Transcript What is Parkinson`s Disease

Parkinson’s Disease 101
Maria De Leon, M.D., Parkinson’s specialist and
member, Parkinson’s Disease Foundation, People with
Parkinson’s Advisory Council
Linda Pituch, Patient Services Manager, Parkinson’s
Disease Foundation
www.pdf.org
Goals and Objectives:
• Understand Parkinson’s disease
• List the main symptoms
• Understand the benefits and challenges of
medications
• Learn other strategies for managing PD at all
stages
• Understand how PDF can help you and your
patients
What is Parkinson’s Disease?
A chronic and progressive movement disorder,
meaning that symptoms continue and worsen
over time. The cause is unknown, and although
there is presently no cure, there are treatment
options such as medication and surgery to
manage its symptoms.
Who Has Parkinson’s Disease?
• Approximately 1,000,000 Americans
• Seven to 10 million people worldwide
• Mostly (but not all) people over age 60
– About two percent of population over 60
– Average age of onset is 57
– Four percent are diagnosed before age 50
How is Parkinson’s diagnosed?
• There is no test yet for Parkinson’s disease.
• Making an accurate diagnosis is difficult
• A skilled practitioner (PDF recommends a
movement disorders specialist) must observe
a person’s symptoms, to diagnose Parkinson’s
What are the Symptoms of Parkinson's?
Primary Movement
Symptoms:
• Resting tremor
• Bradykinesia (Slowness)
• Rigidity
• Postural instability
(balance)
Nutt&Wooten,NEJM2005
AManualOfDiseasesOfTheNervousSystem,Gowers,1896
Other Common Movement Symptoms
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Freezing
Micrographia (shrinkage in handwriting)
Mask-like Facial Expression
Unwanted Accelerations
Stooped posture, a tendency to lean forward
Dystonia
Impaired fine motor dexterity and motor coordination
Impaired gross motor coordination
Poverty of movement (decreased arm swing)
Akathisia
Speech problems, such as softness of voice or slurred speech =
Difficulty swallowing
Sexual dysfunction
Cramping
Drooling
More Symptoms: Non-movement
• Sleep
– Restless Leg Syndrome
– REM Sleep Behavior Disorder
• Cognitive
– Mild Impairment
– Dementia
• Autonomic
– GI Motility
– Perspiration
– Heart/Blood Pressure
• Psychosis
– Hallucinations
• Mood
– Depression
– Anxiety
• Sensory
– Pain (shoulder)
– Hyposmia
• Fatigue/weakness
– Often due to rigidity
– Sleep issues too
What Causes Parkinson’s Disease?
• Scientists believe Parkinson’s is due to a combination
of genetic and environmental factors.
• 90 percent of cases are of unknown origin
• 10 percent are inherited because of known to cause
Parkinson’s
Parkinson’s Disease
Loss of neurons in the substantia nigra
http://www.urmc.rochester.edu/neuroslides/slide199.html
Madame Curie Bioscience Database
But Parkinson’s
is more than a
loss of
dopamine
neurons in the
substantia
nigra…
How Does Parkinson’s Progress?
• Differently for everyone
• Rating scales?
How Can You Treat Parkinson’s?
• Prescription Medications
• Surgical Treatments
• The “Pipeline” and Clinical Trials
How Can You Treat Parkinson’s?
Prescription Medications
• Most common is dopamine
replacement/augmentation therapy
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Carbidopa/Levodopa
Dopamine Agonists
Anticholinergics
MAO-B Inhibitors
COMT Inhibitors
Other medications
How Can You Treat Parkinson’s?
Surgical Options
• Deep Brain Stimulation
– reserved for later stages of disease
Motor Cortex
Motor Cortex
How Can You Treat Parkinson’s?
“Pipeline” and Clinical Trials
• Gene Therapy
– CERE-120 (neurturin), ProSavin, NLX-P101,
GDNF
• Stem Cell Therapy
– eSC, iPS, adult stem cells
• New Drugs
– help with non-motor symptoms
– help with side effects of levodopa
How Can You Treat Parkinson’s?
Side Effects and Limitations of Medications
• Side effects: Dyskinesia
• Limitations: depression, constipation, sexual
dysfunction , fatigue, sleep disorder etc.
Managing Parkinson’s
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Finding a Specialist
Managing Medications
Coping with Symptoms
Exercise
Nutrition
Finding Support
Staying Independent
Hospital visits and other special issues
Some Myths:
There are “exacerbations” in PD?
• Common assumption
• Potentially very dangerous
Reality: PD changes slowly, not over days or
weeks
• Something else must be going on!
• This cannot be attributed to the PD
• Need to find the underlying cause
Nirenberg, PDF Webinar Sep 29, 2009
Some symptoms should not
be attributed to PD
• Fever
• Weight Loss
• Headache
• Acute or Sudden
Weakness
• Vision Loss
• Back Pain
Nirenberg, PDF Webinar Sep 29, 2009
What can cause rapid
worsening of PD symptoms?
Infection
Other illness
Medications
Nirenberg, PDF Webinar Sep 29, 2009
Secret: What is one of the most common
silent causes for a “PD exacerbation?”
Urinary tract infection
Nirenberg, PDF Webinar Sep 29, 2009
Some medication changes
can worsen PD symptoms
• Nausea medications
• Antipsychotic medications
• Reduction of PD medications
Nirenberg, PDF Webinar Sep 29, 2009
About the
Parkinson’s Disease Foundation
Parkinson’s Disease Foundation
PDF was founded in 1957. We support the
research and ideas that will improve the
lives and futures of people touched by
Parkinson’s.
Parkinson’s Disease Foundation
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$96 million in scientific research funding
$40 million to education & advocacy programs
Reached and helped millions of people with
Parkinson’s and their families
Parkinson’s Disease Foundation
How We Can Help
• How can we help you?
– Continuing Education for Health Care
Professionals
• Course for physical therapists
• Course for nurses
• CEUs through our webinars
– Free publications for your patients
– A HelpLine for you and your patients to find
doctors, resources, support groups and more.