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Parkinson's disease is also called primary parkinsonism for which no cause has yet been found.
Parkinson has no cure but a variety of medications provide dramatic relief from the symptoms.     Learn more...
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What is Parkinson's?

Creating Awareness About Parkinson's Disease
The Society's principal mission is to create awareness about the disease. As part of the Global Parkinson’s Day the Chairman of Pakistan Parkinson’s Society, Mr. Haroon Basheer, participated together with two leading neurologists in a 30 minute TV program on Parkinson’s disease [PD]. This program was aired on Indus TV's program, Sehat Online, and was broadcast nationally and beamed to 132 countries of the world. Mr. Basheer shared his personal perspective as a patient and gave a message of hope and a ”Never Surrender” attitude.

Penmanship Maintenance with Parkinson's
by Erica Jacques
During one of my internships, I worked with a patient who was having trouble with his writing. I had never seen anything like his script before. The beginning of his sentence was fairly legible, but as he continued to write, the words gradually shrank in size until they were barely visible.
With little to no understanding of what was going on with this gentleman, I consulted my fieldwork supervisor. She looked at his writing sample, and passed it to another therapist. The two exchanged knowing glances. I felt like I was missing something huge.
"Does he have the diagnosis yet?" the other therapist asked my supervisor. She shook her head, and looked back at me.
"Do you know what this is, Erica?"
It was my turn to shake my head.
"I think your patient has Parkinson's disease."
At that time, as a student, I had no idea how she had come to that conclusion merely by looking at a writing sample. When I think back now, however, it was obvious.
Writing problems are common to many conditions, such as arthritis or multiple sclerosis. Most manifest as illegible words due to lack of hand control, or decreased ability to grip a pen or pencil. In most cases, words are often shaky or wavy. Only in Parkinson's do the words become impossibly small, a trait known as micrographia.
Some writing strategies for Parkinson's patients include using pens with a larger or built-up grip, or repeatedly tracing large letters or shapes on paper to make the flow of writing more consistent. Pausing between words can sometimes help, as can printing instead of writing in cursive. A great way to practice penmanship maintenance is to work on word or number puzzles that require printing one letter or number at a time.
Different methods work for different people, and no solution works 100 percent of the time, so it is always best to have a backup plan. Any of these techniques may help ease a loved one's frustration.
My patient was discharged from the hospital before I had a chance to follow up with him. Years later, I still wonder what happened to him, and if he was ever diagnosed with Parkinson's disease.
What is Parkinson's Disease
Parkinson's disease belongs to a group of conditions called motor system disorders. The four primary symptoms are tremor or trembling in hands, arms, legs, jaw, and face; rigidity or stiffness of the limbs and trunk; bradykinesia or slowness of movement; and postural instability or impaired balance and coordination. As these symptoms become more pronounced, patients may have difficulty walking, talking, or completing other simple tasks. The disease is both chronic, meaning it persists over a long period of time, and progressive, meaning its symptoms grow worse over time. It is not contagious nor is it usually inherited that is, it does not pass directly from one family member or generation to the next. Parkinson's disease is the most common form of parkinsonism, the name for a group of disorders with similar features. These disorders share the four primary symptoms described above,
and all are the result of the loss of dopamine producing brain cells. Parkinson's disease is also called primary parkinsonism or idiopathic Parkinson's disease; idiopathic is a term describing a disorder for which no cause has yet been found. In the other forms of parkinsonism either the cause is known or suspected or the disorder occurs as a secondary effect of another, primary neurological disorder.
What Causes the Disease?
Parkinson's disease occurs when certain nerve cells, or neurons, in an area of the brain known as the substantia nigra die or become impaired. Normally, these neurons produce an important brain chemical known as dopamine. Dopamine is a chemical messenger responsible for transmitting signals between the substantia nigra and the next "relay station" of the brain, the corpus striatum, to produce smooth, purposeful muscle activity. Loss of dopamine causes the nerve cells of the striatum to fire out of control, leaving patients unable to direct or control their movements in a normal manner. Studies have shown that Parkinson's patients have a loss of 80 percent or more of dopamine-producing cells in the substantia nigra. The cause of this cell death or impairment is not known but significant findings by research scientists continue to yield fascinating new clues to the disease.
Who Gets Parkinson's Disease?
About 50,000 Americans are diagnosed with Parkinson's disease each year, with more than half a million Americans affected at any one time. Getting an accurate count of the number of cases may be impossible however, because many people in the early stages of the disease assume their symptoms are the result of normal aging and do not seek help from a physician. Also, diagnosis is sometimes difficult and uncertain because other conditions may produce some of the symptoms of Parkinson's disease.
Parkinson's disease strikes men at a slightly higher rate than women and it knows no social, economic, or geographic boundaries. Some studies show that African-Americans and Asians are less likely than whites to develop Parkinson's disease. Scientists have not been able to explain this apparent lower incidence in certain populations. It is reasonable to assume, however, that all people have a similar probability of developing the disease.
Age, however, clearly correlates with the onset of symptoms. Parkinson's disease is a disease of late middle age, usually affecting people over the age of 50. The average age of onset is 60 years. However, some physicians have reportedly noticed more cases of "early-onset" Parkinson's disease in the past several years, and some have estimated that 5 to 10 percent of patients are under the age of 40.
What are the Early Symptoms?
Early symptoms of Parkinson's disease are subtle and occur gradually. Patients may be tired or notice a general malaise. Some may feel a little shaky or have difficulty getting out of a chair. They may notice that they speak too softly or that their handwriting looks cramped and spidery. They may lose track of a word or thought, or they may feel irritable or depressed for no apparent reason. This very early period may last a long time before the more classic and obvious symptoms appear.
Friends or family members may be the first to notice changes. They may see that the person's face lacks expression and animation (known as "masked face") or that the person remains in a certain position for a long time or does not move an arm or leg normally. Perhaps they see that the person seems stiff, unsteady, and unusually slow.
As the disease progresses, the shaking, or tremor, that affects the majority of Parkinson's patients may begin to interfere with daily activities. Patients may not be able to hold utensils steady or may find that the shaking makes reading a newspaper difficult. Parkinson's tremor may become worse when the patient is relaxed. A few seconds after the hands are rested on a table, for instance, the shaking is most pronounced. For most patients, tremor is usually the symptom that causes them to seek medical help.
What are the Major Symptoms of the Disease?
Parkinson's disease does not affect everyone the same way. In some people the disease progresses quickly, in others it does not. Although some people become severely disabled, others experience only minor motor disruptions. Tremor is the major symptom for some patients, while for others tremor is only a minor complaint and different symptoms are more troublesome.
  • Tremor: The tremor associated with Parkinson's disease has a characteristic appearance. Typically, the tremor takes the form of a rhythmic back-and-forth motion of the thumb and forefinger at three beats per second. This is sometimes called "pill rolling." Tremor usually begins in a hand, although sometimes a foot or the jaw is affected first. It is most obvious when the hand is at rest or when a person is under stress. In three out of four patients, the tremor may affect only one part or side of the body, especially during the early stages of the disease. Later it may become more general. Tremor is rarely disabling and it usually disappears during sleep or improves with intentional movement.
  • Rigidity: Rigidity, or a resistance to movement, affects most parkinsonian patients. A major principle of body movement is that all muscles have an opposing muscle. Movement is possible not just because one muscle becomes more active, but because the opposing muscle relaxes. In Parkinson's disease, rigidity comes about when, in response to signals from the brain, the delicate balance of opposing muscles is disturbed. The muscles remain constantly tensed and contracted so that the person aches or feels stiff or weak. The rigidity becomes obvious when another person tries to move the patient's arm, which will move only in ratchet-like or short, jerky movements known as "cogwheel" rigidity.
  • Bradykinesia: Bradykinesia, or the slowing down and loss of spontaneous and automatic movement, is particularly frustrating because it is unpredictable. One moment the patient can move easily. The next moment he or she may need help. This may well be the most disabling and distressing symptom of the disease because the patient cannot rapidly perform routine movements. Activities once performed quickly and easily such as washing or dressing may take several hours.
  • Postural instability: Postural instability, or impaired balance and coordination, causes patients to develop a forward or backward lean and to fall easily. When bumped from the front or when starting to walk, patients with a backward lean have a tendency to step backwards, which is known as retropulsion. Postural instability can cause patients to have a stooped posture in which the head is bowed and the shoulders are drooped. As the disease progresses, walking may be affected. Patients may halt in mid-stride and "freeze" in place, possibly even toppling over. Or patients may walk with a series of quick, small steps as if hurrying forward to keep balance. This is known as festination.
Are There Other Symptoms?
Various other symptoms accompany Parkinson's disease; some are minor, others are more bothersome. Many can be treated with appropriate medication or physical therapy. No one can predict which symptoms will affect an individual patient, and the intensity of the symptoms also varies from person to person. None of these symptoms is fatal, although swallowing problems can cause choking.
  • Depression: This is a common problem and may appear early in the course of the disease, even before other symptoms are noticed. Depression may not be severe, but it may be intensified by the drugs used to treat other symptoms of Parkinson's disease. Fortunately, depression can be successfully treated with antidepressant medications.
  • Emotional changes: Some people with Parkinson's disease become fearful and insecure. Perhaps they fear they cannot cope with new situations. They may not want to travel, go to parties, or socialize with friends. Some lose their motivation and become dependent on family members. Others may become irritable or uncharacteristically pessimistic. Memory loss and slow thinking may occur, although the ability to reason remains intact. Whether people actually suffer intellectual loss (also known as dementia) from Parkinson's disease is a controversial area still being studied.
  • Difficulty in swallowing and chewing: Muscles used in swallowing may work less efficiently in later stages of the disease. In these cases, food and saliva may collect in the mouth and back of the throat, which can result in choking or drooling. Medications can often alleviate these problems.
  • Speech changes: About half of all parkinsonian patients have problems with speech. They may speak too softly or in a monotone, hesitate before speaking, slur or repeat their words, or speak too fast. A speech therapist may be able to help patients reduce some of these problems.
  • Urinary problems or constipation: In some patients bladder and bowel problems can occur due to the improper functioning of the autonomic nervous system, which is responsible for regulating smooth muscle activity. Some people may become incontinent while others have trouble urinating. In others, constipation may occur because the intestinal tract operates more slowly. Constipation can also be caused by inactivity, eating a poor diet, or drinking too little fluid. It can be a persistent problem and, in rare cases, can be serious enough to require hospitalization. Patients should not let constipation last for more than several days before taking steps to alleviate it.
  • Skin problems: In Parkinson's disease, it is common for the skin on the face to become very oily, particularly on the forehead and at the sides of the nose. The scalp may become oily too, resulting in dandruff. In other cases, the skin can become very dry. These problems are also the result of an improperly functioning autonomic nervous system. Standard treatments for skin problems help. Excessive sweating, another common symptom, is usually controllable with medications used for Parkinson's disease.
  • Sleep problems: These include difficulty staying asleep at night, restless sleep, nightmares and emotional dreams, and drowsiness during the day. It is unclear if these symptoms are related to the disease or to the medications used to treat Parkinson's disease. Patients should never take over-the-counter sleep aids without consulting their physicians.
How do Doctors Diagnose Parkinson's Disease?
Even for an experienced neurologist, making an accurate diagnosis in the early stages of Parkinson's disease can be difficult. There are, as yet, no sophisticated blood or laboratory tests available to diagnose the disease. The physician may need to observe the patient for some time until it is apparent that the tremor is consistently present and is joined by one or more of the other classic symptoms. Since other forms of parkinsonism have similar features but require different treatments, making a precise diagnosis as soon as possible is essential for starting a patient on proper medication.
For more information on PD management and how we can help write to us at info@parkinsons.org.pk.