Parkinson’s Disease

*The information on this website is not intended to diagnose, treat, cure or prevent any disease.

What is Parkinson’s Disease?

Parkinson’s Disease is a debilitating chronic disease affecting the central nervous system. It is slowly progressive, worsening over years. The major effects (and most noticeable) are on motor control, but it also affects cognitive function and is associated with depression, anxiety, and dementia. The motor control issues associated with Parkinson’s disease include tremors, difficulty maintaining posture, and difficulty or slowness when beginning voluntary movements.

Parkinson’s disease tends to begin later in life, affecting about 1% of people over the age of 60. There is also a form of Parkinson’s disease which affects people under the age of 50. Michael J. Fox is a famous example of young-onset Parkinson’s disease, being diagnosed at the age of 29. Approximately 6 million people are affected by Parkinson’s disease around the world. Men are more likely to develop the disease compared to women. It tends to be a life-limiting disease, with the average survival after diagnosis being approximately 10 years.

The disease is characterized by the accumulation of abnormal proteins in the brain and the death of neurons within a specific region of the brain called the substantia nigra. The death of these cells results in adequate dopamine production. This lack of dopamine is largely responsible for the abnormal motor control in Parkinson’s disease.

Common Symptoms

There are four symptoms which are considered cardinal signs of Parkinson’s Disease when they occur in combination:

Tremors
Slowness movement
Muscle rigidity (may be asymmetrical early in the disease)
Inability maintain posture (later in the disease)

The disease is also characterized by these common symptoms:

Speech changes
Loss of “automatic” movements (movements which usually do not require conscious input, such as blinking or swinging arms while walking)
Changes to speech patterns
Difficulty writing, small handwriting
Joint pain
Clumsiness
Shuffling of feet
Depression
Difficulty planning, abstract thinking
Memory difficulties
Hallucinations
Anxiety
Sleep disturbances
Constipation
Tingling/numbness

Diagnosis

There is no specific antemortem diagnostic test for Parkinson’s disease; however, based on symptoms, a physical examination, and ruling out other diseases, a diagnosis can usually be reached. Diagnostics which can be helpful in identifying Parkinson’s disease include:

Advanced Neurologic Imaging Studies: These tests can be helpful in diagnosing Parkinson’s disease or excluding other causes which can result in similar signs.
- MRI
- CT Scan
- Positron Emission Tomography (PET scans)
- Dopamine Transporter Scan (DAT)
Blood tests
- Infectious disease testing
- Heavy metal testing
- Complete blood count
- Serum chemistry profiles
Levodopa Trial
- This test involves prescribing the medication levodopa and monitoring for a response. People with Parkinson’s disease will tend to show improvement after a few days of treatment

Treatment Options:

There is no known cure for Parkinson’s disease. Treatment revolves around improving quality of life and minimizing symptoms of the disease. Treatment recommendations typically depend on the stage of disease.

Pharmaceuticals and Medical Procedures:

Carbidopa-Levodopa: This medication is converted to dopamine in the brain. It is a combination drug in order to ensure that the conversion process occurs in the brain rather than in the rest of the body. It is the gold-standard for treatment particularly in the early stages of Parkinson’s disease. Over time, it tends to become less efficacious.
Catechol-O-Methyltransferase (COMT) Inhibitors: These medications block the activity of an enzyme which breaks down dopamine in the brain. It is often combined with levodopa. Examples include tolcapone and entacapone.
Dopamine Agonists: These drugs work on dopamine receptors in the brain. These may provide more steady effects than levodopa, and may be used in combination with it. Drugs prescribed include ropinirole, pergolide, apomorphine, rotigotine, and pramipexole.
Monoamine Oxidase (MAO) B Inhibitors: These drugs inhibit another enzyme responsible for breaking down dopamine in the brain. They are generally less efficacious than levodopa, but may be used in combination. Drugs include selegiline and safinamide.
Amantadine: This medication is sometimes used in early Parkinson’s disease and in combination with levodopa to offset a side effect which causes involuntary movement.
Antimicrobials: Lyme disease can sometimes attack the brain and central nervous system and may play a role in Parkinson’s disease in some people.
Surgical Approaches
- Deep Brain Stimulation: In this procedure, an electrical device is implanted into the brain. It generates electrical impulses and can help in people who do not respond well to medication or people with advanced disease.
- Pallidotomy: This involves intentional damage to an area of the brain called the globus pallidus. This may help reduce involuntary movements.

Non-pharmaceutical options:

There are many non-pharmaceutical therapies for Parkinson’s disease which may be beneficial in some people.

Acupuncture: Acupuncture can relieve pain, reduce depression, and improve quality of sleep in people with Parkinson’s disease.
Aromatherapy: Aromatherapy can help relieve stress and take the mind off of pain, discomfort, and anxiety.
Magnetic Field Therapy: Exposure to magnetic fields may help some Parkinson’s patients reduce their need for medications.
Physical Therapy:
- Water Aerobics: Low impact exercise in a pool can help people stay physically fit while reducing the risks of falls.
- Guided Physiotherapy: Studies have shown that exercise programs under the guidance of a physiotherapist show more improvement in motor control, psychologic well-being, and quality of life.
- Massage Therapy: The muscle control issues in Parkinson’s can result in pain and tension. Massage therapy can help relieve pain, improve emotional well-being, and relax tired muscles.
Mind-Body Approaches:
- Meditation: Mindful meditation can help take focus off of pain and build a sense of well-being.
- Biofeedback: This approach allows you to monitor your own biological responses and learn techniques to control them through mental techniques.
- Yoga: This can improve flexibility and balance. Consider seated yoga to maintain strength and flexibility while minimizing the risk of falls.
- Tai Chi: This gentle exercise can improve balance and muscle strength in people with Parkinson’s disease. It has been shown to be very helpful at improving balance in the early stages of the disease.
- Deep Diaphragmatic Breathing: This is very helpful for people with Parkinson’s, as breathing difficulties often arise later in the disease. This strengthens the muscles associated with breathing and improves lung function.
- Progressive Muscle Relaxation: Alternating tightening and relaxing of muscles combined with breathing exercises may relieve tension, pain, and promote overall relaxation.
- Art Therapy: Music and art therapy is helpful for relieving stress and anxiety. Practicing singing can also be helpful in managing speech conditions.
Dietary Modification:
- Reduce intake of refined sugars and carbohydrates, which are pro-inflammatory.
- Increase consumption of green tea, which appears to have a protective effect on the neurons in the substantia nigra.
- Increase fiber intake: many people with Parkinson’s suffer from constipation. Increasing fiber can ensure more regular, easier bowel movements.
- Increase intake of antioxidants and omega-3 fats, such as from fish and nuts.
Probiotics: Parkinson’s patients often have abnormal GI flora. Taking a probiotic can help restore this to a normal state. GI flora play a role in generating neurotransmitters and helping maintain normal intestinal health.
Mold Binders: Products like cholestyramine and apple pectin can help remove toxic mold from the body. Mold toxins may contribute to Parkinson’s signs.
Stem Cells: Stem cells are a promising future treatment for Parkinson’s disease.
Chelation Therapy: Treatment with EDTA and Succimer can help bind heavy metals which may contribute to the development of Parkinson’s disease.
Supplements:
- Dopa Mucuna: This is a bean which is a natural source of levodopa.
- Turmeric/Curcumin: This is a potent anti-inflammatory which is also neuroprotective. Research suggests that it may be helpful in preventing the clumping of abnormal proteins in the brain.
- Coenzyme Q10: This is a powerful anti-oxidant which may be helpful in people with Parkinson’s disease.
- Fish Oil: Omega-3 fatty acids are anti-inflammatory in nature and are important to brain health as well as managing depression, which can occur in Parkinson’s disease.
- Creatine: This amino acid can serve as an energy source for neurons. It may slow progression of early Parkinson’s disease.
- Glutathione: Glutathione is an important substance for normal neuronal function and anti-oxidant protection. It may have protective effects in the substantia nigra.
- Ginger: Ginger has two benefits: it is a major anti-inflammatory compound and also can help relieve nausea associated with medications.
- B Complex Vitamins: Folic acid, B12, and vitamin B6 are important for normal functioning of the nervous system and are very safe to supplement.
- St. John’s Wort: This herb is a natural anti-depressant and may be beneficial in people with Parkinson’s disease. Use with caution, is it can have many interactions with neuroactive medications.
- Vitamin C and E: These essential vitamins are important anti-oxidants and may be neuroprotective.
- Vitamin D: Deficiencies in this essential vitamin have been linked to many issues. Deficiency is common in people with Parkinson’s disease.

Prevention

There is no known surefire way to prevent Parkinson’s disease, however certain risk factors can be reduced. One of the easiest things to do which has been shown to reduce the risk of Parkinson’s disease is simply to exercise more often. Regular aerobic exercise in middle age has been shown to be associated with a reduced risk of Parkinson’s later in life. This, combined with eating well-balanced, nutritious diet rich in vitamins and plant-based anti-oxidants can help protect your brain from oxidative damage. Eat organic and locally-grown products to avoid exposure to pesticides and herbicides which are thought to increase the risk of Parkinson’s disease. Use natural products and weed by hand to in your own garden to avoid using chemicals.

Consider increasing your dietary intake of fish, which is a good source of omega-3 fatty acids as well as vitamin D. Both of these are often deficient in Western diets, and supplementation can help protect the body from many different disease processes, including Parkinson’s disease.

Caffeine also appears to be protective against Parkinson’s disease. It appears that caffeine intake in any form is associated with a reduced risk in a dose-dependent manner. This means that your daily cup of coffee may be protective against future disease. There are many other side effects of caffeine, however, and too much intake has negative effects of its own. Consider increasing your intake of green tea, which contains caffeine, but also seems to be protective against Parkinson’s disease in its own right.

Causes

There are a large number of potential causes of Parkinson’s disease in people. There are certainly genetic factors, but having mutations in associated genes does not guarantee the disease will occur. Likewise, absence of genetic mutations does not mean the you will not get the disease. There is likely complex interplay between genetic factors and other environmental/risk factors which determines who gets the disease. The end result of these interactions is the accumulation of proteins in the brain which are unable to be degraded, which form intracellular inclusions in neurons called “Lewy bodies.” As these Lewy bodies accumulate, they result in death of the neurons, eventually causing Parkinson’s disease.

Pesticide and herbicide exposure are major risk factors in the development of the disease. It is unclear if these toxins accumulate in the body, eventually resulting in the death of the neurons, or cause other impairments which results in the body being unable to break down the abnormal proteins. Other toxins which may contribute to Parkinson’s disease include heavy metals such as lead, mercury, or cadmium. These metals are known to accumulate within the brain and can lead to the death of neurons.

Traumatic brain injury is also associated with an increased risk of developing Parkinson’s disease. Repeated trauma, as often happens in people who play sports, eventually results in death of neurons in the substantia nigra.

Lyme disease, the infectious disease with many different manifestations, has also been associated with Parkinson’s disease. This disease is transmitted by ticks and is endemic in the Northeastern United States. It is often underdiagnosed due to the many different forms it can manifest as.

Toxic mold exposure is another potential cause of Parkinson’s disease which is under-diagnosed. Research published in the peer-reviewed journal Proceedings of the National Academy of Sciences has shown that a compound called octen-3-ol which is produced in mold can interfere with dopamine production in the brain, and may contribute to Parkinson’s-like signs. Toxic molds are in many older or water-damaged homes, and cause a variety of illnesses. Some cases of Parkinson’s disease may simply be another manifestation of these toxic agents.

There is also some thought that Parkinson’s disease may be due to immune dysregulation, and may actually be an auto-immune disorder in some instances. Western lifestyles which have resulted in excessive hygiene practices, inflammatory diets, sedentary lifestyles, and vitamin D deficiencies may be resulting in increased risk of auto-immune disorders of all kinds. Now, there is evidence that accumulation of abnormal proteins in the brain actually triggers the immune system to attack neurons as well.