Parkinson's Disease - Group 19


Definition

Parkinson's Disease (PD) is a disorder of the brain. It leads to shaking tremors and difficulty with walking, movement, and coordination.
Parkinson's disease is a progressive disorder of the nervous system that affects movement. It develops gradually, often starting with a barely noticeable tremor in just one hand. But while tremor may be the most well-known sign of PD, the disorder also commonly causes a slowing or freezing of movement.

Causes

Genes: Genetic mutations cause PD. Some of these mutations involve genes that play a role in Dopamine cell function. PD has developed at an early age in individuals with mutations in genes PINK1, LRRK2, DJ-1 and glucocerebrosidase.
Environment: Exposure to toxins or some viruses can trigger PD. These include insecticides permethrin, beta-hexachlorocyclohexane (beta-HCH), herbicides paraquat, 2,4- dichlorophenoxyacetic acid and fungicide maneb. A synthetic neurotoxin agent MPTP can cause immediate and permanent Parkinsonism.
Lack of Dopamine: PD occurs when certain brain cells that produce Dopamine die or become impaired.
Low Norepinephrine levels: Norepinephrine plays a role in regulating the autonomic nervous system, which controls automatic functions, such as blood pressure regulation. People with PD have damage to nerve ending that that make norepinephrine.
Presence of Lewy bodies: Unusual protein clumps found in the brain of patients with PD.

PD_pic.gif
This graph shows the dopamine levels for a normal movement and for a movement with disorders. As you can see, dopamine levels are very low in a person with Parkinson's Disease and very high in a person who doesn't have Parkinson's disease. Dopamine is a neurotransmitter that sends signals to the other nerve cells.
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Signs and Symptoms

*Symptoms vary from person to person
*Early signs often go unnoticed
*Begins on one side of the body then later affects both sides

There are 7 main signs and symptoms of Parkinson's Disease:
1. Tremors—the characteristic of shaking. It often begins in a hand. When the hand is at rest, a back-and-forth rubbing of the thumb and forefinger is also common.

Watch this to view a person with tremors from PD:


2. Bradykinesia (slow motion)—Over time, ability to initate voluntary movement may be reduced. This means that simple tasks may now be difficult. For example, if you are walking, your steps may become short and shuffling. Feet “freezing” to the floor can also happen making your first step very hard.

Watch this to view a person walking with PD before and after taking L-dopa (which will be discussed later):


3. Rigid muscles—muscle stiffness can occur in any part of your body. The more severe the stiffness, the more it limits the range of movement a person can do and causes more pain. Most people notice this when they can no longer swing their arms while walking (also demonstrated in the Shuffling gait video).

4. Impaired posture and balance—posture becomes stooped and balance problems occur; this usually appears in later stages.

5. Loss of automatic movements—things such as blinking, smiling, and swinging your arms when you walk are all unconscious acts that can be diminished or lost due to PD.

6. Speech changes—speech may be more soft, rapid, monotone, slurring, or repeating of words can happen.

7. Dementia—Memory and mental clarity may develop in later stages of PD.
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Medical Treatment

*There is no direct cure for Parkinson's Disease but there are medications and surgeries that can help control the disease. Physical therapy, lifestyle changes, and a diet modification are also recommended when diagnosed with Parkinson's disease to help control it.

Medications

*Medications can be helpful in managing walking, movements, and tremor by increasing dopamine in the brain.
The following are medications usually prescribed by doctors depending on what symptoms you have for Parkinson's Disease:
Levadopa—most effective drug which is always taken as a combination drug with another medication. It passes into the brain and is converted into dopamine.
Dopamine agonists—mimics the effects of dopamine in the brain and causes neurons to react as though dopamine is present. This drug cannot change into dopamine.
MAO B inhibitors—helps prevent the breakdown of both naturally occuring dopamine and dopamine formed from levodopa. They do this by inhibiting the activity of the enzyme monoamine oxidase B (MAO B). This enzyme metabolizes dopamine in the brain.
Catechol O-methyltransferase (COMT) inhibitors—prolongs the effect of carbidopa-levodopa therapy by blocking an enzyme that breaks down levodopa.
Anticholinergics—helps control the tremor in PD.
Glutamate (NMDA) blocking drugs—prescribed to provide short term relief of mild, early stage of PD.

Surgery

Deep brain stimulation is a surgical procedure used to treat PD. This involves implanting an electrode deep within the parts of your brain that control movement. The amount of stimulation delivered by the electrode is controlled by a pacemaker-like device placed under the skin in your upper chest. A wire that travels under your skin connects the device, to the electrodes. This is most often used with people in the advanced stage of PD. The risk factors to this surgery can include brain hemorrhage, stroke, infection, and sometimes requires parts of the device to be replaced. Infection is also a risk and sometimes requires parts of the device to be replaced.

Watch this video to hear from a PD patient who underwent this procedure:

Physical Therapy

Physical therapy may also be advised by doctors to maintain function. It can help with mobility, range of motion, and muscle tone. Maintaining muscle strength and agility can help counter some of the tendencies of the disease and make a patient feel more capable of doing things on their own.
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Dietary Treatment

**There have been no specific dietary treatments for Parkinson ‘s disease.

If taking L-dopa (7)
  • Watch intake of protein, pyridoxine and aspartame
  • Minimize dietary protein at breakfast and lunch
  • OR limit overall protein intake to 0.5-1 g protein/kg with even distribution throughout all meals

Weight loss is common (8)
  • Eat a well, balanced diet
  • Don’t skip meals

Constipation may occur (8)
  • Eat a diet with high fiber
    • Whole grain bread
    • Bran cereals or muffins
    • Fruits and vegetables
    • Beans & legumes
    • Prunes
  • Increase fluid intake

May have an increased risk of osteoporosis (9)
  • Consume calcium-rich foods
    • Milk & milk products
    • Calcium fortified foods
    • Dark, leafy greens
    • Three servings/day
  • Adequate Vitamin
    • Sun exposure regularly
    • Vitamin D-fortified milk
    • Yogurt
    • Breakfast cereals
    • Fatty fish

Some research may show that Coenzyme Q10 slows disease progression (8)

If there is nausea from medications
  • Ginger ale
  • Small snack with meds

Michael J. Fox is one person you may know that has PD. The video below shows a few insights about the disease from Fox himself.

References

1) http://www.mayoclinic.com/health/parkinsons-disease/DS00295/DSECTION=symptoms
2) http://www.mayoclinic.com/health/parkinsons-disease/DS00295/DSECTION=treatments-and-drugs
3) http://students.cis.uab.edu/kelseycp/Parkinson's.html
4) http://www.mayoclinic.com/health/parkinsons-disease/DS00295
5) http://www.mayoclinic.com/health/parkinsons-disease/DS00295/DSECTION=causes
6) http://www.pdf.org/en/causes?gclid=CIHvsaucv68CFYdeTAodRVQXuQ
7) Clinical class notes
8) http://www.livestrong.com/article/304390-nutritional-therapy-for-parkinsons/
9) http://www.pdf.org/en/winter06_07_Nutrition_and_Parkinson