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Parkinsonism, Parkinsonian, and Parkinson Disease

By: Dr. Vikki Alvarez
Neurologist, Movement Disorders Specialist

Parkinsonism is any condition that causes a combination of the movement abnormalities— such as tremor, slow movement, impaired speech or muscle stiffness. Patients with combination of these abnormal findings on examination as commonly identified as Parkinsonian patients. The most common cause of Parkinsonism is Parkinson disease or PD. In Parkinson’s disease, certain nerve cells (neurons) in the brain gradually break down or die. Many of the symptoms are due to loss of neurons that produce a chemical messenger in the brain called dopamine. When dopamine levels decrease, it causes abnormal brain activity, leading to signs of Parkinsonism.

Newly diagnosed PD patients can have several questions about their condition/diagnosis, so in this newsletter, I would like to address some of the most common questions asked by newly diagnosed PD patients.

Why did my neurologist think I have PD?

PD is a clinical diagnosis. The bedside examination by a neurologist remains the first and most important diagnostic tool for patients suspected of having PD. When questions arise, some newer imaging modalities such as PET and DAT scans may aid diagnosis, when performed by an expert in neuroimaging.

The classic or cardinal features of PD seen during examinations are:
Resting tremor
And Postural reflex impairment.

Could it be anything else other that PD?

Yes. PD is just the most common cause of Parkinsonism but there are other potential or possible causes. In general, there are ”red flags” that distinguish PD from other forms of Parkinsonism and neurologists will more likely discuss this if needed before a patient even asked.

Below are some of the possible causes of pakinsonism:

Degenerative causes like MSA, PSP, CBGD, FTD/PD, SCA, Alzheimer disease, Huntington’s disease, Wilson’s disease, Basal ganglia calcification etc.
Secondary causes like: post encephalitis, post traumatic, vascular/stroke, hydrocephalus, tumor, certain drugs, certain toxic substance etc.

How common is PD?

According to Parkinson’s Disease Foundation:
As many as one million Americans live with Parkinson’s disease, which is more than the combined number of people diagnosed with multiple sclerosis, muscular dystrophy and Lou Gehrig’s disease. Approximately 60,000 Americans are diagnosed with Parkinson’s disease each year, and this number does not reflect the thousands of cases that go undetected. An estimated seven to 10 million people worldwide are living with Parkinson’s disease. Incidence of Parkinson’s increases with age, but an estimated four percent of people with PD are diagnosed before the age of 50. Men are one and a half times more likely to have Parkinson’s than women

Are there risk factors? How did PD develop?
PD is a slowly progressive neurodegenerative disorder. Recent studies report that disease onset can be as early as 15 years before parkinsonism presents.

The following are risk factors in PD:
Age, family history, exposure to environmental toxins such as pesticide, head injury, constipation, depression, REM behavior sleep disorder.

The following had been proposed as potential mechanism s in the development of PD: Oxidative stress, mitochondrial failure, excitotoxicity, interference with DNA transcription, nitric oxide, inflammation, apoptosis, trophin deficiency, and infection.

So, what is next? Cure? Treatment?

At the moment, there is no cure for PD.
Similarly, there are no definite neuroprotection agent for PD in spite of more than 5000 research subjects. However, both the AAN (American Academy of Neurology) and MDS (Movement Disorders Society) recognize that utilizing current oral medications or surgical interventions may help alleviate or reduce parkinsonism. With appropriate medication adjustments with or/ without DBS (deep brain stimulation surgery), patients not only can have reduction of parkinsonian symptoms, they can also have less fluctuations, less dyskinesia, and better quality of life.

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