What is Parkinson’s Disease?

Parkinson’s disease is a result of the loss of neurons (brain cells) in the substantia nigra, a part of the brain which is in charge of the production of the chemical messenger called dopamine. A reduced level of dopamine is produced and transported to the striatum as the cells die. The striatum is the part of the brain in charge of movement. When 80% of dopamine gets lost, symptoms begin. This disease was named after the doctor who first discovered the condition, Dr. James Parkinson. Parkinson’s is a progressive condition that develops gradually. It may begin with a tremor in one hand that is barely noticeable.

Parkinson’s disease prevalence in the US is about one million people and there are approximately 50000 new cases each year. Men are twice likely to be diagnosed with Parkinson’s disease. A patient with Parkinson’s disease present with recognizable symptoms like lack of coordination, difficulty in speech, uncontrollable shaking or tremor, bradykinesia (Slowed movement), limb stiffness, difficulty in balance and eventually problems with standing up, and changes in writing. Symptoms may get worse are disease progress.

What Causes Parkinson’s Disease?

The main cause of Parkinson’s disease is still unknown though there are factors which play a role which includes genetics and environmental triggers. Common risk factors of this disease also include age. Exposure to toxins, heredity, and sex. Parkinson’s disease on its own cannot lead to mortality but the symptoms associated with the disease tend to be fatal. For instance, when a patient fall he or she may get seriously injured not to talk of having aspiration pneumonia due to difficulty in swallowing as food or foreign objects are mistakenly inhaled to the lungs.

There is a scale known as Hoehn and your rating scale used by a wide range of doctors to diagnose this brain disorder and find out the severity of symptoms. According to the disease progression, the scale is divided into five stages. The advancement of the disease is evaluated by the help of this scale.

Five Stages of Parkinson’s Disease

Stage One: this is the mildest form of the disease. During this stage, symptoms may appear but not severe enough to limit daily activities or affect lifestyle in any way. Most times the symptoms are missed because of how minimal they are at this stage. Changes in posture, walk, or facial expression may just be noticed by family or close friends. A specific symptom of stage one Parkinson’s is that difficulties in movement and tremor are confined to one side of the body (unilateral involvement). Symptoms can be minimized or decreased at this stage by prescribed medicines.

Stage Two: this is still an early disease in Parkinson’s disease though symptoms begin to be more pronounced than in stage one. It is the moderate form of the disease. Changes in facial expression can appear and tremor, trembling and stiffness is present. Time for completion of the task may increase due to muscle stiffness, this stage does not affect balance. There may be an increased problem with walking and noticeable change in posture. There may also difficulty in speech and symptoms are felt on both sides of the body (bilateral involvement) through one side will be more affected than the other. There is a lifelong expectancy for those with this stage even though they will be faced with spending longer time with the completion of tasks. Individual progression cannot be predicted. It could take months to years for the disease to progress from stage one to stage two.

Stage Three: This is the middle stage of Parkinson’s and it is the turning point in the disease progression. The symptoms that occur in this stage are the same as those in stage two. The major difference is that there is a higher chance of experiencing reduced reflexes and significant loss of balance. At this stage, daily activities are greatly affected but the patient still manages to complete them. A way to reduce symptoms is to combine occupational therapy with medication.

Stage Four: The difference between stage three and stage four is independence. Assistance is not required in stage four while standing. Though, when it comes to movement, an assistive device or a walker is needed. Patients with this stage of Parkinson’s disease have a great decline in ability to move and reaction time, so they have to live with people who will assist them in most cases. The choice of living alone in stage four or later is not advisable as it can be very dangerous and many tasks may not be possible.

Stage Five: This is the most advanced stage of Parkinson’s disease. At this stage, it not possible to stand or walk. There is freezing upon standing due to progressed stiffness in the legs. Patients, in this case, cannot stand on their own without falling. They usually require wheelchairs. Hallucinations, confusion, and delusions are common symptoms in up to 30% of patients in stage three and stage four. Just to expatiate, delusions occur when even if the idea you have been presented with is false, you still believe in things that are not true. Hallucinations happen when you visualize things that are not really there. Up to 75% of patients with Parkinson’s disease also suffer from dementia.

Treatment of Parkinson’s Disease

Parkinson’s Disease has no standard treatment. Treatment is based on improving symptoms and it varies with individuals, so does he doses of medication. Since the reduction of dopamine in the brain is the reason for most symptoms of Parkinson’s disease, most medications aim to boost the dopamine production temporarily or imitate dopamine in the brain. The drugs are known as dopaminergic medications. They aid in the reduction of rigid muscles, decreases tremor, improve coordination of movement and speed.

Here are some medications that can be administered:

  • Levodopa (most potent medication for Parkinson’s disease)
  • Dopamine agonist (pramipexole, ropinirole, apomorphine)
  • Amantadine
  • COMT inhibitors (entacapone, tolcapone)
  • Anticholinergic drugs (trihexyphenidyl, benztropine mesylate)
  • MAO-B inhibitors (Selegiline, rasagiline)

Other interventions that can are also used to alleviate the struggle of Parkinson’s disease.

  • Surgery: This is done if a patient has exhausted medical treatment of tremor or suffer from severe motor fluctuations.
  • Medical marijuana
  • Exercise

Parkinson’s Disease is a slowly progressing disease and its severity varies by individuals. Gradual loss of independence with this disease is difficult because it affects every part of the life of the patient. A patient suffering from this disease should be in touch with a medical professional to monitor how the disease progresses. The neurologist can change therapy if needed to help the patient keep a high quality of life.




10 facts about Parkinson’s disease – Orion Pharma (UK). (2018). Orionpharma.co.uk. Retrieved 26 April 2018, from http://www.orionpharma.co.uk/Products-and-Services-Orion/Parkinsons-disease/10-facts-about-Parkinsons-disease/

Cherney, K., & Gotter, A. (2017). 5 Stages of Parkinson’sHealthline. Retrieved 26 April 2018, from https://www.healthline.com/health/parkinsons/stages#stage-2

Prescription Medications. (2018). Parkinson’s Foundation. Retrieved 26 April 2018, from http://www.parkinson.org/Understanding-Parkinsons/Treatment/Prescription-Medications