Parkin­son’s dis­ease: More than shak­ing go­ing on

Re­searchers dis­cov­er­ing non-mo­tor symp­toms may hap­pen first

The Compass - - TRINITY SOUTH -

Parkin­son’s is much more than a tremor.That’s a mes­sage Parkin­son So­ci­ety Canada hoped to drive home this April dur­ing Parkin­son’s Aware­ness Month.

In Parkin­son’s, the most com­mon symp­toms are move­men­tre­lated: tremor, slow­ness, mus­cle stiff­ness and bal­ance prob­lems.

How­ever, by the time Parkin­son’s is di­ag­nosed, peo­ple have al­ready lost 60 to 70 per­cent of the dopamine-pro­duc­ing cells. Now re­searchers are dis­cov­er­ing that non-mo­tor symp­toms such as sleep prob­lems, de­pres­sion and smell loss may rep­re­sent the ear­li­est signs of Parkin­son’s, for some peo­ple, and may ap­pear years be­fore the di­ag­no­sis.

In re­search at Montreal’s SacréCoeur Hospi­tal, Dr. Ron­ald Pos­tuma, as­sis­tant pro­fes­sor of neu­rol­ogy at McGill Uni­ver­sity found that peo­ple with a rare sleep dis­or­der where they phys­i­cally acted out their dreams had a 50 per cent risk of de­vel­op­ing Parkin­son’s dis­ease or de­men­tia within 12 years. The pa­tients had REMsleep be­hav­iour dis­or­der, which Pos­tuma de­scribes as “punch­ing and yelling or kick­ing out while asleep. It mostly af­fects peo­ple in their 60s and 70s, al­most al­ways men.”

Not all will de­velop a neu­rode­gen­er­a­tive dis­ease but Pos­tuma says, “Pa­tients with true REM-sleep be­hav­iour dis­or­der have a con­sid­er­able risk of de­vel­op­ing Parkin­son’s dis­ease.”

De­pres­sion

De­pres­sion and anx­i­ety can sur­face early in Parkin­son’s.

“Many peo­ple, as they’re start­ing to lose their dopamine, may not yet have de­vel­oped a tremor, slow­ness or trou­ble walk­ing, but may feel anx­ious and de­pressed,” says Dr. Su­san Fox, as­sis­tant pro­fes­sor of neu­rol­ogy at Uni­ver­sity of Toronto.“De­pres­sion is also part of Parkin­son’s dis­ease it­self and not just a re­ac­tion to hav­ing a chronic neu­ro­log­i­cal dis­or­der.”

Fox notes un­treated de­pres­sion can re­duce qual­ity of life.

Smell loss is a com­mon oc­cur­rence.

“The gen­eral con­sen­sus is that the changes in ol­fac­tion (sense of smell) oc­cur about five years be­fore the Parkin­son’s di­ag­no­sis,” says Dr. Harold Robert­son, a pro­fes­sor in the Brain Re­pair Cen­tre and Depart­ment of Phar­ma­col­ogy at Dal­housie Uni­ver­sity in Hal­i­fax. “That could give us enough lead time to try to stop the process.”

Joyce Gor­don, Parkin­son So­ci­ety Canada pres­i­dent and CEO says, “The more dol­lars we can put to­wards Parkin­son’s re­search, the sooner we may be able to es­tab­lish if there is a def­i­nite link to Parkin­son’s when a per­son has sleep prob­lems, de­pres­sion or loss of smell.This would lay the ground­work for de­vel­op­ing treat­ments to de­lay or stop this de­bil­i­tat­ing dis­ease in its tracks. The an­swers can’t come soon enough for the 100,000 Cana­di­ans who have Parkin­son’s dis­ease and those who are un­know­ingly at risk.”

In the mean­time, the first step for any­one ex­pe­ri­enc­ing dif­fi­cul­ties with sleep or mood is to see a doc­tor for a proper di­ag­no­sis. REM sleep be­hav­iour dis­or­der and de­pres­sion are treat­able. Smell loss is not cur­rently treat­able but is worth men­tion­ing to the doc­tor, dur­ing a rou­tine visit, as it may be due to a va­ri­ety of causes.

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