach the brain mor effectively. Other types of medications all act to “boost” dopamine by either making dopamine receptors more responsive or prolonging the effects of dopamine. These types of agents include dopamine agonists, COMT inhibitors, and monoamine oxidase (MAO) inhibitors. Your physician will let you know if these medications will benefit you as there are side effects that need to be considered.
Risk of melanoma
Studies suggest that persons with PD have a 2 to 20 times increased risk for melanoma compared to persons without PD. This risk is not thought to be related to the medications taken for PD, but you may see it written that melanoma is a potential adverse effect to medication.
We recommend that you see a dermatologist for a thorough evaluation and then follow up for skin screening on an annual basis. It is possible that the dermatologist you see may not be familiar with the increased risk of melanoma associated with PD. This is likely because the data are relatively new and mainly published in the movement disorders scientific literature rather than the dermatology literature.
Symptoms
There are numerous other symptoms that can be a result of having Parkinson’s Disease. There is often not enough time to discuss all of these potential symptoms, but here is a list of symptoms that are associated with PD: shrinking handwriting, loss of smell, hand or foot cramping, shuffled gait, short steps, feet feeling stuck when trying to start moving (called “freezing of gait”), falls, decreased facial expression, quiet voice, troubles swallowing liquids, excessive drooling, lightheadedness or dizziness with standing, constipation, frequent urination (both during the day and/or overnight), vivid dreams, sleep talking, acting out dreams while asleep, falling out of bed, anxiety, depression, apathy, short-term memory problems, hallucinations, and delusional/paranoid/odd thinking. Please know that these are only possible symptoms you may have, and that these symptoms may be unrelated to Parkinson’s Disease.
Additional information about the basics of Parkinson’s can be found throughout ipmdc.org.
- PowerPoint slides from our April 2024
- Recordings of our physicians speaking on the basics of Parkinsons
- Recently Diagnosed online guide
- Care Partner Tips and Tricks series