Parkinson’s disease

As per medical science Parkinson’s disease is a neurological disease mostly found in the middle aged to the elderly. It was first described by James Parkinson in 1817. It is seen in 1 % of the population above 60 years of age. More than 1 million people are suffering from this disease in America about one and half times more commonly in men as compared to woman.
Usually it begins with a tremor of the fingers and the thumb is frequently affected and the characteristic tremor involves the thumb and is known as pill rolling movement.
To begin with it usually involves one side of the body but later on the other side of the body is involved. One peculiarity of the tremor is that it is seen when the hand or fingers are at rest i.e. they are not active and with action i.e. when the person moves the hand the tremor tends to disappear.
The other symptoms that are seen in PD is a stiffness of the body which to begin with may be localized but becomes more generalized with the passage of time. More important than these above two symptoms is another symptom which we call bradykinesia which means all the actions of the patient become very slow and the patient is not able to keep pace with friends or family members when they are walking with them. They start taking a significantly more time in changing clothes.
Another peculiar thing which is observed in these patients is that as the disease advances they have a lot of difficulty in initiating a movement i.e. if they are sitting then standing up takes a long period of time and if they are standing and then trying to walk then they cannot start walking easily and seem to be frozen, but once they start walking, they can keep on walking. The walk of patients with PD is slow and the patient tends to stoop forward and has short shuffling steps i.e. they seem to drag their feet along the ground.
The speech of these patients become slow and feeble with the passage of time and gradually it becomes so dysarthric that one cannot make out what they are saying. The face of the patient with PD cases become expressionless and the expression hardly changes- a condition which we call mask facies. They tend to blink eyes less frequently than normal people.
Even the swallowing mechanism is affected and saliva seems to drool from their mouth. A significant percentage of cases of PD also seem to develop an impairment of their intellectual faculties- a condition which in medical parlance is known as dementia- seen in around 30 % of patients. The patients cannot think clearly, their memory starts failing and they start forgetting many things and also have difficulty in comprehending slightly complex things. In the later stages the patient becomes disoriented to time i.e. they do not know the date, day of the week or the time of the day.
As the disease progresses they may fail to recognize friends or relations. With the passage of time the PD patients activities becomes very restricted and he/she becomes wheelchair bound or bedridden.
The pattern of abnormalities described above are seen not only in Parkinson’s disease but also in other conditions known as Parkinson plus syndrome which are a group of conditions. They have a lot of resemblance to PD but in reality are different disorders and their response to treatment is very different from that of PD. Usually a CT scan of the brain or MRI is done in PD to rule out other conditions. A number of other investigations may have to be done when in some cases where the diagnosis is not clear. PD is highly responsive to treatment and a number of modalities of treatment are available which will be discussed in a later article.