Parkinson’s disease

Parkinson's disease develops when nerve cells in a part of the brain called the substantia nigra are gradually lost. These cells are the ones responsible for making dopamine, a chemical that acts as a messenger between the areas of the brain and nervous system that control and coordinate body movement. As dopamine levels fall, the brain's movement centre can't work the way it should, and this is what makes movements grow slow and abnormal.

This loss of nerve cells happens gradually, over a long stretch of time. In fact, symptoms usually don't show up until around 80 percent of the nerve cells in the substantia nigra have already been lost. Exactly why these cells die off in the first place still isn't fully understood, but most experts believe it comes down to a mix of genetic and environmental influences.

Who tends to be affected

Parkinson's disease is thought to affect around 1 in 500 people, which works out to an estimated 127,000 people living with the condition in the UK. Most people who develop it are over 50 years old, though about 1 in 20 first notice symptoms before turning 40. It's also slightly more common in men than in women.

What actually causes the nerve cell loss

Researchers still don't know exactly why this loss of nerve cells happens, though studies are continuing to look for answers. At present, the leading idea is that a combination of genetic changes and environmental exposures is behind it.

On the genetic side, several genetic factors are known to raise a person's risk of developing Parkinson's, although how exactly they make someone more vulnerable to the condition isn't clear yet. Parkinson's can occasionally run in families when a faulty gene is passed down from parent to child, but this kind of inherited pattern is uncommon.

As for environmental factors, some researchers believe these may also play a role in raising a person's risk. There's been some suggestion that pesticides and herbicides used in agriculture, as well as pollution from traffic or industry, could be contributing factors. That said, the evidence connecting environmental exposure to Parkinson's disease is still far from conclusive.

Other conditions that cause parkinsonism

Parkinsonism is the broader term used for the group of symptoms that includes tremors, muscle stiffness, and slowed movement. Parkinson's disease is by far the most common cause of parkinsonism, but there are rarer forms where doctors can actually pinpoint a specific cause. These include parkinsonism brought on by certain medications, known as drug-induced parkinsonism, where symptoms appear after taking particular drugs, such as some antipsychotic medicines, and tend to ease once the medication is stopped. It can also result from other progressive brain conditions, such as progressive supranuclear palsy, multiple systems atrophy, and corticobasal degeneration, or from cerebrovascular disease, where a series of small strokes damages several areas of the brain.

You can find more information about parkinsonism on the Parkinson's UK website.

Diagnosing Parkinson’s disease

No tests can conclusively show that you have Parkinson’s disease. Your doctor will base a diagnosis on your symptoms, medical history and a detailed physical examination.

Your GP will talk to you about the problems you’re experiencing and may ask you to perform some simple mental or physical tasks, such as moving or walking around, to help with the diagnosis.

In the early stages, your GP may find it difficult to say whether you definitely have the condition because symptoms are usually mild.

Referral to a specialist

If your GP suspects Parkinson’s disease, you’ll be referred to a specialist. This will usually be:

• a neurologist – a specialist in conditions affecting the brain and nervous system
• a geriatrician – a specialist in problems affecting elderly people

If your GP thinks you may be in the early stages of Parkinson’s disease, you should see a specialist within six weeks. If they think you may be in the later stages, you should see a specialist within two weeks.

The specialist will most likely ask you to perform a number of physical exercises so they can assess whether you have any problems with movement.

A diagnosis of Parkinson’s disease is likely if you have at least two of the three following symptoms:

• shaking or tremor in a part of your body that usually only occurs at rest
• slowness of movement (bradykinesia)
• muscle stiffness (rigidity)

If your symptoms improve after taking a medication called levodopa, it’s more likely you have Parkinson’s disease.

Special brain scans, such as a single photon emission computed tomography (SPECT) scan, may also be carried out in some cases to try to rule out other causes of your symptoms.

Receiving the diagnosis

Being told you have Parkinson’s disease can be emotionally distressing, and the news can often be difficult to take in.

This means it’s important that you have the support of your family and a care team who will be able to help you come to terms with the diagnosis.

You may find it useful to contact Parkinson’s UK, the Parkinson’s support and research charity.

They can be contacted by:

• free helpline on 0808 800 0303 (Monday to Friday, 9am to 7pm, and 10am to 2pm on Saturdays)
• email: hello@parkinsons.org.uk

Parkinson’s UK brings people with Parkinson’s, their carers and families together through a network of local groups, as well as online resources and a confidential helpline.

Parkinson’s UK provides information and support on every aspect of living with Parkinson’s.

Treating Parkinson’s disease

Although there’s currently no cure for Parkinson’s disease, treatments are available to help reduce the main symptoms and maintain quality of life for as long as possible.

These include:

• supportive treatments – such as physiotherapy and occupational therapy
• medication
• in some cases, brain surgery

You may not need any treatment during the early stages of Parkinson’s disease, as symptoms are usually mild. However, you may need regular appointments with your specialist so your condition can be monitored.

Read more about treating Parkinson’s disease

There are several therapies that can make living with Parkinson’s disease easier and help you deal with your symptoms on a day-to-day basis.

There are efforts underway to try to increase the availability of these supportive therapies for Parkinson’s patients on the NHS.

Your local authority may be able to advise and help you. Ask your local authority for a care and support needs assessment.

Physiotherapy

A physiotherapist can work with you to relieve muscle stiffness and joint pain through movement (manipulation) and exercise.

The physiotherapist aims to make moving easier, and improve your walking and flexibility. They also try to improve your fitness levels and ability to manage things for yourself.

Occupational therapy

An occupational therapist can identify areas of difficulty in your everyday life – for example, dressing yourself or getting to the local shops.

They can help you work out practical solutions, and ensure your home is safe and properly set up for you. This will help you maintain your independence for as long as possible.

Read more about occupational therapy

Speech and language therapy

Many people with Parkinson’s disease have swallowing difficulties (dysphagia) and problems with their speech.

A speech and language therapist can often help you improve these problems by teaching speaking and swallowing exercises, or by providing assistive technology.

Diet advice

For some people with Parkinson’s disease, making dietary changes can help improve some symptoms.

These changes can include:

• increasing the amount of fibre in your diet and making sure you’re drinking enough fluid to reduce constipation
• increasing the amount of salt in your diet and eating small, frequent meals to avoid problems with low blood pressure, such as dizziness when you stand up quickly
• making changes to your diet to avoid unintentional weight loss

You may see a dietitian, a healthcare professional trained to give diet advice, if your care team thinks you may benefit from changing your diet.

Medication

Medication can be used to improve the main symptoms of Parkinson’s disease, such as shaking (tremors) and movement problems.

However, not all the medications available are useful for everyone, and the short- and long-term effects of each are different.

Three main types of medication are commonly used:

• levodopa
• dopamine agonists
• monoamine oxidase-B inhibitors

Your specialist can explain your medication options, including the risks associated with each medication, and discuss which may be best for you. Regular reviews will be required as the condition progresses and your needs change.

Read on to learn about the treatments you may be offered. You can also see a summary of the pros and cons of treatments for Parkinson’s disease, where you can compare your options.

Levodopa

Most people with Parkinson’s disease eventually need a medication called levodopa.

Levodopa is absorbed by the nerve cells in your brain and turned into the chemical dopamine, which is used to transmit messages between the parts of the brain and nerves that control movement.

Increasing the levels of dopamine using levodopa usually improves movement problems.

It is usually taken as a tablet or liquid, and is often combined with other medication, such as benserazide or carbidopa.

These medications stop the levodopa being broken down in the bloodstream before it has a chance to get to the brain.

They also reduce the side effects of levodopa, which include:

• feeling sick (nausea) or vomiting
• tiredness
• dizziness

If you’re prescribed levodopa, the initial dose is usually very small and will be gradually increased until it takes effect.

At first, levodopa can cause a dramatic improvement in the symptoms.

However, its effects can be less long-lasting over the following years – as more nerve cells in the brain are lost, there are fewer of them to absorb the medicine. This means the dose may need to be increased from time to time.

Long-term use of levodopa is also linked to problems such as uncontrollable, jerky muscle movements (dyskinesias) and “on-off” effects, where the person rapidly switches between being able to move (on) and being immobile (off).

Dopamine agonists

Dopamine agonists act as a substitute for dopamine in the brain and have a similar but milder effect compared with levodopa. They can often be given less frequently than levodopa.

They are often taken as a tablet, but are also available as a skin patch (rotigotine).

Sometimes dopamine agonists are taken at the same time as levodopa, as this allows lower doses of levodopa to be used.

Possible side effects of dopamine agonists include:

• nausea or vomiting
• tiredness and sleepiness
• dizziness

Dopamine agonists can also cause hallucinations and increased confusion, so they need to be used with caution, particularly in elderly patients, who are more susceptible.

For some people, dopamine agonists have been linked to the development of compulsive behaviours, especially at high doses, including addictive gambling and an excessively increased libido.

Talk to your healthcare specialist if you think you may be experiencing these problems.

As the person themselves may not realise the problem, it’s key that carers and family members also note any abnormal behaviour and discuss it with an appropriate professional at the earliest opportunity.

If you’re prescribed a course of dopamine agonists, the initial dose is usually very small to prevent nausea and other side effects.

The dosage is gradually increased over a few weeks. If nausea becomes a problem, your GP may prescribe anti-sickness medication.

A potentially serious, but uncommon, complication of dopamine agonist therapy is sudden onset of sleep.

This generally happens as the dose is being increased and tends to settle once the dose is stable.

People are usually advised to avoid driving while the dose is being increased in case this complication occurs.

Monoamine oxidase-B inhibitors

Monoamine oxidase-B (MAO-B) inhibitors, including selegiline and rasagiline, are another alternative to levodopa for treating early Parkinson’s disease.

They block the effects of an enzyme or brain substance that breaks down dopamine (monoamine oxidase-B), increasing dopamine levels.

Both selegiline and rasagiline can improve the symptoms of Parkinson’s disease, although their effects are small compared with levodopa. They can be used alongside levodopa or dopamine agonists.

MAO-B inhibitors are generally very well tolerated, but can occasionally cause side effects, including:

• nausea
• headache
• abdominal pain
• high blood pressure

Catechol-O-methyltransferase inhibitors

Catechol-O-methyltransferase (COMT) inhibitors are prescribed for people in later stages of Parkinson’s disease. They prevent levodopa from being broken down by the enzyme COMT.

Side effects of COMT inhibitors include:

• nausea or vomiting
• diarrhoea
• abdominal pain

Non-oral therapies

When Parkinson’s symptoms become difficult to control with tablets alone, a number of other treatments can be considered.

Apomorphine

A dopamine agonist called apomorphine can be injected under the skin (subcutaneously) either by:

• a single injection, when required
• a continuous infusion using a small pump carried around on your belt, under your clothing, or in a bag

Duodopa

If you have severe on-off fluctuations, a type of levodopa called duodopa may be used.

This medication comes as a gel that’s continuously pumped into your gut through a tube inserted through your abdominal wall.

There’s an external pump attached to the end of the tube, which you carry around with you.

About 25 specialist neuroscience centres in the UK offer this treatment. This treatment is only available if you have very severe on-off fluctuations or involuntary movements.

Surgery

Most people with Parkinson’s disease are treated with medication, although a type of surgery called deep brain stimulation is used in some cases.

This surgery is also available in specialist neuroscience centres around the UK, but it’s not suitable for everyone.

If surgery is being considered, your specialist will discuss the possible risks and benefits with you.

Deep brain stimulation

Deep brain stimulation involves surgically implanting a pulse generator similar to a heart pacemaker into your chest wall.

This is connected to one or two fine wires placed under the skin, and is inserted precisely into specific areas in your brain.

A tiny electric current is produced by the pulse generator, which runs through the wire and stimulates the part of your brain affected by Parkinson’s disease.

Although surgery doesn’t cure Parkinson’s disease, it can ease the symptoms for some people.

Vaccinations

Everyone with a long-term condition is encouraged to get a yearly flu jab each autumn.

The pneumococcal vaccination is also usually recommended, which is a one-off injection that protects against a serious chest infection called pneumococcal pneumonia.

Relationships and support

Being diagnosed with a long-term condition like Parkinson’s disease can put a strain on you, your family and friends. It can be difficult to talk to people about your condition, even if they’re close to you.

Dealing with the deterioration of symptoms, such as increasing difficulty with movement, may make you feel frustrated and depressed. Spouses, partners or carers will inevitably feel anxious or frustrated as well.

Be open about how you feel, and let your family and friends know what they can do to help. Don’t feel shy about telling them you need some time to yourself, if that’s what you want.

Support

If you have any questions about your condition, your GP or Parkinson’s disease specialist nurse may be able to help.

You may also find it helpful to talk to a trained counsellor or psychologist, or someone at a specialist helpline. Your GP surgery will have details of these.

Some people find it helpful to talk to others with Parkinson’s disease, either at a local support group or in an internet chat room.

Care and support services

It’s worth taking time to think about your specific needs and what would help you achieve the best quality of life.

For example, you may wish to consider equipment, help in your home, and home adaptations.

Parkinson’s UK

Parkinson’s UK is the main Parkinson’s support and research charity in the UK.

They can offer the support and advice you may need if you’re living with Parkinson’s disease, and can let you know about support groups in your local area.

They can be contacted by:

• free confidential helpline on 0808 800 0303 (Monday to Friday, 9am to 7pm, and 10am to 2pm on Saturdays)
• email: hello@parkinsons.org.uk

The Parkinson’s UK website also features all the latest news, publications and research updates, as well as an online community where you can share your experiences of living with Parkinson’s.

Work and finances

Being diagnosed with Parkinson’s doesn’t mean you have to stop working. Many people with the condition keep working for years after their diagnosis.

You may find it hard to cope financially if you do have to stop work or work part-time because of your condition.

However, you may be entitled to one or more of the following types of financial support:

• You are entitled to Statutory Sick Pay from your employer if you have a job but can’t work because of your illness.
• You may be entitled to Employment and Support Allowance (ESA) if you don’t have a job and can’t work because of your illness.
• You may be eligible for Personal Independence Payment (PIP), which replaced the Disability Living Allowance (DLA), if you’re aged 64 and under and need help with personal care or have walking difficulties.
• You may be able to get Attendance Allowance if you’re aged 65 or over.
• You may be entitled to Carer’s Allowance if you’re caring for someone with Parkinson’s disease.
• You may be eligible for other benefits if you have children living at home or if you have a low household income.

Driving

If you’ve been diagnosed with Parkinson’s disease, you must inform the Driver and Vehicle Licensing Agency (DVLA) and your insurance company.

You won’t necessarily have to stop driving. You’ll be asked to complete a form providing more information about your condition, as well as details of your doctors and specialists. The DVLA will use this to decide whether you’re fit to drive.

Complex Parkinson’s disease and palliative care

Complex Parkinson’s disease is defined as the stage when treatment is unable to consistently control symptoms, or the person has developed uncontrollable jerky movements (disabling dyskinesia).

These problems can still be helped by adjustment or addition of some of the medications used to treat Parkinson’s disease, under the supervision of a doctor with a specialist interest in Parkinson’s disease.

As Parkinson’s disease progresses, you’ll be invited to discuss the care you want with your healthcare team as you near the end of your life. This is known as palliative care.

When there’s no cure for an illness, palliative care tries to alleviate symptoms, and is also aimed at making the end of a person’s life as comfortable as possible.

This is done by attempting to relieve pain and other distressing symptoms, while providing psychological, social and spiritual support for you and your family.

Palliative care can be provided at home or in a hospice, residential home or hospital. You may want to consider talking to your family and care team in advance about where you’d like to be treated and what care you wish to receive.

Don’t include personal information e.g. name, location or any personal health conditions.

পারকিনসন্স রোগ যত এগিয়ে যায়, উপসর্গগুলো তত তীব্র হতে পারে, আর প্রতিদিনের সাধারণ কাজগুলোও অন্য কারও সাহায্য ছাড়া সামলানো কঠিন হয়ে পড়তে পারে।

বেশিরভাগ মানুষের ক্ষেত্রে চিকিৎসা ভালো কাজ করে এবং তাদের অক্ষমতা মৃদু থেকে মাঝারি পর্যায়েই থেকে যায়। তবে অল্প কিছু মানুষের ক্ষেত্রে চিকিৎসা তেমন ভালো কাজ করে না এবং সময়ের সঙ্গে সঙ্গে তারা আরও বেশি অক্ষম হয়ে পড়তে পারেন।

পারকিনসন্স রোগ নিজে সরাসরি মৃত্যুর কারণ হয় না, তবে এটি শরীরের ওপর যথেষ্ট চাপ ফেলতে পারে এবং কারও কারও ক্ষেত্রে গুরুতর, জীবনের জন্য ঝুঁকিপূর্ণ সংক্রমণের আশঙ্কা বাড়িয়ে দিতে পারে।

তবে চিকিৎসার অগ্রগতির কারণে পারকিনসন্স রোগে আক্রান্ত বেশিরভাগ মানুষ এখন স্বাভাবিক বা প্রায় স্বাভাবিক আয়ু আশা করতে পারেন।

পারকিনসন্স রোগ নিয়ে জীবনযাপন সম্পর্কে আরও পড়ুন।

যাঁদের সহায়তা প্রয়োজন এবং তাঁদের সেবাদানকারী ও পরিবারের সদস্যদের জন্য লেখা যত্ন ও সহায়তার নির্দেশিকাটি পড়াও আপনার কাজে লাগতে পারে।

পারকিনসন্স রোগ নিয়ে জীবনযাপন

আপনার যদি পারকিনসন্স রোগ থাকে, তাহলে যতটা সম্ভব নিজের শারীরিক ও মানসিক সুস্থতার যত্ন নেওয়া জরুরি।

ব্যায়াম ও স্বাস্থ্যকর খাওয়াদাওয়া

নিয়মিত ব্যায়াম মাংসপেশির শক্ত ভাব কমাতে, মন ভালো রাখতে এবং মানসিক চাপ কমাতে বিশেষভাবে সহায়ক।

সক্রিয় থাকার অনেক উপায় আছে, টেনিস ও সাইকেল চালানোর মতো বেশি পরিশ্রমের কাজ থেকে শুরু করে হাঁটা, বাগান করা ও যোগব্যায়ামের মতো হালকা কাজ পর্যন্ত।

এর পাশাপাশি সব ধরনের খাদ্য উপাদান রেখে একটি সুষম খাদ্যতালিকা মেনে চলার চেষ্টা করবেন, যাতে সুস্থ থাকার জন্য প্রয়োজনীয় পুষ্টি আপনার শরীর পায়।