Parkinson Disease

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What is PD?
Parkinson Disease (PD) is neurodegenerative disease affecting the nerve cells in the brain (substantia nigra) that produces dopamine resulting in dopamine deficiency. Dopamine is a chemical needed in order to send messages to part of the brain that controls movements and coordination. When the amount of dopamine produced in the brain decreases, a person will experience difficulty in controlling his or her movements.

Is Parkinsonism equal to the diagnosis of PD?
No. Parkinsonism is a general term that refers to a group of neurological disorders that cause movement problems, such as tremors, slow movement and stiffness. There are number of causes for Parkinsonism and one of the causes is PD.

Does it affect only older people?
No, PD can also affect younger adults (less than 40 years old) or even teenagers, although it mostly affects older people. The average age of onset is 60 years, and the incidence rises significantly with increasing age.

What is the cause of PD?
About 5-10% of PD cases are inherited and majority is multifactorial. Researches show links between PD and environmental factors such as exposure to pesticide, carbon monoxide toxicity, metal manganese and other chemicals. But in the great majority of PD cases, the cause is unknown.

What are the symptoms of PD?
PD is generally thought as a disease that only involves movement, such as slowness of movement, tremors and stiffness. However, most PD cases develop other symptoms not related to movement (non-motor symptoms), years before the movement symptoms. The non-motor symptoms are common and can be troublesome and disabling. The few common non-motor symptoms are loss of smell, sleep problems, constipation, anxiety and depression.

How to diagnose PD?
PD is diagnosed clinically based on the history and physical examination. It is important for the treating doctor to exclude other PD mimics such as Parkinson Plus Syndrome and secondary causes of Parkinsonism.
Do I need a scan of the brain to diagnose PD?
DaT scan, a dopamine transporter (DAT) single photon emission computerised tomography (SPECT) imaging can give your doctor more information regarding the cells’ function and support the diagnosis of Parkinsonism. However, DaT scan is not widely available and it does not confirm the diagnosis of PD.
CT brain or MRI brain scans basically give your doctor information regarding secondary causes of Parkinsonism.

What are the treatment options?
Generally the treatment for PD is to restore dopamine. This is usually done with medications either oral or patch. Medication will help to relieve or reduce the symptoms of PD. With the progression of PD, some patients might benefit from Apomorphine infusion or deep brain stimulation when the symptoms cannot be adequately controlled with oral medications.

What is the support and resources for PD patients?
Fortunately, nobody has to deal with PD all by themselves. It would be beneficial for PD patients to seek help from physician or neurologist with specialist interest in PD. Patients also can seek advice from Malaysian Parkinson’s Disease Association (MPDA).