Overview of Parkinson's Disease


By David P. Gerstman, M.D.

Guest Blogger, Resident at the Mildred Shor Inn

Parkinson’s disease, or PD, is the second most common chronic neurological degenerative disease after Alzheimer’s. It mainly occurs later in life and is linked to decreased dopamine production in the substantia nigra of the midbrain. There is no known cause and no known cure.

The disease was originally reported by Dr. James Parkinson in the early 1800’s who described six cases of “Shaking Palsy,” consisting of tremor, abnormal posture and gait leading to paralysis. Those findings remain true today.

Treatment is palliative and includes both surgical and medical interventions due to the discovery of levodopamine in 1911. Life expectancy is generally reduced. After 10 years, most patients with PD will have sleep problems and cognitive decline.

There are five clinical stages of Parkinson’s disease:

  • Stage 1: Mild tremor affecting only one side of the body.
  • Stage 2: Symptoms are bilateral. There are generally problems with balance and walking because of increased tremors.
  • Stage 3: Movements are slowed. Patient has difficulty standing and often needs a wheelchair. There are writing and speech changes.
  • Stage 4: Slower movements and shuffling of feet. There is muscle rigidity. Patient needs assistance with daily activities. 
  • Stage 5: End stage Parkinson’s disease. Patient needs care around the clock. Patient may no longer be able to walk or stand without assistance. Patient is usually bedridden.    

Those suffering from PD include such celebrities as Mohammed Ali and Michael J. Fox. Mohammed Ali suffered from multiple episodes of head trauma occurring in the boxing ring, leading to PD.

There are also environmental causes of the disease including Agent Orange, a pesticide used in the Vietnam War. Approximately 15 % of the disease is hereditary. In addition to medication and surgery, physical therapy helps patients with PD restore balance. Robotics may also help patients with mobility.     

Diagnosis of PD is aided when there are brown-stained Lewy bodies in the substantia nigra, a structure located in the midbrain. However, Lewy bodies may also be found in such entities as Lewy body dementia, a rapidly progressing degenerative disease. In Lewy body dementia, symptoms occur upon discovery of the disease whereas in Parkinson’s disease dementia symptoms usually don’t occur until one year after discovery of the disease.

Some studies have shown that prevention of PD symptoms may occur with the use of exercise in middle age and increased consumption of caffeine.

April 11th has been designated as Parkinson’s Day which is the birthday of Dr.James Parkinson. A red tulip was chosen as the symbol of the disease in 2005.