Parkinsons Disease Parkinsons disease is an incurable neurological disorder.

It affects 3% of the elderly population and as many as one million people live with it in the United States ("Statistics on Parkinson's," 2011). It is a disorder of the brain that leads to shaking or tremors, difficulty with walking, movement, and coordination. This disease is progressive and over time, the physical damage increases. It is associated with damage to a part of the brain that controls muscle movement. Parkinson's disease is a growing concern, and though the symptoms are known, it is not know for sure what causes it or how to cure it. Throughout this paper, the definition and history will be covered, as well as the causes, symptoms, treatment options and ways to cope with the disease. Parkinson's disease belongs to a group of conditions called movement disorders. It is chronic and progressive. Some cases seem to be hereditary and they can be traced to specific gene mutations, but in most cases the disease does not seem to run in families. The four main symptoms are tremor, or trembling in hands, arms, legs, jaw, or head; rigidity, or stiffness of the limbs and trunk; slowness of movement; and postural instability, or impaired balance (Berardelli, 2001). These symptoms begin gradually and worsen with time. Not everyone with one or more of these symptoms has Parkinsons, as the symptoms sometimes appear in other diseases as well. Parkinsons is a disorder for which no cause has been found yet. Parkinsons disease symptoms were first recognized in an ancient civilization in India, 5000 B.C. They called it Kampavata and treated it with a plant called Macuna, which is a natural source of L-dopa. The Chinese also defined the symptoms of Parkinsons disease around 500 B.C. They described symptoms, diagnosis and treatments methods in the Su Wen, which is the oldest existing Chinese medical text ("History of Parkinson's"). In the sixteenth century, Leonardo da Vinci (1452 1519) kept notebooks of his ideas and observations. There he described people he saw with symptoms that coincided with the tremors in Parkinsons disease. John Gerard, a famous English botanist, published in 1583 a list of plants, including

sage, cabbage, pellitory and mugwort for treating shaking of the hands. Parkinsons disease was first formally described by James Parkinson in 1817 in his work An Essay on the Shaking Palsy. In this essay, he described the medical history of six people who had symptoms of the disease. Eventually, the disease was named after him. The first named patient was Wilhelm Von Humboldt, who in 1828 wrote letters relating a more complete description of Parkinsons symptoms than James Parkinson. In 1861 and 1862, Jean Charcot and Alfred Vulpian added more symptoms to the description of Parkinsons, and attached the name of Parkinsons disease to the syndrome ("History of Parkinson's"). Parkinsons is the result of the deterioration of neurons in the region of the brain called the substantia nigra. Neurons there produce the neurotransmitter dopamine, which sends signals to initiate and control patterns of movement (Meadows, 1999). Dopamine is a brain inhibitor of nerve impulses and is involved in suppressing involuntary movement. When dopamine-producing neurons are damaged or destroyed, dopamine levels drop and the normal signaling system is disturbed (Meadows, 1999). The low levels of dopamine interrupt the balance between dopamine, acetylcholine and other transmitters. Without dopamine the nerve cells have difficulty transmitting messages resulting in the loss of muscle function. The causes of Parkinsons disease are unknown, but studies show that the disease is caused by a combination of genetic and environmental factors. The majority of Parkinsons cases are not inherited. Only about 15 to 25 percent of people with the disease have a close relative who also has Parkinsons. Researchers found that people with an affected relative (parent or sibling) have a 4 to 9 percent higher chance of developing Parkinsons disease (Understanding Parkinsons, 2011). A gene mutation that can cause the disease directly has been discovered, but only affecting a minor number of families. This gene mutation was found in people that developed Parkinsons at an early age. The mutations were found in genes for parkin, PINK1, LRRK2, DJ-1, glucocerebrosidase, etc (Understanding Parkinsons, 2011).

Environmental factors may also influence Parkinsons disease. Parkinsons disease may result from exposure to environmental toxins. Studies have found that living in a rural area, drinking well water, or being exposed to pesticides, herbicides, or wood pulp mills may increase the risk for developing Parkinson's disease (Understanding Parkinsons, 2011). Parkinsons has been added to a list of diseases that are possibly associated with exposure to Agent Orange. In addition, a synthetic neurotoxin agent called MPTP causes Parkinsons like symptoms. This neurotoxin was discovered in 1980 in heroin addicts that used a synthetic form of heroin contaminated with MPTP (Understanding Parkinsons, 2011). Some studies show that trauma to the head, neck, and spine also contributes to the damage of the substantia nigra cells. The trauma to the central nervous system will either cause Parkinsons to develop or will make symptoms worsen. When trauma happens, a blood-brain barrier is disrupted, releasing some proteins or poisons into the bloodstream that then enter the brain, triggering a process that takes 20 years to produce symptoms ("Head trauma linked," 2003). There are also secondary forms of Parkinsons disease that are caused by medications such as haloperidol, a drug used to treat confusion and hallucinations; reserpine, an ingredient in some anti-hypertension drugs; and metoclopramide, an anti-nausea drug (Espay, 2010). As a result of the reduction of dopamine, Parkinsons patients undergo symptoms which only increase over time. The main symptom is tremors. A tremor is a rhythmic shaking over which one has no control. Tremors of the hands and sometimes the head often occur. In some cases tremors can become so intense that patients have difficulty doing many day to day activities. Many people suffer from muscle rigidity and loss of balance, resulting in a difficulty walking and writing. Some other symptoms are changes in facial expressions, staring, voice and speech changes, and difficulty speaking (Espay, 2010). In the later stages of Parkinson's disease, some people develop problems with memory and mental clarity. Alzheimer's drugs appear to alleviate some of these symptoms to a mild degree. To better understand the symptoms, they have been classified in five stages. During stage I, the

initial stage, the patient experiences mild tremors or shaking in one of the limbs that may just inconvenience the day to day activities. Symptoms are inconvenient but not disabling. Stage II is characterized by symptoms that are bilateral, affecting both limbs and both sides of the body. There are minimal problems walking, with balance and minimal disability is observed. Posture and gait are affected. During stage III, the symptoms of Parkinsons are more severe and include the inability to walk straight or to stand. A person in this stage is considered to have moderate Parkinson's disease and this is when levodopa is usually first prescribed. In stage IV, the symptoms are severe and visible. Walking is limited and the patient suffers from rigidity and bradykinesia (slowness of movement). Patients need assisted living, although for non-known reason, the tremors or shakiness in the previous stages lessens or disappear. During stage V, the final stage of Parkinsons disease, the patient may not be able to walk and will require one on one nursing care (Glass, 2010). Now days, Parkinsons patients enjoy an active lifestyle by maintaining a healthy diet, and staying physically active. Parkinson's disease can be treated with self-care, medication, and surgery. Exercise is very important, as much as medication. It helps maintain flexibility and improves balance and range of motion. No known treatment can stop or reverse the breakdown of nerve cells that causes Parkinson's disease, but drugs can relieve many symptoms ("Parkinsons disease," 2011). Medications can help manage problems with walking, movement and tremor by increasing the brain's supply of dopamine. The most effective Parkinson's drug is levodopa. When Levodopa is taken in pill form, it passes into the brain and it is converted to dopamine. It is combined with carbidopa which protects levodopa from premature conversion to dopamine outside the brain and to prevent nausea ("Parkinsons disease," 2011). Other drugs called Dopamine Agonists are also used. They do not convert into dopamine in the brain; instead, they mimic dopamine and cause neurons to react as if dopamine is present. They are not as effective and have side effects like hallucinations, sleepiness, water retention and low blood pressure. They may also change patients behavior provoking hypersexuality, compulsive gambling and compulsive overeating ("Parkinsons

disease," 2011). COMT inhibitors are used to prolong the effects of carbidopa-levodopa therapy. It has been linked to liver damage and liver failure, so it is only used when patients are not responding to other therapies. Anticholinergics help control the tremors of Parkinsons disease, but may cause side effects such as impaired memory, confusion, constipation, dry mouth and eyes, and impaired urination ("Parkinsons disease," 2011). Glutamate blocking drugs are also prescribed to provide short term relief of mild symptoms, usually in the early stages. It is also added to carbidopa-levodopa therapy in later stages if there are problems with involuntary movements (dyskinesia). Side effects include a purple mottling of the skin and hallucinations. Surgery can also be effective in a small number of people. When medications fail to control symptoms or have intolerable side effects, surgery is considered. Some surgical procedures include pallidotomy, where the surgeon destroys a small part of the globus pallidus in the brain by creating a scar. This reduces the brain activity in the area, which may help tremor and stiffness (Poinier, 2010). Thalamotomy is the destruction of the thalamus that controls some involuntary movements. Interestingly, the patient is awake during the surgery. Surgery on one side of the brain affects the opposite side of the body, so if the tremor is in the right hand, the left side of the brain will be treated (Poinier, 2010). Deep brain stimulation (DBS) is a surgical procedure to implant a pacemaker-like device that sends electrical signals to brain areas responsible for body movement. When turned on, the stimulator sends electrical pulses to block the faulty nerve signals causing tremors, rigidity, and other symptoms (Espay,2010). Stem cell therapies for Parkinsons are not yet a routine clinical procedure but have great potential because a single, well identified type of cell is affected. The main purpose for the treatment would be to replace the dead cells with other identical dopaminergic neurons which can be obtained from embryonic stem cells in the laboratory, although this carries ethical dilemmas. There have been some problems along the way. Some patients that received fetal cell transplants presented signs of Parkinsons disease, showing

that the disease was transmitted from the patient to the transplanted fetal cells. Stem cells could also provide information about new novel drugs that would benefit cell therapy. Embryonic like stem cells can be obtained from adults through a method called reprogramming. Using this method, a sample of adult specialized cells can be used to make induced pluripotent stem (iPS) cells, which can make up any type of cell in the body, including dopaminergic neurons. Scientists are now using this method in order to learn why these nerve cells die in Parkinsons disease and to use the cells to test new drugs ("Discover the advances," 2010). The emotional and psychological changes of someone dealing with Parkinsons can be as important as the physical changes. The most common reactions are denial and disbelieve. Depression and stress also occurs in most of the people diagnosed with Parkinsons. These symptoms, if left untreated, are damaging at best and deadly at worst. When coping with the disease, it is very important to keep physically and mentally active so the mind and body can be maintained to the greatest possible degree. Physiotherapy is critical to help body functioning, and a good support group is also important for the mind. Since depression is so common, it is essential to understand that it is a normal feeling and to seek help if needed. Nutrition plays a key role as well. A diet high in fiber can counteract the constipation that may come with the disease. A cure has not been discovered for Parkinsons disease yet, but many advances have been made recently and the future looks bright. Today, people with Parkinsons can be productive members of society and can live long lives. This paper helped understand the definition and history of Parkinsons, the causes, symptoms, treatments, and coping mechanisms of Parkinsons disease. Information is key to help people that suffer from this debilitating and disease.

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