Identifying the Symptoms of Parkinson's Disease

What Is Parkinson's Disease?

You must have seen an older person having difficulty walking and finding words to talk clearly. The most common explanation for this is age-related changes. But have you ever thought that it could be a sign of Parkinson's Disease?

Why Do These Slowing Down Symptoms Occur in Parkinson’s Disease?

It occurs because PD is a neurodegenerative disease, meaning there is a constant deterioration of nerve function in the body. 

The nerve controls almost everything in your body, from movement to thinking. In someone with PD, you see the degeneration in a part of the brain called the substantia nigra. The substantia nigra is a critical brain region that produces and releases dopamine. Dopamine affects many systems of the central nervous system, ranging from movement to cognitive executive functions and emotional activity. 

That is why someone with PD will have multi-system atrophy symptoms (decreasing in size or wasting away of a body part or tissue).

It is just like having an inefficient voltage supply in your house.

What Are the Causes of Loss of Nerve Cells in PD?

A combination of environmental factors and genes can cause nerve function loss in Parkinson's Disease. One key player in genes is a pesky protein called "α-synuclein," which can go rogue and cause severe damage to the nerve cells. 

Interestingly, according to the causes, there are three main types of Parkinson's, with the rare childhood type linked to gene mutation. This type of PD, when it starts before the age of 50, is called early-onset Parkinson's Disease or young-onset Parkinson's Disease. Moreover, having a family member with Parkinson's may increase your own risk of developing it, regardless of whether it's early or late-onset. 

According to research published in the Canadian Medical Association Journal, the risk factors of PD are as follows.

Whether you're personally affected by Parkinson's or just curious to learn more, let's see how to recognise some early symptoms of Parkinson's Disease.

Signs and Symptoms of Parkinson's Disease    

The signs and symptoms can range from simple fatigue to Parkinson's hallucinations. This variation depends upon the progression of the disease. The loss of nerve cells is a slow process. So, the actual symptoms of Parkinson's Disease usually start to develop when you lose around 50% of the nerve cell activity in the substantia nigra of the brain.

So, though the first signs of Parkinson's often may not be motor (movement) related, it's essential to recognise symptoms of Parkinson's Disease as early as possible. 

Early Signs and Symptoms of PD

If you have seen someone with Parkinson's Disease, the first thing you may notice in them is the classic symptom: resting tremor. 

This earliest symptom of Parkinson's usually affects one upper limb. However, 31-30% of cases of PD first present with a tremor in the lower extremity. There may also be lip, jaw, or tongue tremors. 

Read on to learn more about different symptoms and their progression in PD.

First Symptoms of Parkinson's Disease

Check if any of the following sounds familiar. If they do, you may be experiencing early signs of Parkinson's.

• Struggling to turn in bed.
• Feeling frozen in your shoulder.
• Experiencing stiffness, numbness or pain in your limbs.
• Having trouble with fine finger movements
• Noticing tremors in your hands, jaw or feet.
• Decreased facial expressions or arm swings.
• Dragging your legs or having Parkinson's gait (small shuffling steps and a general slowness of movement)
• Soft voice ( Has anyone ever told you that your voice has turned too soft than before or that they can't hear you over the phone? )

In addition to the above symptoms related to your body movements, some other early symptoms of PD are;

• Recurrent constipation 
• REM sleep(deep stage of sleep) behaviour disorder such as hand gestures, violent thrashing, punching or kicking.
• Depression 
• Olfaction (sense of smell) impairment.

Later Symptoms of Parkinson's Disease

Later features of Parkinson's Disease start showing up after 5-10 years of recognising the first symptoms or diagnosis of Parkinson's Disease. 

The late signs are;

• Motor (Movement) fluctuations
• Dyskinesia (involuntary, erratic, twisting movements of the face, arms, legs or trunk.)
• Gait freezing (sudden absence of walking forward even after intending to) 
• Repeated falls

Other late signs unrelated to your body movements are;

• Dysphagia (difficulty in swallowing)
• Neuropsychiatric symptoms include hallucinations, sleep disturbance and dementia
• Autonomic disturbances include sweating, orthostasis, excessive saliva production and urinary dysfunction.
• Seborrheic dermatitis (A scalp disorder usually involving the forehead, with flaky oily skin)

If any of these symptoms resonate with you, you may need an evaluation by a healthcare expert. 

In the early stages of Parkinson's Disease, symptoms can be mild, and people may not notice them. But here's another catch. You may not know it, but a condition with similar signs and symptoms like PD can be the cause of what you are experiencing. It is called Parkinsonism, a more dangerous health condition.

How to Know if it is Parkinson's Disease or Parkinsonism?

When you experience symptoms more than just related to your movements, it's called Parkinsonism and not Parkinson's Disease. 

• Parkinsonism is also called atypical Parkinson's or Parkinson's plus. 

Parkinsonism is a comparatively more rapidly progressive condition than Parkinson's Disease, with hallucinations, delusions, and dementia.

Progression and Stages of Parkinson's Disease

In 1967, Hoehn & Yahr established five stages of Parkinson's Disease (PD) based on the extent of clinical disability - the Hoehn and Yahr Scale of Grading symptoms of PD. Your healthcare provider will use these stages to describe how motor symptoms of PD progress. According to this scale,

• Stages 1 and 2 are considered early-stage
• Stages 2 and 3 mid-stage
• Stages 4 and 5 are advanced-stage or end stages of Parkinson's Disease.

Read on to find out which stage of Parkinson's Disease you or your loved one is in.

Stage 1

In the first stage of Parkinson's Disease, you experience mild symptoms that typically do not hinder your daily activities. The symptoms usually affect only one side of the body, including tremors and other movement-related issues. Changes in posture, walking, and facial expressions may also occur during this stage.

Stage 2

As Parkinson's Disease progresses, the symptoms tend to worsen. You may experience tremors, rigidity, and other movement issues affecting both sides of the body or the midline, such as the neck and trunk. Walking may become problematic, and poor posture may be noticeable. While you can still live independently, daily tasks become more challenging and time-consuming.

Stage 3

At the mid-stage of the condition, you may experience a loss of balance, resulting in instability. When turning or being pushed from standing, you experience an increased frequency of falls. Motor symptoms will continue deteriorating, and daily activities will become somewhat restricted. However, you will still be capable of leading an independent life with only mild to moderate disability at this stage.

Stage 4

By this stage, symptoms have fully developed and are severely disabling. Although you can still walk and stand without assistance, you may require a cane or walker for safety reasons. You require significant assistance with daily activities and cannot live independently.

Stage 5

This stage is the most advanced and can be debilitating. You may experience leg stiffness, making it difficult to stand or walk. As a result, it progresses to being bedridden or confined to a wheelchair with required attention around the clock for all activities. 

Someone in the end stage of Parkinson's sleeps all the time.

Overall, the most significant 5 signs you will get in Parkinson's Disease are;

• Tremor
• Small Handwriting
• A Soft or Low Voice
• Masked Face
• Trouble Moving or Walking

Your healthcare provider will diagnose Parkinson's Disease using the signs and symptoms and other tests. Read on to learn how the experts arrive at a conclusive diagnosis.

Diagnosis, Treatment and Management of Parkinson's Disease

Apart from the signs and symptoms, diagnosing Parkinson's Disease involves reviewing the patient's medical history, a neurological examination, and sometimes imaging tests. 

• Examination: During the examination, neurologists look for common symptoms of Parkinson's, such as tremors, slowed movement, rigidity, and postural instability. They assess you through physical examinations, including muscle strength, reflexes, and coordination tests. 
• Tests: Imaging tests like MRI or CT scans may rule out other conditions that could be causing similar symptoms, although there is no definitive imaging test for Parkinson's. 

The aim of treating Parkinson's Disease is to alleviate symptoms and improve the overall quality of life. This protocol often involves a combination of medications, physical therapy, and lifestyle modifications. 

• Medications that improve the functioning or production of dopamine in your brain are commonly prescribed to manage motor symptoms. 
• Physical therapy can help improve mobility and balance, while occupational therapy can assist with daily tasks. 
• Lifestyle modifications like regular exercise and a healthy diet are crucial in managing Parkinson's symptoms. 

It would help if you worked closely with their healthcare team to develop a personalised treatment plan that addresses their needs and concerns. 

Parkinson's support groups provide essential emotional support and practical advice. These groups offer a sense of community and understanding, allowing you to share experiences, coping strategies, and resources. 

Connecting with others facing similar challenges will make you feel less isolated and better equipped.

Conclusion

Parkinson's disease is a progressive degenerative condition that can leave you disassociated from your surroundings and loved ones. So, identifying and differentiating symptoms of Parkinson's Disease as soon as possible helps you receive appropriate treatment at the right time. If you or someone you know is experiencing these symptoms, it is essential to seek medical attention.