Parkinson’s Disease 101

Maria De Leon, M.D., Parkinson’s specialist and member, Parkinson’s Disease Foundation, People with

Parkinson’s Advisory CouncilLinda Pituch, Patient Services Manager, Parkinson’s

Disease Foundationwww.pdf.org

Goals and Objectives:

• Understand Parkinson’s disease• List the main symptoms• Understand the benefits and challenges of

medications• Learn other strategies for managing PD at all

stages• Understand how PDF can help you and your

patients

What is Parkinson’s Disease?

A chronic and progressive movement disorder, meaning that symptoms continue and worsen over time. The cause is unknown, and although there is presently no cure, there are treatment options such as medication and surgery to manage its symptoms.

Who Has Parkinson’s Disease?

• Approximately 1,000,000 Americans • Seven to 10 million people worldwide• Mostly (but not all) people over age 60– About two percent of population over 60– Average age of onset is 57– Four percent are diagnosed before age 50

• There is no test yet for Parkinson’s disease.• Making an accurate diagnosis is difficult• A skilled practitioner (PDF recommends a

movement disorders specialist) must observe a person’s symptoms, to diagnose Parkinson’s

How is Parkinson’s diagnosed?

What are the Symptoms of Parkinson's?

Primary Movement Symptoms:• Resting tremor• Bradykinesia (Slowness)• Rigidity• Postural instability

(balance)A Manual Of Diseases Of The Nervous System, Gowers, 1896

Nutt & Wooten, NEJM 2005

Other Common Movement Symptoms

• Freezing• Micrographia (shrinkage in handwriting)• Mask-like Facial Expression• Unwanted Accelerations• Stooped posture, a tendency to lean forward• Dystonia• Impaired fine motor dexterity and motor coordination• Impaired gross motor coordination• Poverty of movement (decreased arm swing)• Akathisia• Speech problems, such as softness of voice or slurred speech =• Difficulty swallowing• Sexual dysfunction• Cramping• Drooling

More Symptoms: Non-movement

• Sleep– Restless Leg Syndrome– REM Sleep Behavior Disorder

• Cognitive– Mild Impairment– Dementia

• Autonomic– GI Motility– Perspiration– Heart/Blood Pressure

• Psychosis – Hallucinations

• Mood– Depression– Anxiety

• Sensory– Pain (shoulder)– Hyposmia

• Fatigue/weakness– Often due to rigidity– Sleep issues too

What Causes Parkinson’s Disease?

• Scientists believe Parkinson’s is due to a combination of genetic and environmental factors.

• 90 percent of cases are of unknown origin

• 10 percent are inherited because of known to cause Parkinson’s

Madame Curie Bioscience Database

Parkinson’s DiseaseLoss of neurons in the substantia nigra

http://www.urmc.rochester.edu/neuroslides/slide199.html

But Parkinson’s is more than a

loss of dopamine

neurons in the substantia

nigra…

How Does Parkinson’s Progress?

• Differently for everyone• Rating scales?

How Can You Treat Parkinson’s?

• Prescription Medications• Surgical Treatments• The “Pipeline” and Clinical Trials

How Can You Treat Parkinson’s?Prescription Medications

• Most common is dopamine replacement/augmentation therapy– Carbidopa/Levodopa– Dopamine Agonists– Anticholinergics– MAO-B Inhibitors– COMT Inhibitors– Other medications

How Can You Treat Parkinson’s?Surgical Options• Deep Brain Stimulation

– reserved for later stages of disease

Motor Cortex

Motor Cortex

How Can You Treat Parkinson’s? “Pipeline” and Clinical Trials

• Gene Therapy– CERE-120 (neurturin), ProSavin, NLX-P101,

GDNF • Stem Cell Therapy– eSC, iPS, adult stem cells

• New Drugs– help with non-motor symptoms– help with side effects of levodopa

How Can You Treat Parkinson’s?

Side Effects and Limitations of Medications

• Side effects: Dyskinesia• Limitations: depression, constipation, sexual

dysfunction , fatigue, sleep disorder etc.

Managing Parkinson’s

• Finding a Specialist• Managing Medications• Coping with Symptoms• Exercise• Nutrition• Finding Support• Staying Independent• Hospital visits and other special issues

Some Myths: There are “exacerbations” in PD?• Common assumption • Potentially very dangerous

Reality: PD changes slowly, not over days or weeks• Something else must be going on!• This cannot be attributed to the PD• Need to find the underlying causeNirenberg, PDF Webinar Sep 29, 2009

Some symptoms should not be attributed to PD

• Fever

• Weight Loss

• Headache

• Acute or Sudden Weakness

• Vision Loss

• Back Pain

Nirenberg, PDF Webinar Sep 29, 2009

What can cause rapid worsening of PD symptoms?

Infection Medications Other illness

Nirenberg, PDF Webinar Sep 29, 2009

Secret: What is one of the most common silent causes for a “PD exacerbation?”

Urinary tract infection

Nirenberg, PDF Webinar Sep 29, 2009

Some medication changes can worsen PD symptoms

• Nausea medications• Antipsychotic medications• Reduction of PD medications

Nirenberg, PDF Webinar Sep 29, 2009

About the Parkinson’s Disease Foundation

Parkinson’s Disease Foundation

PDF was founded in 1957. We support the research and ideas that will improve the lives and futures of

people touched by Parkinson’s.

Parkinson’s Disease Foundation

• $96 million in scientific research funding• $40 million to education & advocacy programs• Reached and helped millions of people with• Parkinson’s and their families

Parkinson’s Disease FoundationHow We Can Help

• How can we help you?– Continuing Education for Health Care

Professionals• Course for physical therapists• Course for nurses• CEUs through our webinars

– Free publications for your patients– A HelpLine for you and your patients to find

doctors, resources, support groups and more.