Parkinson’s Disease

1. What are the causes to Parkinson’s disease?

Parkinson’s disease is a neurodegenerative condition that affects a specific part of the brain called basal ganglia.  It is still a mystery what causes the neurodegeneration process.  This part of the brain coordinates movements of the body, making it smooth and purposeful.  As a result of the degeneration of nerves there, movements of muscles become affected.  Movement is stiff and coarse, hence gives the typical features of Parkinson’s disease, being tremors and rigidity.  This degeneration may be genetic, due to ageing, due to environmental toxin.

2. Who are more prone to getting this illness?

Many people have a conception that this is a elderly’s illness, is it true to say so? what is the age range of the patients? what which age group is the most common?

Older people tend to develop Parkinson’s disease.  It is common among those above age 50 years, with the average age being 60 years old.  The incidence and prevalence of PD increases with age.  The reasons why older people tend to develop the condition is because number of brain cells on the whole is reduced in old age, so easier to get imbalance of neuro chemicals at the basal ganglia.

a. Is there a difference in the risk of male and female? Males tend to have higher risk of developing PD than female.  Not sure what the reasons are.
b. How does our daily life affect our risk of getting this illness?
e.g. lifestyle, eating habits, stress level, hereditary, etc.

Environmental factors linked to development of PD include manganese or iron toxicity, carbon monoxide poisoning,  chronic alcohol abuse, heavy metal toxicity, exposure to pesticides, use of illegal drugs, repeated trauma to the head (brain) as in boxers, hereditary (has a genetic basis in some families with PD).  Stress increases production of free radicals in the body, and these free radicals may cause or aggravate neurodegeneration potentiating PD.

3. What are the symptoms of Parkinson’s disease?

Initial stages – may just present with mild tremor or shaking of one limb and usually affecting only one side of the body.  As it progresses, it gradually involves both upper and lower limbs of both sides.

Intermediate stages – person usually have postural instability and may present with falls.  Their sense of balance is affected, usually falling forward or backward.  They are unsteady on their feet and maintains a stooped posture.  They usually walk with little or no arm swing, taking small steps.  But as they are stooped, they end up walking faster and faster, like someone chasing after their own centre of gravity, and finally they fall.  They would also have a ‘masked like facies’ – meaning little facial expression and blinking of the eyes.  They may also drool saliva because of slow swallowing of their saliva.

Advanced stages – their instability worsens and need assistance in walking or even confined to a wheelchair.  They start having difficult swallowing and in more advanced cases, may even be tube fed because of inability or unsafe to swallow.  In advanced stage, they may also become demented.

4. How does doctors diagnose and confirm that the patient have contracted this illness?

This is a clinical diagnosis and the main features are the presence of 3 out of 4 signs – tremor, rigidity, postural instability and slowness in movement or to initiate movement.  Blood test and brain scans are usually normal.

5. How do you treat this disease?

The main stay of treatment is to address the imbalance between inadequate dopamine and excessive acetylcholine.  Various medications are available – either to increase dopamine (using levodopa) or via dopamine receptors (using dopamine receptor stimulant like bromocriptine) or reducing acetylcholine (e.g artane).  In some cases, and when the patient is relatively young, surgery may be able to reduce the tremors and rigidity when medications do not work well.

a. What is the most important factor for recovery?

Medications and exercise is important.  The condition can be controlled by medications and there is no know treatment to heal the condition completely.

6. Is it possible to recover fully from it?


7. How long does it take to recover? and what is the recovery process like?

Patients usually respond to medical treatment for the first 5 years or so, later, they become less and less responsive and may develop complications as a result of the medications – e.g. ‘end of dose effect’ – just before the next dose of medication, patient become very stiff and trembles; ‘peak dose dyskinesia’ – where after a dose of medication is taken, the person develops involuntary movement as though he had an excessive dose of medicine.

8. Is there anything we can do to prevent ourselves from getting this illness?

Mainly to reduce degeneration of nerve cells of the brain – take antioxidant rich food –  food rich in
Vit C, Vit E and gingko biloba.  Food rich in Vit B12 (like meat, eggs), folate (green leafy vegetables), brightly coloured fruits (strawberries, blue berries, tomatoes, lantern peppers).  Meat should be taken only in moderation.

Exercise is important, so as physiotherapy to improve muscle mass and improve balance and walking stability.

Do feel free to add on if there is any piece of information that i have missed out and your would like to share.
This article would be due on 12/7 thus it will be good if we can arrange the interview with the patient and their family during next week.

Patient that I have arranged for your interview presented with shaking of the hands and falling.