How to tell if you have Parkinson’s
We are getting older. There’s no disputing it. And I’m not just referring to myself and my wonderful partner, friends and peers – as a country we are ageing at a phenomenal rate. In the next 30 years, the population of over-75s is expected to double, which will inevitably mean that diseases affecting ‘‘old people’’ will become extremely common.
One such disease is Parkinson’s, or PD. The number of people with PD has risen steadily from approximately 7300 in 2006 to 10,700 in 2017 – and is expected to double in the next 25 years.
This predicted growth in numbers is partly because PD is much more common in older people, but also because people diagnosed with PD at younger ages are now living much longer than they did previously.
PD is a progressive condition, so tends to get worse with time, and can’t be cured. Despite this, it is treatable, which means that for many sufferers the symptoms can be kept at bay, or controlled to a degree.
PD affects a small part of the brain known as the substantia nigra. Cells in this part of the brain are responsible for producing a neurotransmitter (or chemical) called dopamine.
Dopamine is essential for our functioning and affects our emotional responses, how we control our movements and also our ability to focus and be attentive. In PD, cells in the substantia nigra die, leading to a deficiency in levels of dopamine.
We don’t know much about why some people get PD and others don’t, but around 10 per cent of cases are thought to be familial – they have a genetic link and can affect several members of the same family.
It is slightly more common in men than women and is definitely related to ageing – rates are three times as high for people in their 80s, compared to those in their 60s.
The onset of PD is insidious and gradual – and signs can often be very subtle to start with. The main symptoms include:
Slowness of movement
Known as bradykinesia, sufferers may notice a slowing down of a variety of movements, such as walking, or getting up from a chair. At first, this is often attributed to ‘‘getting old’’ and it isn’t until other symptoms appear that the significance may become clear. In later stages of PD, bradykinesia can cause a very slow, shuffling gait and people can experience real difficulty both starting and stopping walking.
Stiffness or rigidity
Muscles start to feel tense and can be difficult to move freely. Typically, this may mean that when someone with PD walks, their arms won’t swing and, if it affects the face, they can appear ‘‘expressionless’’, finding it difficult to move the muscles that lead to smiling, frowning and other expressions.
Tremor
Shaking or tremor is very common in PD, but, for some people, this won’t be an issue. It tends to affect the hands, fingers, thumb and arm predominately, but can affect other parts of the body, too. It is worse when at rest and improves when focusing on a task, such as tying a shoelace or picking up a cup of tea.
Other symptoms that can occur later in the course of the disease, but certainly don’t affect everyone with PD, include:
■ Difficulty with balance and posture, leading to an increased tendency to fall
■ Monotonous, slow speech
■ Issues with swallowing leading to pooling of saliva in the mouth, and sometimes dribbling ■ Tiredness
■ Aches and pains
■ Constipation and bladder symptoms, including for some people incontinence
■ Hallucinations, for example, seeing, hearing or smelling things that are not real
■ Sweating
■ Sexual difficulties
■ Sleep problems
■ Weight loss
■ Depression and anxiety
■ Dizziness on standing (due to a sudden fall in blood pressure).
The symptoms of PD are the key to making a diagnosis: if a number of them are present, particularly if they are getting gradually worse, then it is very possible that PD could be the cause.
Although there is no positive, definitive test that confirms it, the diagnosis is usually made by a specialist who may request some investigations, such as blood tests or a brain scan, to make sure the symptoms aren’t the result of some other condition or disease.
Some medication can cause Parkinson’s-like symptoms, so your doctor will check that any drugs you are taking aren’t contributing to your condition.
A diagnosis of PD can understandably feel devastating for sufferers and their loved ones, but the good news is that treatment is available, and, for many people, it will reduce symptoms and improve quality of life quite dramatically.
All treatment should be tailored to the individual and their family and should be reviewed regularly.
A package of care should be ‘‘multidisciplinary’’ and might include several therapists, such as
physios, speech language and occupational therapists, as well as extra support and home modification for the family and patient – as required.
Medication involves three groups of drugs, and treatment often requires a combination of these:
■ Levodopa – This tends to be the most effective treatment, and most Parkinson’s sufferers will respond to it, at least initially. Unfortunately, it can bring side-effects especially in longer-term use, and its efficacy tends to wear off with time, so delaying its use until the disease is more advanced can be a good tactic.
■ Dopamine agonists – They tend to be less effective than levodopa, but are often used as the first option for younger patients; then levodopa can be substituted or added in if side-effects become problematic, or when the disease progresses.
■ Monoamine oxidase B inhibitors – Again, this group tends to be used early on, to delay the need for levodopa. It can also be used in combination with levodopa in more advanced stages of PD. There are also newer medications (known as COMT inhibitors) that can be tried and other drugs that can be used to target specific symptoms, such as dribbling.
As the disease progresses and perhaps starts to impact more on quality of life, co-existing depression and anxiety are commonplace, and entirely understandable. Talking therapies, appropriate support and antidepressants can all help, so make sure you talk to your doctor, if this is an issue.
I highly encourage anyone who either has or cares for someone with PD to contact Parkinson’s New Zealand (parkinsons.org.nz, or 04 801 8850) which can connect people with local support groups.
It also has a wealth of resources, and its community educators can provide home visits to assess your needs, and develop a medical plan that upholds your health and lifestyle.