Parkinson’s

Parkinson’s disease is one of the most common neurological (affecting the nerves) disorders. Although Parkinson’s disease is not curable, proven and novel medications and advanced treatments provide relief.

Overview: What is Parkinson's?

Parkinson’s disease predominantly – but not only – affects people older than 55 years. Men are affected slightly more often than women. When a person suffers from Parkinson’s disease, certain nerve cells in the brain gradually perish. It is mainly cells that produce the endogenous substance dopamine. As a hormone-like messenger between nerve cells, dopamine ensures that they can communicate with each other.

The lack of dopamine leads to an overabundance of other neurotransmitters in your brain. This imbalance can cause noticeable disturbances in mobility, for example, slowing down of movements. We can treat these limitations with medications. Complementary treatments (for example, physiotherapy) can give you further relief.

In addition, Parkinson’s disease also leads to disorders in other areas of the brain, and even in the nervous system that supplies the internal organs. Therefore, individuals affected by Parkinson’s suffer not only from motor symptoms such as slowing down and tremors, but also from a variety of non-motor symptoms. This can include constipation, loss of smell, acting out dreams at night, and as the disease progresses, other sleep problems, blood pressure disturbances, mood swings, memory problems, pain, and many other symptoms. It should be noted that these symptoms do not occur equally in all sufferers, or may not occur at all.

Parkinson’s disease – frequency and age

More than 15,000 people in Switzerland suffer from Parkinson’s disease. Every year, about 1,000 to 1,500 more people are affected. Most of them are between 50 and 60 years old at the time of diagnosis. The likelihood of developing PD increases with age: about one percent of 60-year-olds have PD and about three percent of 80-year-olds. It is true that Parkinson’s occurs much less frequently at younger ages. However, between five and ten percent of all people suffering from Parkinson’s disease are younger than 40. In these cases, experts speak of “early onset” Parkinson’s disease. When Parkinson’s presents before age 21, which is even less common, it is called “juvenile” (adolescent) Parkinson’s disease.

Parkinson's disease: causes and risk factors

Although Parkinson’s disease was described by the English physician James Parkinson as early as 1817, the cause of the disease named after him remains unknown in most cases. Experts therefore also speak of “idiopathic Parkinson’s syndrome”, or IPS for short. “Idiopathic” means that there is no identifiable cause. About 75 percent of all Parkinson’s patients have the idiopathic form of the disease.

This idiopathic Parkinson’s syndrome is based on a so-called protein aggregation disorder. This means that a protein, which also occurs in the healthy brain, folds pathologically and is then deposited in nerve cells. According to our current understanding, this leads to premature death of the nerve cells, i.e. a neurodegenerative disease. But why the protein behaves in this way is still not clear – we do not know the cause.

For the remaining 25 percent of people with PD, the cause of their disease is known. These can be divided into the following groups:

• Patients with familial Parkinson’s syndrome (also called genetic Parkinson’s syndrome) have inherited the predisposition to their disease. It often occurs before the age of 40.
• In patients with symptomatic Parkinson’s syndrome (also called secondary Parkinson’s syndrome), environmental factors or another disease are the trigger. For example, toxins, medications, a circulatory disorder, or a metabolic disorder.
• Individuals with atypical Parkinson’s syndrome suffer from a different neurodegenerative disease in which proteins are abnormally deposited and nerve cells die. These include, for example, progressive supranuclear palsy, multisystem atrophy, and Lewy body disease.

Symptoms: Parkinson

If someone has Parkinson’s disease, it must be expected that sooner or later noticeable symptoms will appear, which also do not remain hidden from the people around. They usually do not appear at the onset of the disease, and they can vary in severity:

• Akinesia: This symptom is always present, occasionally called bradykinesia or hypokinesia. It characterizes a slowing down and impoverishment of movements. Fluid movements become increasingly difficult and movements become slower. As a result, affected people may take longer to undo buttons or comb their hair. Steps when walking may become slower and smaller.
• Rigor: This refers to a stiffening of the muscles, which is often perceived as unpleasant by patients.
• Tremor: When the arms or legs rest still, tremor often occurs. Like all symptoms of Parkinson’s disease, it occurs initially on one side only, but later on both sides. It should be noted that not every person affected by Parkinson’s suffers from tremors.
• Postural instability: It is possible that Parkinson’s disease causes patients to unexpectedly lose their balance and fall. We call this lack of stability of the body postural instability (the Latin term “postura” means posture). The positional reflexes that keep us upright when we stand are diminished.

In addition to these typical Parkinson’s symptoms that affect motor function (the technique of movement), there may be other and non-motor symptoms, for example

• Sleep disorders, daytime sleepiness
• Constipation, delayed gastric emptying, bladder weakness, erectile dysfunction.
• Decreased blood pressure regulation (drop in blood pressure when standing up).
• Odor disorders
• Memory disorders
• Anxiety, depressive moods
• Pain
• Swallowing disorders, speech disorders

Parkinson’s disease: diagnosis by us

At a later stage of the disease, diagnosis is usually not so difficult: the combination of typical symptoms with the response to certain drugs gives good clues to the diagnosis. Detecting Parkinson’s disease early is much more difficult. Therefore, it helps to note changes in yourself that seem strange or suspicious as early as possible (with date). Perhaps you notice that your handwriting has changed, perhaps brushing your teeth is more difficult than before, perhaps daydreaming occurs towards the morning hours, perhaps your sense of smell is impaired. Such signs can help to detect Parkinson’s disease at an early stage.

After a clinical interview and examination, it must be clarified whether the diagnosis is correct or whether another disease is possibly present. Various methods are suitable for ruling out other clinical pictures:

• The levodopa test ( L-dopa test for short). The active ingredient levodopa (L-dopa) is a precursor of the body’s own dopamine. After administration of this substance, it is observed whether certain symptoms indicative of Parkinson’s improve as a result. If so, the L-dopa test has confirmed the suspicion of PD without being conclusive. With this detailed Test1 we get to know our patients very well.
• Magnetic resonance imaging(MRI), also known as nuclear magnetic resonance imaging This imaging procedure can be used to produce cross-sectional images that show the structures of the brain. Magnetic resonance imaging does not produce X-rays. Most often, people affected by Parkinson’s have a normal MRI, but individual findings may still indicate the diagnosis.
• Computed tomography(CT). This imaging technique is based on X-rays and is mainly used to rule out other causes of the disorder, such as a stroke or brain tumor. As with MRI, individuals affected by Parkinson’s usually present a normal image on CT.
• Nuclear medicine examinations (SPECT (Datscan®) and PET). These imaging techniques can visualize metabolic processes in the brain. Datscan® SPECT can be used to determine whether the amount of nerve cells that secrete dopamine is reduced. FDG-PET is used to visualize the brain’s sugar metabolism, which can be helpful in distinguishing Parkinson’s disease from other early-stage movement disorders.
• Sleep lab exams. In Parkinson’s disease there are very typical abnormalities in night sleep, which can be detected in the sleep laboratory and support the diagnosis. Furthermore, the examination helps in the differentiation of certain atypical Parkinson’s syndromes.
• Genetic Tests. If a familial burden or a genetic cause is suspected, further testing of specific genes can be diagnostic.
• With new devices, in our case developed by ETH, which are worn on the body, certain movement disorders can be examined in more detail, which can be very helpful from a diagnostic point of view.

Parkinson's disease: prevention, early detection, prognosis

There are no specific preventive measures that can be used to specifically avoid the changes in the brain that trigger Parkinson’s disease. However, general measures for health are recommended in any case, by eating a healthy diet, getting enough and good sleep, and getting plenty of exercise on a regular basis. A study from the USA suggests that people who do a lot of sport at a younger age have a lower risk of developing Parkinson’s disease later on. In an unpublished study from Germany, there is evidence that a meat-free or low-meat diet has a positive effect on risk, and our own research from Zurich shows a link between good deep sleep and a better prognosis.

There is still no proven treatment that delays or slows Parkinson’s disease. It is possible, however, that such a strategy will be available in a few years, although experience from Alzheimer’s research shows that we should not set our expectations too high for such a breakthrough. Then it becomes even more crucial to detect Parkinson’s disease early, if possible before motor symptoms. In particular, acting out dreams during sleep, known as REM sleep behavior disorder, could then play a key role.

Progression and prognosis of Parkinson’s disease

It is impossible to predict how a Parkinson’s disease will progress. The clinical picture is individual and can change several times over the years. It is to be expected that medications that initially help well will need to be re-dosed and supplemented after a period of time. In addition, as the disease progresses, more and more non-motor symptoms become apparent, which in certain cases can be even more drastic than the slowing and tremors.

Self-help groups

The exchange with people who are affected by the same disease can be a great support in coping with the disease. Advice on finding a suitable self-help group is available from Selbsthilfe Zürich. Self-Help Zurich and the University Hospital Zurich are cooperation partners in the national project “Health literacy thanks to self-help-friendly hospitals”.