ABOUT PARKINSON'S

WHAT IS PARKINSON'S?

Parkinson’s disease is a brain disorder associated with a loss of dopamine-producing nerve cells (neurons) deep inside the brain. Dopamine is a neurotransmitter (a chemical substance) that helps regulate the body’s movement. Less dopamine in the brain means less control over movement and less mobility in general. Many treatments for Parkinson’s work to replace or enhance lost dopamine.

Parkinson’s is both chronic and progressive, which means symptoms will change and get worse as time goes on. The rate of progression will vary from person to person. While Parkinson’s does not directly cause death, complications such as choking due to swallowing difficulties, pneumonia from aspirating food into the lungs or severe injury caused by falls that can come in the late stages of Parkinson’s may lead to death.

Parkinson’s is officially classified as a movement disorder because it involves damage to the areas of the brain, nerves and muscles that affect the speed, quality, fluency and ease of movement. While the effects of Parkinson’s on movement are often the most visible symptoms, like tremor, other impacts of Parkinson’s not related to movement, like emotional and cognitive challenges, can sometimes have an even greater effect on your quality of life.

No two-people living with Parkinson’s will experience symptoms or progression of the disease in the exact same way. Just because something is listed as a symptom of Parkinson’s does not mean you will experience it.

Often, non-motor symptoms of Parkinson’s begin before the more visible physical symptoms. These are called “pre-motor symptoms.” Symptoms such as loss of smell, depression and constipation may appear years before your actual diagnosis.

Other non-motor symptoms of Parkinson’s can include difficulties sleeping, trouble with executive functioning, like making a decision or packing a suitcase, mood changes that can bring depression, apathy, anxiety (or some combination of these), sleep problems and fatigue.

The more visible physical symptoms of Parkinson’s, like tremors, slowness or stiffness, start in most people after 60-80% of certain dopamine-producing nerve cells are damaged. These symptoms are called motor symptoms. One of the main jobs dopamine-producing nerve cells have is controlling our movement, which includes the planning and initiation of movement. As these dopamine-producing neurons are lost, once routine everyday activities like walking and balance are affected.

By 2031, the number of Canadians diagnosed with Parkinson's is expected to double

Parkinson’s is a complex disease that can affect almost every part of the body, ranging from how you move to how you feel to how you think and process. While researchers have discovered certain genetic and environmental factors that seem to influence the development of Parkinson’s, there is no single cause of Parkinson’s or predictor of who will get it. Parkinson’s is not life-threatening, but it is progressive, meaning symptoms and effects of Parkinson’s get worse over time.

Since Parkinson’s affects everyone differently, the specific ways you choose to live well will be unique and will change over time. However, a positive attitude, staying engaged in your own health, consistently exercising and making a commitment to take action are steps everyone living with Parkinson’s can take to live well right now.

WHAT SYMPTOMS OCCUR WITH PARKINSON’S?

While there are common symptoms, Parkinson’s affects everyone differently. Simply because something is considered a symptom of Parkinson’s does not mean you will necessarily experience it. In the same way, being informed about the various effects Parkinson’s can have will help you and your family take action to live well today. Keep in mind that the combination of different Parkinson’s symptoms can sometimes compound the effects of each symptom, making you feel more overwhelmed and frustrated. For instance, falling asleep and staying asleep can be hard for people with Parkinson’s. Not getting a good night’s rest makes you more tired during the day, which can exacerbate feelings of fatigue and mood shifts like anxiety, apathy and depression.

COMMON SYMPTOMS OF PARKINSON'S INCLUDE:

Pre-motor: symptoms that happen before the common movement symptoms appear
Motor: symptoms that primarily impact movement
Non-motor: symptoms not directly related to movement, such as changes in mood, skin, vision, swallowing and how your brain processes information

PRE-MOTOR SYMPTOMS OF PARKINSON’S:

Diagnosing Parkinson’s typically focuses on the presence of cardinal motor signs of slowness, stiffness and rest tremor. However, many people with Parkinson’s can look back and realize they started experiencing early non-motor symptoms many years before motor symptoms began.

Early non-motor symptoms have become known as pre-motor symptoms, which include:

Rapid eye movement sleep behaviour disorder (RBD): may start 15 – 50 years before motor symptoms. The temporary “paralysis” most of us experience when we sleep preventing us from acting out our dreams is disrupted in people with RBD, so they physically act out their dreams.
Constipation: may start 10 – 20 years before motor symptoms
Depression and anxiety: may start up to 20 years before motor symptoms
Loss of smell: may occur only a short time before motor Symptoms appear

Researchers are investigating pre-motor symptoms with the hope that more information could help doctors diagnose Parkinson’s earlier, before so many of the dopamine-producing nerve cells are lost and motor symptoms set in. More knowledge about how Parkinson’s develops and evolves may also enable researchers to determine how to slow the progression of Parkinson’s or even prevent motor symptoms from starting.

MOTOR SYMPTOMS:

The impacts of Parkinson’s on movement are called motor symptoms. Primary motor symptoms include:
Tremor: a rhythmic shaking in your arms, legs or chin. Most people with Parkinson’s who experience tremor that is worse when relaxing and resting have rest tremor. Others experience active tremor, which means their shaking will worsen when trying to do something, like drinking out of a cup of coffee or eating with a spoon.

Rigidity: painful stiffness, often in the arms, legs, neck or back muscles.

Akinesia, Bradykinesia, Hypokinesia: Akinesia and bradykinesia refer to the reduction of movement, slowness of movement and sometimes even complete lack of movement that can be caused by Parkinson’s. Hypokinesia refers to a loss of momentum or force in movement that can come with Parkinson’s, usually in connection with akinesia, bradykinesia or both. The small, cramped handwriting (called micrographia) that some people with Parkinson’s experience is thought to be some combination of akinesia and hypokinesia.
Postural Instability: balance problems caused by a loss of reflexes that help you stay upright. This can cause challenges with general balance as well as walking (especially making a turn). Sometimes postural instability brings the tendency to fall backward, called retropulsion.

Early motor symptoms can also include a mask-like face or loss of facial expression, small, cramped handwriting (micrographia) and decreased natural arm swing.

People often complain of a heaviness feeling, dragging of one side or cramping in certain muscles. Speech can become softer and more difficult as Parkinson’s progresses and swallowing can also be affected.

As Parkinson’s progresses, walking can change from shuffling steps to festination, or a tendency toward smaller and faster steps that can tip you forward. Sometimes people with Parkinson’s will experience freezing of gait, feeling like your feet are glued to the floor and trouble starting to walk again once this happens. Freezing often occurs when you first begin to walk, make a turn or are in a tight and crowded space.

NON-MOVEMENT (NON-MOTOR) SYMPTOMS:

Parkinson’s is officially classified as a movement disorder and many of the most visible symptoms of the disease affect movement. Although these motor symptoms are often more noticeable, Parkinson’s also causes effects that are not related to movement, called non-motor symptoms. Non-motor symptoms may actually outnumber motor symptoms and can appear years before motor symptoms.
Non-motor symptoms can include:
Cognitive challenges
Memory problems
Feeling tongue-tied
Fatigue
Sleep problems
Anxiety
Depression
Apathy
Loss of smell
Numbness or tingling
Pain

*Information from Davis Phinney Foundation for Parkinson’s*