Number of people of affected:
1 million in the U.S.

Who gets it:
One in 100 people over age 60.

Symptoms:
tremors or trembling of a limb, especially when the body is at rest, slow movement, an inability to move, rigid limbs, a shuffling gait, and stooped posture.

Treatments:
Dopamine Replacement Therapies, Dopamine Agonists, MAO-inhibitors, COMT-inhibitors or pallidotomy surgery

Doctors to see:
Neurologist, Movement Disorders Specialist

Parkinson's disease was first characterized extensively by an English doctor, James Parkinson, in 1817. Parkinson's is a disorder of the central nervous system that results from the loss of cells in various parts of the brain, including a region called the substantia nigra, which produces dopamine, a chemical messenger responsible for coordination of movement. Loss of dopamine causes neurons to fire without normal control, leaving patients less able to direct or control their movement. Parkinson's is one of several diseases categorized by clinicians as movement disorders.

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Often, the first symptom of Parkinson's disease is tremor (trembling or shaking) of a limb, especially when the body is at rest. The tremor often begins on one side of the body, frequently in one hand. Other common symptoms include:

• Slow movement (bradykinesia)
• Inability to move (akinesia)
• Rigid limbs
• A shuffling gait Stooped posture
• Balance problems
• Difficulty swallowing or chewing
• Foot pain and toe curling

People with Parkinson's disease often have reduced facial expressions and speak in a soft voice. Occasionally, the disease also causes depression, personality changes, dementia, sleep disturbances, speech impairments, or sexual difficulties. The severity of Parkinson's symptoms worsen over time.

Parkinson's disease is usually diagnosed by a neurologist who can evaluate symptoms and their severity. There is no test that can clearly identify the disease. Sometimes people with suspected Parkinson's disease are given anti-Parkinson's drugs to see if they respond. Other tests, such as brain scans, can help doctors decide if a patient has true Parkinson's disease or some other disorder that resembles it.

There is no cure for Parkinson's disease. Many patients are only mildly affected and need no treatment for several years after the initial diagnosis. When symptoms grow severe, doctors usually prescribe levodopa (L-dopa), which helps replace the brain's dopamine. Sometimes doctors prescribe other drugs that affect dopamine levels in the brain. Medications include: Dopamine Replacement Therapies, (Examples: Levodopa/Carbidopa), Dopamine Agonists (Example: Pramipexole, Ropinerole, Bromocriptine), MAO-inhibitors (Brand names: Selegiline, Rasagilene), COMT-inhibitors (Examples: Entacapone, Tolcapone)

In patients who are very severely affected, a kind of brain surgery known as pallidotomy has reportedly been effective in reducing symptoms. Another kind of brain surgery, in which healthy dopamine-producing tissue is transplanted into the brain, is also being tested. Finally, researchers are trying to identify substances that will prevent dopamine-producing brain cells from dying.

The single biggest risk factor for Parkinson's disease is advancing age. Men have a somewhat higher risk compared to women. One in 100 people over age 60 are diagnosed with Parkinson's.

Head injury and pesticide exposure have also been associated with higher risk.

Several genes have been definitively linked to Parkinson's in some people. In addition, several chromosomal regions have been linked to Parkinson's in some families.

Severe Parkinson's-like symptoms have been described in people who took an illegal drug contaminated with the chemical MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine) and in people who contracted a particularly severe form of influenza during an epidemic in the early 1900s.

It is important that caregivers understand that this disease affects everyone in different ways. The symptoms won't always be the same in all patients. In fact, the symptoms that are the most difficult to manage usually happen in a small number of patients.

When they do occur, they tend to show up much later in the course of the disease. The more serious symptoms include patients having problems maintaining their balance, periods of extreme confusion or hallucinations, severe tremors, difficulty swallowing, depression and withdrawal.

If your loved one has trouble swallowing food, it may be useful or even life-saving to learn how to use the Heimlich maneuver to dislodge food stuck in the throat.

Pharmaceutical drugs have proven to be highly effective in treating Parkinson's disease and newer drugs make this form of treatment even more promising.