Which clinical manifestations are included in a diagnosis of Parkinsons disease?

Parkinson's disease is a disorder of the nervous system. It results from damage to the nerve cells that produce dopamine, a chemical that is vital for the smooth control of muscles and movement.

Parkinson's disease mainly affects people aged over 65, but it can come on earlier.

What are the symptoms of Parkinson's disease?

The main symptoms of Parkinson's disease are:

• tremor or shaking, often when resting or tired. It usually begins in one arm or hand
• muscle rigidity or stiffness, which can limit movement and may be painful
• slowing of movement, which may lead to periods of freezing (inability to start moving) and small shuffling steps
• stooped posture and balance problems

The symptoms of Parkinson's disease vary from person to person as well as over time. Some people also experience:

• loss of unconscious movements, such as blinking and smiling
• difficulties with handwriting
• changes to speech, such as soft, quick or slurred speech
• anxiety or depression
• loss of smell
• constipation
• lack of urinary control
• sleep disturbance
• fatigue
• impotence
• drop in blood pressure leading to dizziness
• difficulty swallowing
• sweating

Many of the symptoms of Parkinson's disease could be caused by other conditions. For example, stooped posture could be caused by osteoporosis. But if you are worried by your symptoms, it is a good idea to see your doctor.

What causes Parkinson's disease?

Doctors do not yet know the cause of the disorder, and it's thought to be inherited in only a small proportion of cases. Exposure to certain toxins in the environment is also thought to play a small role.

When should I see my doctor?

See your doctor if you notice shaking, stiff muscles, lack of balance or slowing down of your movement. If they suspect you may have Parkinson's disease, they will refer you to a specialist such as a neurologist or geriatrician.

How is Parkinson's disease diagnosed?

Diagnosis is difficult at every stage of the disease, but particularly in the early stages. No single test can provide a diagnosis. A diagnosis will likely involve physical and neurological examinations, conducted over time to assess changes in reflexes, coordination, muscle strength, and mental function. Your doctor might also see how you respond to medicine.

You may need to have brain imaging tests to rule out other conditions that might be causing your symptoms. Such tests could include MRI and CT scans and possibly some other types of scans. Blood tests may also be done to exclude other illnesses.

How is Parkinson's disease managed?

Your doctors will tailor your treatment based on your individual circumstances. You will manage your condition best if you have the support of a team, which may include a general practitioner, neurologist, physiotherapist, occupational therapist, psychologist, specialist nurse and dietitian.

While there is no cure for Parkinson's disease, symptoms can be treated with a combination of the following.

Medicines

The medicines used to treat Parkinson's disease are designed to increase the level of dopamine in the brain. They may be given in pill form or via an injection or tube straight into the small intestine.

There are many different types of these medicines. The most commonly used are:

• levodopa, which replaces dopamine
• dopamine agonists, which copy the function of dopamine
• COMT inhibitors, which boost the response of levodopa
• MAO-B inhibitors, which help stop the breakdown of dopamine in the brain
• anticholinergics to help with the tremor
• amantadine, which is used for people who may have developed abnormal movements (known as dyskinesia)

People respond to medicines in different ways. So, if you are being prescribed medicine for Parkinson's disease, it may take some time to find the one that suits you best.

Surgery

Deep brain stimulation surgery can be used for some people to reduce the amount of medicine they need. It can reduce the tremor, or lessen wriggling movements in the body.

It involves implanting electrodes into the part of the brain that controls movement. The electrodes are connected to a tiny generator, implanted in the chest, that you can switch on to send electrical impulses to the brain. In most cases you are awake during the procedure.

Deep brain stimulation is not suitable for everyone. If you are interested in surgery, please discuss it with your doctor to see whether or not it is right for you.

Lifestyle changes

If you are living with Parkinson's, making changes to your lifestyle and physical environment may make it easier.

Healthy diet

Eating a high-fibre diet of fruit, vegetables and grains, and drinking plenty of water, can help prevent the constipation that often accompanies Parkinson's disease. Make sure you eat a balanced diet high in omega-3 fatty acids.

Exercise

Exercising may increase muscle strength and balance, and reduce depression and anxiety. A physiotherapist can advise about an exercise program and strategies to overcome problems such as freezing of movement and loss of balance.

Work

Your ability to continue working safely and productively may involve simple modifications to your workplace, flexible hours, and the regular review and adjustment to your medicines. Whether you tell your employer is up to you. Remember, it is illegal in Australia for employers to discriminate against employees or potential employees on the grounds of disability.

Relationships and sex

Some people with Parkinson's disease experience a decrease in sexual desire, performance or satisfaction. In others, medicines that substitute for dopamine can result in a preoccupation with sexual thoughts and desires. Seek advice from your doctor or a professional counsellor if this is affecting you.

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