Parkinson's Disease: Stages, Symptoms And More – Forbes Health – Forbes

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Approximately 500,000 people in the U.S. are diagnosed with Parkinson’s disease, the second most common neurological disorder after Alzheimer’s disease, according to the National Institute of Neurological Disorders and Stroke (NINDS).
However, since many people with Parkinson’s go undiagnosed or are misdiagnosed, the estimated number of Americans with Parkinson’s disease is closer to 1 million, reports the NINDS[1].
If you or a loved one received a diagnosis of Parkinson’s or are navigating symptoms associated with the disease, it’s important to understand what you may experience in each stage of progression. Continue reading to learn more about Parkinson’s, including symptoms, treatment options and when to speak to a movement disorders neurologist.
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Parkinson’s disease is a chronic and progressive brain and movement disorder that occurs in five stages. Depending on the stage, a person with Parkinson’s may experience problems with coordination and balance, uncontrollable movements, muscle stiffness, tremors and shaking.
Parkinson’s can also affect speech, posture and walking. In later stages, Parkinson’s may cause dementia and other cognitive issues.
Around 70% to 80% of people with Parkinson’s disease will develop some form of cognitive impairment, with increased risk as the disease progresses, says Carine W. Maurer, M.D., Ph.D., who is board-certified in neurology and specializes in movement disorders at Stony Brook Medicine in Stony Brook, New York.
“Dementia is more common in those who are older, have more advanced disease with more severe motor symptoms and experience visual hallucinations,” says Dr. Maurer.
Parkinson’s disease generally affects more men than women. People with Parkinson’s most often begin to show symptoms after age 60. For 5% to 10% of the population, however, early onset Parkinson’s can begin before age 50.
The precise cause of Parkinson’s disease is unknown. Symptoms of Parkinson’s occur when nerve cells in the basal ganglia—the area of the brain that controls movement—die or become impaired. These nerve cells produce dopamine, a crucial brain chemical that helps the brain transmit messages for smooth, intentional movements.
As the amount of dopamine in the brain decreases, abnormal nerve-firing patterns interfere with smooth and intentional muscle movement.
Damage to the brain structure regulating chemical messenger pathways, particularly the nerve endings that produce the neurotransmitter norepinephrine, may also cause non-motor symptoms, such as depression, fatigue, impaired digestion and behavioral changes.
Most people with Parkinson’s don’t have hereditary Parkinson’s, meaning it doesn’t often run in families. “Only about 10% to 15% of people with Parkinson’s disease have an identifiable variant in a gene associated with Parkinson’s disease,” says Dr. Maurer.
Research on environmental causes of Parkinson’s is inconsistent, but some studies indicate there could be a link between genetic vulnerability to toxins and environmental exposure to toxins, such as pesticides and herbicides.
Some research also suggests that exposure to heavy metals, including iron, copper, lead and manganese, may increase a person’s risk of developing Parkinson’s disease.
Early symptoms of Parkinson’s disease may be subtle: A person’s handwriting may become smaller and more cramped than usual, or they may have trouble standing from a seated position. Their voice may become softer, or their face may lack expression or animation.
One arm or leg might stop moving normally. For example, the person’s arm may no longer swing normally when they walk or one leg may experience involuntary movements.
A person with Parkinson’s may experience movement symptoms, such as muscle stiffness, slowed movements and balance issues. As the disease progresses, other symptoms may include behavioral changes, fatigue, depression and cognitive impairment.
Some people with Parkinson’s develop what’s known as a “Parkinsonian gait,” where they tend to lean forward and take short, quick steps without much arm movement. Someone with Parkinson’s may not be able to stop or continue movement as they wish.
“Parkinson’s is very different in each patient,” says Hooman Azmi, M.D., a neurosurgeon specializing in the surgical treatment of Parkinson’s disease and other movement disorders at New Jersey Brain and Spine in Oradell, New Jersey. Dr. Azmi is also the director of the division of functional and restorative neurosurgery at Hackensack Meridian Health University Medical Center in Hackensack, New Jersey.
“Not every patient will have similar symptoms, and the rate of progression is quite different in each person,” says Dr. Azmi. “This often is a very slow process and takes years. Initially, patients may not feel any difference, but over time, certain symptoms [called the prodrome] can occur.”
Primary movement and motor skills symptoms of Parkinson’s disease may include:
Non-movement symptoms of Parkinson’s disease may include:
The progression of Parkinson’s disease is commonly divided into five stages of symptoms that worsen over time. However, while some people with Parkinson’s may become severely disabled, others may not.
“Not everyone experiences all the symptoms of Parkinson’s, and symptoms are not necessarily experienced [by everyone] in the same order,” says Dr. Maurer.
The stages of Parkinson’s are generally defined as follows.
Parkinson’s symptoms are generally mild in this initial stage and may not interfere much with the affected person’s daily activities.
“In stage one, the symptoms are, by definition, limited to one side of the body and are often milder,” says Dr. Maurer. “Changes in facial expression and walking may be noticed.”
During the second stage, movement symptoms, such as tremors, rigidity and others, generally worsen. The person with Parkinson’s may experience posture changes as well.
“In stage two, symptoms become more apparent and impact both sides of the body. It may take longer to perform daily activities, and individuals may notice more difficulty with walking,” says Dr. Maurer.
In the third stage, a person with Parkinson’s may experience balance issues, such as unsteadiness when they turn. Motor symptoms often worsen, restricting the person’s daily activities like walking, dressing and eating to some extent due to impaired movement.  Disability at this stage is generally mild to moderate, usually allowing the person to continue leading a fairly independent life without extensive assistance.
In the fourth stage, symptoms can interfere with someone’s ability to bathe, groom, dress and move around their home. They may no longer be able to live alone. At this point, the person with Parkinson’s may need to hire in-home care or move to an assisted living community to get help dressing, bathing and moving around the house.
“In stage four, symptoms significantly impact activities of daily living (ADLs), and individuals need assistance with ADLs,” says Dr. Maurer. Individuals may also require a walker for mobility support.
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Stage five is the most debilitating stage of Parkinson’s disease. The person with Parkinson’s may have to use a wheelchair or be confined to bed much of the time and will likely need round-the-clock care.
“At this stage, hallucinations and delusions, as well as dementia, are common,” says Dr. Maurer.
While these five stages show how Parkinson’s generally progresses, every symptom won’t apply to everyone with the disease.
“Parkinson’s is very different in each patient,” says Dr. Azmi. “No patient will have similar symptoms, and the rate of progression is quite different in each person.”
It’s important to see a doctor about Parkinson’s symptoms when you first notice them.
Non-genetic cases of Parkinson’s can’t be diagnosed through blood or laboratory tests. Instead, a neurologist specializing in movement disorders can make the diagnosis by performing a neurological examination.
“While symptoms may initially be discussed with a primary care provider, it’s important to be seen by a neurologist to receive a thorough neurological examination and a diagnosis,” says Dr. Maurer.
“People with Parkinson’s disease benefit from seeing a neurologist with specialty training in movement disorders,” she adds. “Movement disorders neurologists have completed extra training in Parkinson’s disease, and typically a large fraction of their practice revolves around seeing patients with Parkinson’s disease.”
“While there is currently no cure for Parkinson’s, medication is used to treat the symptoms of Parkinson’s disease and can often have a significant positive impact,” says Dr. Maurer.
Treatment options for Parkinson’s include medications that can increase levels of the neurotransmitter dopamine to alleviate certain symptoms, such as muscle rigidity, poor coordination and tremors.
Medications can work in conjunction with complementary and supportive therapies, such as nutrition counseling, exercise, physical therapy, occupational therapy and speech therapy, as well as surgery, according to Dr. Maurer.
“A movement disorders specialist will also be more likely to help with referrals to other providers who can help deal with the symptoms of Parkinson’s disease, including physical therapists, occupational therapists and speech therapists,” says Dr. Maurer.
Furthermore, a movement disorders specialist may be familiar with local support groups for people with Parkinson’s disease, as well as available clinical trials, she adds.
A surgical procedure known as deep brain stimulation (DBS) may alleviate certain Parkinson’s symptoms. With DBS surgery, a movement disorders neurosurgeon surgically implants a pacemaker in a specific part of the brain to help relieve symptoms. The surgery can improve the person’s symptoms and quality of life. However, DBS surgery doesn’t stop Parkinson’s from progressing, and some symptoms may return.
“DBS can be quite effective but is not a cure and only treats certain symptoms of Parkinson’s disease,” says Dr. Azmi, who was the first neurosurgeon on the East Coast to perform MRI-guided DBS for Parkinson’s. “A movement disorder team will assess patients to determine if they are good candidates for surgery.”
“You should see a doctor about Parkinson’s symptoms when you first notice symptoms,” says Dr. Maurer. “While these symptoms may initially be discussed with a primary care provider, it’s important to be seen by a neurologist to receive a thorough neurological examination and a diagnosis.”
Sometimes, a loved one may be the first to notice early symptoms of Parkinson’s, such as changes in facial expressions, gait or handwriting. If you suspect a loved one is developing any symptoms associated with Parkinson’s disease, make an appointment with a neurologist for proper testing and diagnosis.
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Deb Hipp is a freelance writer in Kansas City, Missouri. She is a former investigative reporter with more than 25 years of experience as a journalist and writer. She specializes in aging, long-term care, caregiving, retirement and a variety of other health and retirement topics.
Dr. Amanda Smith is a professor of psychiatry and behavioral neurosciences at the University of South Florida Morsani College of Medicine and the director of clinical research at the USF Health Byrd Alzheimer’s Institute in Tampa, Florida. She is a clinician, researcher and educator committed to promoting brain health, preventing and treating dementia, and finding new treatment options for Alzheimer’s disease. Dr. Smith serves on the steering committees of the national Alzheimer’s Clinical Trial Consortium, the Alzheimer’s Disease Neuroimaging Initiative and the Alzheimer’s Disease Cooperative Study. She is also the co-chair of the ACTC’s IDEA-CT outreach and policy committee aimed to increase diversity and inclusion in clinical trials. She serves on several subcommittees for the State of Florida Health Improvement Plan that aims to help Floridians living with Alzheimer’s disease and related disorders. She also serves as a site principal investigator on multiple clinical trials and has pioneered the first mobile clinical trial unit for Alzheimer’s research in the United States.

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