symptoms of parkinsons disease : Other Parkinsonism Syndromes

The characteristic symptom-complex of Parkinson disease (tremor, rigidity, bradykinesia, postural instability) is termed parkinsonism. This is a general term and not all patients with parkinsonism have typical Parkinson disease. Early in the disease process it may be difficult to know whether a patient has typical Parkinson disease or a syndrome that mimics it. The development of additional symptoms and the subsequent course of the disease generally points to the correct diagnosis.

Recognizing other causes of Parkinsonism

A number of patients with parkinsonism do not have PD. One study of patients with parkinsonism found that 65% had PD, 18% had drug-induced parkinsonism, 7% had vascular parkinsonism (i.e. from blocking-up of the small blood vessels feeding the brain) and 10% had atypical parkinsonism. Atypical parkinsonism should be considered particularly in patients with poor dopaminergic responsiveness, early loss of balance, prominent intellectual changes (dementia), rapid onset or progression, conspicuous postural hypotension, and little or no tremor. The present of neurological findings not associated with classic Parkinson disease, such as myoclonic jerking (shock-like sudden muscle contractions), should also suggest other diagnostic possibilities. The autonomic nervous system regulates the “involuntary” internal functions of the body, such as blood pressure, heart rate, and bladder, rectum, and sexual function. It may be affected in certain atypical parkinsonian syndromes.

Medication-induced Parkinsonism

Although tremor and postural instability may be less prominent, this condition may be indistinguishable from Parkinson disease. Medications frequently associated with the development of parkinsonism include antipsychotics, metaclopramide, reserpine, tetrabenazine and some calcium-channel blockers (especially cinnarizine and flunarizine). The parkinsonism usually resolves within weeks to months after discontinuing the offending medication.

Progressive Supranuclear Palsy (PSP)

Early onset of imbalance, frequent falls, rigidity of the trunk, and (eventually) eye-movement problems characterize PSP. Symptoms usually begin after age 50 and progress more rapidly than with Parkinson disease. The most characteristic eye movement abnormality is a vertical gaze paralysis. Upgaze and downgaze are therefore limited. Patients may present with frequent falls while walking downstairs, because they cannot look down. Dementia develops later in the disease. There is no specific treatment for PSP. Dopaminergic treatment should be tried but often provides little benefit. Supportive measures such as speech therapy, physical therapy, and antidepressants may help.

Corticobasal Degeneration (CBD)

CBD is the least common of the atypical causes of parkinsonism. It often affects patients quite asymmetrically and progresses more rapidly than Parkinson disease. The initial symptoms of CBD usually develop after age 60 and include asymmetric bradykinesia, rigidity, limb dystonia (abnormal postures), postural instability, and disturbances of language (speech expression or comprehension). There is often marked and disabling apraxia, i.e., it becomes difficult or impossible to use the affected limb even though there is no weakness or sensory loss.

There is no specific treatment for CBD. Supportive treatment such as botulinum toxin for dystonia, antidepressant medications and speech and physical therapy may help. Levodopa and dopamine agonists seldom offer benefit.

Multiple System Atrophy (MSA)

MSA is a neurodegenerative disease of unknown cause. Initially it may be difficult to distinguish from Parkinson disease, but it is far less common and progresses more rapidly. The mean age of onset is in the mid-50s. Clinically, it presents with bradykinesia, poor balance, abnormal autonomic function, rigidity, difficulty with coordination, or a combination of these features. Abnormalities of autonomic function include impotence, low blood pressure upon standing, excessive or reduced sweating, and constipation. There are three subtypes of the illness, each affecting different systems.

Striatonigral degeneration (SND) is characterized by parkinsonism, but without much tremor and with poor response to Sinemet. In the Shy-Drager syndrome, parkinsonism and autonomic abnormalities are conspicuous. In olivopontocerebellar atrophy (OPCA), patients have lack of coordination and clumsiness which affect balance and gait.

As MSA progresses, other symptoms and signs develop that reflect involvement of a different system. Patients with the parkinsonian presentation typically have an asymmetrical tremor, bradykinesa, rigidity and postural instability. Men often develop impotence; both men and women often experience urinary urgency and incontinence. Patients with Shy-Drager syndrome present with more prominent symptoms of autonomic dysfunction.

Although 30% of patients with MSA obtain a definite but short-lived benefit from levodopa and dopamine agonists, the parkinsonism is typically poorly responsive to medications. Dyskinesias and dystonia emerge in half of treated patients. There is not much experience of using deep brain stimulators (DBS) for MSA, but some researchers have found a modest benefit of DBS that persisted for over two years in a few patients.

Vascular Parkinsonism

Multiple small strokes can cause parkinsonism. Patients with this disorder are more likely to present with gait difficulty than tremor and are more likely to have symptoms that are worse in the lower than upper limbs. Some will also report the abrupt onset of symptoms or give a history of step-wise deterioration (symptoms get worse, then plateau for a period). Treatment is the same as for Parkinson disease, but the results are often disappointing.

Dementia with Lewy bodies (DLB)

This disorder is characterized by early dementia, prominent hallucinations, fluctuations over the day in cognitive status, and parkinsonism. The neuropsychological profile is characterized by deficits in attention, executive function (problem solving, planning) and visuospacial function (the ability to produce and recognize figures, drawing or matching figures).

Treatment with cholinesterase inhibitors may reduce delusions, apathy, agitation and hallucinations. A severe reaction to antipsychotic medication is another feature of this disease. If behavioral problems do not respond to cholinesterase inhibitors, low-dose treatment with atypical antipsychotic medications (quetiapine, resperidone, or clozapine) may be considered. Although motor symptoms may respond to levodopa, hallucinations may become worse with its use.

The above information was contributed by Mariann Di Minno, RN, MA, and Michael J. Aminoff, MD, DSc, of the Parkinson’s Disease Clinic and Research Center at the University of California, San Francisco.

symptoms of parkinsons disease : PARKINSON PRIMER 2

Symptoms may originally be restricted to one limb, but will typically spread over time to the other limb on the same side. They eventually progress to the other side of the body. Generally this progression is gradual, but the rate of progression varies in different patients. As symptoms progress, it is important for patients to talk with their physicians so that optimal treatment can be established. The goal of treatment is not to abolish symptoms, but rather to help the patient manage their symptoms, function independently, and make the appropriate adjustments to a chronic illness. The illness will not go away, but management of its symptoms can be successful in reducing disability or other handicap.

Patients are aware of the progressive nature of the illness and this may become a source of much anxiety. It is not uncommon for patients to over-monitor themselves and their symptoms, compare themselves to other Parkinson disease patients whom they may meet (length of diagnosis, level of symptoms, etc.), and avoid situations such as support groups, where they may see patients who are worse off than they are. Concern about the progression of the disease and the ability to continue working is frequently voiced.

It is not possible to predict with any confidence the likely course of the disease in an individual patient. The rate of progression and resulting level of disability vary in different patients. Some guide to the likely outcome in individual patients is provided by the course of the illness since diagnosis, but this is no more than suggestive.

When the disorder is such that normal activities of daily living are impaired, at least to some extent, symptomatic treatment is begun.

Is PD Inherited?

There is a family history of Parkinson disease in 5-10% of patients. It may affect people of the same generation (e.g., a brother or sister) or in two generations, such as a father and son. Environmental toxins such as manganese, carbon monoxide, and, rarely, certain pesticides cause diseases that resemble PD. However, most people with Parkinson disease have not been exposed to these toxins. In less than 1% of cases, PD is clearly familial. Several gene mutations have been shown to cause Parkinson disease in a few families, but these have not been found in most individuals with PD. Studies of identical twins in which one twin was known to have PD showed no increase in the incidence of PD in the other twin compared to the general population of patients over the age of 60 years. However, among identical twins younger than 50, if one member of the twinship has Parkinson disease, there is an increased risk of PD in the other twin. This indicates heredity may play a role in young-onset cases. Currently, researchers suspect that the cause of Parkinson disease in most individuals reflects a combination of genetic factors and environmental exposures.

What Else Could It Be?

There are many causes of tremor other than Parkinson disease, and it generally requires examination by a neurologist to distinguish between them.

by Mariann Di Minno, RN, MA, and Michael J. Aminoff, MD, DSc

symptoms of parkinsons disease : PARKINSON PRIMER

Overview of Parkinson Disease

Parkinson disease (PD) was first described in 1817 by Dr. James Parkinson, a British physician, for whom the disease was named. It is a disease that is characterized by four major features:

Rest tremor of a limb (shaking with the limb at rest)
Slowness of movement (bradykinesia)
Rigidity (stiffness, increased resistance to passive movement) of the limbs or trunk
Poor balance (postural instability)
When at least two of these symptoms are present, and especially if they are more evident on one side than the other, a diagnosis of PD is made, unless there are atypical features that suggest an alternative diagnosis. Patients may first realize something is wrong when they develop a tremor in a limb; movements are slowed and activities take longer to perform; or they experience stiffness and have balance problems. Initially, symptoms are a variable combination of tremor, bradykinesia, rigidity and postural instability. Symptoms typically begin on one side of the body and spread over time to the other side.

Changes occur in facial expression, so that there is a certain facial fixity (blank expression showing little emotion) or a staring appearance (due to reduced frequency of eye blinking). Complaints of a frozen shoulder or foot drag on the affected side are not uncommon. As symptoms come on gradually, older patients may attribute these changes to aging. The tremor is thought to be “shakiness,” bradykinesia is regarded as normal “slowing down,” and stiffness is attributed to arthritis. The stooped posture, common to PD, may be attributed to age or osteoporosis. Both younger and older patients may experience initial symptoms for a year or more before seeking medical evaluation.

Parkinson disease affects 1 in 100 people over the age of 60, with the average age of onset being 60 years. It can also affect younger people. Young-onset Parkinson disease (onset at age 40 or younger) is estimated to occur in 5 – 10% of patients with PD.

Disease Progression

After Alzheimer’s disease, Parkinson disease is the most common neurodegenerative disease.

It is a chronic, progressive disease that results when nerve cells in a part of the midbrain, called the substantia nigra, die or are impaired. These nerve cells produce dopamine, an important chemical messenger that transmits signals from the substantia nigra to another part of the brain called the corpus striatum. These signals allow for coordinated movement. When the dopamine-secreting cells in the substantia nigra die, the other movement control centers in the brain become unregulated. These disturbances in the control centers of the brain cause the symptoms of PD. When 80% of the dopamine-producing cells in the substantia nigra are depleted, symptoms of PD develop.

Initially the symptoms are mild, usually on one side of the body, and may not require medical treatment. Rest tremor is a major characteristic of PD, and the most common presenting symptom, but some patients never develop it. Tremor may be the least disabling symptom, but is often the most embarrassing to the patient. Patients may keep their affected hand in their pocket, behind their back, or hold something to control the tremor, which may be more psychologically distressing than any physical limitation that it imposes.

Over time, initial symptoms become worse. A mild tremor becomes more bothersome and more noticeable. Difficulties may develop with cutting food or handling utensils with the affected limb. Bradykinesia (slowness in movement) becomes a significant problem and the most disabling symptom. Slowness may interfere with daily routines; getting dressed, shaving or showering may take much of the day. Mobility is impaired and difficulty develops in getting into or out of a chair or a car, or turning over in bed. Walking is slower and there is a stooped posture, with the head and shoulders hanging forward. The voice becomes soft and monotonous. A disturbance of balance may lead to falls. Handwriting becomes small (“micrographia”) and illegible. Automatic movements, such as arm swing when walking, are reduced.

by Mariann Di Minno, RN, MA, and Michael J. Aminoff, MD, DSc, of the Parkinson’s Disease Clinic and Research Center at the University of California, San Francisco.

symptoms of parkinsons disease : Is There a Link?

Both Alzheimer's and Parkinson's disease affect nearly half a million people each year with their debilitating and eventually life-robbing symptoms. While Alzheimer's steals memories and personality and eventually leads to decreased motor function, Parkinson's disease robs the person of basic motor function causing a shaking or palsy to run throughout the body. Scientists have wondered for years whether or not there was a connection for the two diseases, either in the genes or some environmental factor that triggered the onset of both Alzheimer's and Parkinson's Disease.

A Discussion of the Two Players:

Parkinson's disease is an incurable disease of the nervous system where the neuro-transmitters in the brain begin to malfunction, causing a trembling in the body and limbs that gets progressively worse over time. Symptoms of rigidity and trouble walking at a normal gait also appear over time. Eventually this disease will rob the person of the ability to control their balance leading to more falls and slips, which is a concern for their well being.

Alzheimer's and Parkinson's disease are different in that while Parkinson's disease appears to focus more on physical ailments, Alzheimer's appears to affect the mental capacities before the motor skills and physical ones deteriorate. Common everyday forgetfulness turns into confusion and forgetfulness that becomes a problem for every day activity. The location of homes or remembering the faces of children or friends becomes more and more difficult with time. Eventually, the personality can change as a result of the disease.

Is There a Connection?:

In April of 2003, a scientific study indicated that there may be a connection between Alzheimer's and Parkinson's disease. In that study, it was concluded that older adults who develop the tremors and other classical symptoms of Parkinson's disease may be up to eight times as likely to develop Alzheimer's disease as well. In addition, it has been shown that the symptoms of both Alzheimer's and Parkinson's disease can be very similar and perhaps follow the same lines, although the root cause may be somewhat different.

Research also suggests that Alzheimer's and Parkinson's disease may have a connection in how the two diseases progress over time. The same study published in the April 2003 issue of The Archives of Neurology tracked the progression of symptoms associated with Parkinson's disease among 824 Catholic clergy members with an average age of 75, and who had no signs of Alzheimer's disease at the beginning of the study. After approximately four and half years, 79% of the study's participants experienced a more rapid progression of the symptoms of Parkinson's disease. Of those who experienced the most rapid progression, it was found that they were eight times as likely to have symptoms of both Alzheimer's and Parkinson's disease.

Is there a connection between Alzheimer's and Parkinson's disease? So far the medical profession is still debating that idea, but more and more studies indicate that they're might be a link between these two debilitating diseases. Only more time, and more research will be able to explain the connection, if any, between Alzheimer's and Parkinson's disease.

By Jonty Smith

symptoms of parkinsons disease : Parkinsons Medicine

To date, there is no known cure for Parkinson's, despite the ongoing research efforts of scientists across the world. Having said that, there are a number of treatments available which can substantially relieve the pain many patients feel as a result of the symptoms of the disease. It is not the case that every patient will require medication and drugs to treat their condition, and these will only be administered where the severity of the symptoms has a strong adverse affect on the patient's lifestyle. The course of Parkinsons Medicine offered to a patient will vary with the amount of disruption the symptoms cause, the state of the patient's condition and the severity of the condition within the patient. Even in these cases, it is not always a guarantee that the symptoms will be helped, although these treatments will go someway to making life more comfortable.

The most effective treatment for the symptoms of Parkinson's Disease by a long shot is the drug levodopa. This is derived from a naturally produced chemical in plant matter and animals, and works with the nerve cells to produce the dopamine which has been eroded by the patient's condition, and is thought to be an underlying cause of the disease. The drug allows the majority of patients to extend the period of time in which they can lead their normal lives, effectively stalling the development of their Parkinson's. Unfortunately, this treatment is only really effective in helping rigidity and bradykinesia, and may be of no help to the tremor or balance problems the patient may be experiencing. The drug is so effective, many patients forgot they are suffering from the disease as they continue to lead their lives as normal. However, levodopa is only a short term solution, as it can never replace the nerve cells which have been irretrievably damaged within the brain.

As with most medications, there are a number of side effects with levodopa, including restlessness, low blood pressure and vomiting. In some cases patients may also occasionally feel confused as to their surroundings , although this is a rare occurrence. It is important for physicians and patients to work together to come up with a happy medium between the benefits and side effects when using levodopa.

When combined with the drug tolcapone, Parkinsons medicine significantly reduces the effects of the disease, and helps block the destruction of dopamine which worsens the condition. Having said that, this tends to increase involuntary movement and twitching over a long course of treatment, and is sometimes withdrawn for several days at a time to ensure its continued effectiveness. However, patients should never completely cease treatment with levodopa without their physician's guidance, due to the extreme and serious side effects that can emerge as a result.

Although there is no cure for the disease, Parkinsons medicine can go a long way to suppressing the debilitating and disabling symptoms of the condition, and making life more bearable for the many thousands of sufferers around the world.

by Clive Jenkins

symptoms of parkinsons disease : Deep brain stimulation-Risks

Risks

Deep brain stimulation is less risky than other surgical procedures used to treat Parkinson's disease. Risks may include:

Bleeding in the brain during the surgery, resulting in a stroke.
Numbness, tingling, twitching, or other abnormal sensations when the device is turned on. (These usually do not last long and can be eliminated by adjusting the programming of the deep brain stimulation device.)
Infection or skin irritation caused by the device in the chest (stimulator) or electrodes.
Break in the wire leading from the electrode to the stimulator. Repairing the problem requires another surgery but not usually in the brain itself.
Need for a new battery for the device. A battery typically will last about 5 years; surgery is needed to replace it. This is a relatively minor procedure and does not require surgery on the brain itself.
Failure or malfunction of the stimulator or the electrodes.
What To Think About

Deep brain stimulation may be considered as an addition to levodopa therapy, not a replacement for it. It does not cure Parkinson's disease and does not eliminate the need for medication. The surgery can help maintain and extend the benefits of levodopa therapy, but should not be considered for people with Parkinson's disease who also respond poorly to levodopa therapy.

One of the possible advantages of deep brain stimulation over "lesional" surgery for Parkinson's disease (such as pallidotomy) is that it can be reversed. While the effects of lesional surgery, which involves creating a lesion or intentionally destroying a small portion of the brain, are permanent, the electrodes used in deep brain stimulation can be turned off or removed if they cause problems.

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symptoms of parkinsons disease : Deep brain stimulation part 2

Why It Is Done

Deep brain stimulation may be used to relieve symptoms of Parkinson's disease, especially tremor, when they cannot be controlled with medication. It is considered the surgical treatment of choice for Parkinson's disease because it is more effective, safer, and less destructive to brain tissue than other surgical methods.

Deep brain stimulation of the thalamus is done to treat disabling tremor caused by Parkinson's disease, as well as essential tremor.

Procedures that stimulate the subthalamic nucleus and the globus pallidus are done to help control a wider range of symptoms (in addition to tremor) and are used more often than stimulation of the thalamus.

How Well It Works

Deep brain stimulation of the thalamus is effective in reducing tremor. It does not affect slow movement (bradykinesia), stiffness (rigidity), or other symptoms.1

Deep brain stimulation of the subthalamic nucleus or the globus pallidus may:1

Reduce tremor and, to a lesser extent, other symptoms of Parkinson's disease. Deep brain stimulation tends to have the greatest effect on tremor, but slow movement and stiffness can also be reduced and gait can be improved.
Reduce the on-off motor fluctuations associated with long-term use of levodopa. During the course of a day, you may have “on” periods when the levodopa controls Parkinson's symptoms and “off” periods when the medication stops working. Deep brain stimulation can reduce the length and severity of “off” periods.
Reduce the abnormal movements (dyskinesias) that are side effects of levodopa therapy.
The practical effects of deep brain stimulation depend in part on which area of the brain receives the stimulation. Stimulation of the subthalamic nucleus reduces symptoms of Parkinson's disease, which allows people to reduce the amount of levodopa they are taking. Taking a lower dose helps reduce the abnormal movements (dyskinesias) that result from long-term levodopa therapy.

In contrast, stimulation of the globus pallidus reduces the dyskinesias associated with levodopa therapy, which allows people to increase the amount of levodopa they are taking without increasing side effects. In this case, the increased dosage of levodopa and the brain stimulation together help reduce tremor and other symptoms caused by Parkinson's disease.

By Healthwise

symptoms of parkinsons disease : Deep brain stimulation part 1

Treatment Overview of parkinsons disease

Deep brain stimulation uses electrical impulses to stimulate a target area in the brain. The stimulation affects movement by altering the activity in that area of the brain. The procedure does not destroy any brain tissue, and stimulation can be stopped at any time by turning off the device that supplies the electrical impulses.

Surgery is required to implant the equipment that produces the electrical stimulation. You are awake during the procedure (your scalp is numbed and you won't feel any pain) because you must work with the surgeon in placing the electrodes where they will have the most benefit. A small hole is drilled in your skull, and tiny wire electrodes are placed in your brain. A small battery-powered device (generator) similar to a pacemaker is implanted in your chest and connected to the electrodes in your brain by a wire. The procedure usually takes 3 to 4 hours, although it may take as long as 8 hours in some cases.

When the device is turned on, it sends 100 to 180 electrical pulses per minute to stimulate the specific area of the brain. You can turn the device on and off by holding a magnet against the skin over the device. Newer models can be turned on and off with a small remote control unit. The device can be programmed so that it delivers the correct level of stimulation to provide the greatest relief of symptoms.

What To Expect After Treatment

You will remain in the hospital for several days after the procedure while your doctor checks the effect of deep brain stimulation.

By Healthwise

symptoms of parkinsons disease : Wise Symptoms Of Parkinson's Disease

Parkinson's disease has been classified into five stages by Hoehn and Yahr. Their classification is based on the severity of symptoms and the degree of disability the patient experiences.

When prescribing treatment, the neurologist will take into account the stage at which the patient is perceived to be, among other things.

Stage 1 is called unilateral disease. The term means that only one side of the body shows symptoms of Parkinson's disease.

This is considered an early stage of the illness and may last for several years. Neuroprotective treatment is common at this stage. This treatment aims to prevent further damage to the nervous system.

Vitamin E was used at this stage, but many researchers are of the opinion that this is not very effective. A selective MAO-B inhibitor called Rasigiline has shown promise.

Stage 2 of Parkinson's disease is labeled bilateral disease. Meaning, symptoms of Parkinson's now show up on both sides of the body. The illness is considered to be at Stage 2 even if there is an insignificant symptom (an occasional tremor, for example) on the side of the body that was symptom-free earlier.

Recent therapies at this stage include use of dopamine agonists. Till some years ago, dopamine agonists were used only at later stages of the disease. Currently, researchers are of the view that if such treatment is started earlier, complications from using drugs like Levodopa may not arise at later stages.

The disease is said to be at stage 3 when symptoms show progression and especially when the patient has difficulty in maintaining their posture. Symptoms at this stage include postural instability and falling down.

Traditionally, this is the stage at which dopamine agonists or Levodopa was prescribed, but as mentioned above, some of these drugs are now used at earlier stages itself.

Stage 4 occurs when there is an increase in the severity of symptoms including postural instability and falling. Surgery is one option for treatment at this stage. Surgery can alleviate some of the symptoms. However, this is generally recommended only for relatively young patients who are in good health otherwise.

Stage 5 is the most advanced stage of Parkinson's disease. The patient is usually wheelchair bound. Walking is possible only with assistance.

Levodopa continues to be a prescribed drug at this stage, along with a COMT inhibitor, which ensures that the effects last longer. Surgery may also be an option, including pallidotomy, which destroys a small group of brain cells. This helps avoid the rigidity often experienced with Parkinson's disease and may stop tremors as well.

Another possible treatment is deep brain stimulation, where electrodes are implanted into the brain tissue and stimulated with low level electric currents.

The symptoms of Parkinson's disease progress as the patient moves from one stage to the next. Ongoing research is producing new treatments including stem cell implants and new drugs.

By Jane Peters

symptoms of parkinsons disease : Are Some People Predisposed To It?

It is well known that Parkinson's disease mostly affects older people. But apart from that, what other factors indicate higher chances of developing this debilitating illness?

Let's take age itself as the starting point, because there are some nuances that are not generally known. In line with popular perceptions, about 90% of people with the illness are over 60 years old.

This is true even if you consider the age at which the symptoms first appear. Not even 10% of cases are diagnosed in adults under age 40. Most of the fresh diagnoses are in those above age 60.

However, that's not the whole story.

Among those over 60, the risk goes up from age 60 to age 75. After that, it drops sharply. In other words, someone who is 85 years old is less likely to get Parkinson's disease than someone who is 70, statistically speaking. This may seem surprising to most people.

Let's look at it from another angle. The above statistics apply to those who have been diagnosed with the illness. If we take what is called Parkinsonism (meaning, symptoms of Parkinson's that have other causes, or symptoms that may develop into the illness itself) into account, fully 15% of those between 60 and 75 have it. And between 75 and 84 years of age, an amazing 30% have the illness.

At the moment, around 3% of the population over age 65 is affected by the disease. But this percentage is estimated to double over the next four decades.

Age obviously has an impact on the disease. What other factors exist?

Gender is evidently another one. It is estimated that men have about twice as much risk of developing Parkinson's as women. This applies to every age group.

Researchers theorize that the female hormone estrogen is responsible for the lower incidence of the disease among women. There are two facts to support this view.

The first is that women who have undergone hysterectomies have a somewhat higher risk of developing Parkinson's disease. Secondly, women who are on hormone replacement therapies tend to have a lower incidence of the condition. These facts seem to imply that estrogen does play a role in preventing Parkinson's.

The illness also seems to progress faster in men than in women. In terms of symptoms, women tend to be prone to disturbances in their gait, while men are more at risk of tremors and rigidity.

Heredity appears to play a role in the disease. Someone whose siblings who have developed Parkinson's disease before the age 40 is at greater risk of falling victim to the illness. However, if the siblings develop the disease only in later years, heredity does not seem to play a prominent role.

There are differences among races in the incidence of Parkinson's, so ethnicity does appear to play a role. Caucasians are at greater risk than Asian Americans or African Americans. Some research indicates that although races other than Caucasians have lower overall risk, they may carry a higher risk of other types of Parkinsonism which involves problems with the thinking process.

Apart from the above, some evidence suggests that caffeine might offer protection against this disease, to an extent. Drinking coffee regularly, it seems, is a useful preventive measure.

As can be seen, some factors do seem to create a higher risk of a person developing Parkinson's disease. Researchers are digging deep for more clues that may one day lead to a full understanding of this condition.

by Jane Peters

symptoms of parkinsons disease : Things to Consider

Being faced with the diagnosis of Parkinson's or any other disease is a frightening, but don't allow that initially felt fear, confusion, or even denial to cloud your judgment.

Doctor's are great at diagnosing diseases, but they 100's of patients and together with all of the paperwork and insurance headache, they tend to not personally get involved with each patient.

Meaning that you need to be the "captain of your own ship". You need to consider a number of things, such as:

Finding the "right" doctor, or doctors, for you. Develop a team of doctors, therapist, etc., that you trust and enjoy speaking with.

Join a support group near you and be on the look out for forums on the Internet where you can "chat" with others similarly affected so as to learn about solutions to problems and new treatments that you and your doctor may not be aware of.

All of the questions and thoughts to consider here are for you to ask yourself, your doctor(s), and other Parkinson's patients who you get to know via support groups and/or Internet forums.

Why did I get this disease?

Might have been a genetic predisposition for them to develop it or environmental factors that played a role, such as where they lived or elements of their workplace.

Or were lifestyle choices such as diet, personal habits and/or exercise to blame?

What treatments are available?

If the parkinsons symptoms are mild some doctors may prescribe nothing more than change in diet or suggest including more exercise into the patient's day-to-day routine.

For symptoms to are more severe the doctor may prescribe medication. Levadopa (Sinemet ® ) is the most common, but newer drugs, Requip ® and Mirapex ® are being prescribed now days too. However medications don't always have the same effect on patients, so while on drug may help one person considerably, it may not work for someone else.

In some cases, usually the severest, surgery is the best option.

Along with the benefits of the medications, don't forget the potential side effects. Parkinson's' sufferers are often going through enough discomfort so you must make sure that you are aware of and prepared for any potential side effects of a medicine.

Not all Parkinson patient are the same in the symptoms they suffer and some respond to medicines and other treatments differently.

What are the short and long term benefits of each treatment, is there anything that can be done to decrease the potential side effects of the treatment (particularly medicines)?

Don't just "sit back" and let your doctor decide everything, ask questions of your doctor but also be willing to allow yourself to accept what your doctor is recommending.

Look at the Yahoo, Healthboards.com, and BrainTalk Communities which are my favorite forums.

You can ask other members if there any alternative and/or non-drug related options that could help your condition?

You may find that some of the members have made modifications to their lifestyles (i.e. diet, exercise, reducing stress levels, etc.) that are helping them physically and emotionally to cope better with the progression of the disease.

Are there particular foods, drinks, over the counter medications and/or vitamin supplements that I should stay away from or look into?

Your health is not as it once was, even the "common" colds aren't so "common" any longer. You don't want any adverse drug reaction when your treatment and medications begin, be very careful about what you do and don't put into your body, especially supplements and other not so common over the counter vitamins and medications. Be sure to speak with your pharmacist.

Can your doctor, your support group, or the Internet forum members recommend any non-traditional (or naturopathic) techniques for relaxation and reducing stress levels?

Look at city services, the local junior college for classes in yoga, meditation, reflexology, massage, deep breathing, etc.

The local support group may be aware of classes that would be of help to you.

Are there any trials or clinical studies that you can be a part of?

If the idea interests you be sure to speak with your doctor, your support group and be on the look out, via the Internet, yourself.

Clinical studies need willing participants and these studies occasionally have very good results for the participants

By Mike Herman

symptoms of parkinsons disease : Why is Parkinson's Disease Difficult to Diagnose?

While Parkinson's disease has very distinctive features, it is rather a difficult disease to identify, particularly while it is in its early stages. Unfortunately there are no precise tests, which doctors can do to establish an exact diagnosis of Parkinson's disease and regrettably especially in its early stages it might be mistaken for other diseases. If and when this happens, it delays or prevents the appropriate action being administered in the quickest feasible time.

The trouble with diagnosing Parkinson's disease accurately is just that the symptoms are not always as clear as doctors would like them to be, Actually there are suggestions that up to 25% of those people presently being treated for Parkinson's disease might have been wrongly diagnosed and are thus getting inappropriate treatment.

Generally patients that are suspected of suffering from Parkinson's disease are given tests to guarantee they are certainly not suffering from an illness that can be diagnosed using common methods such as CT scanning, urine sampling X-ray and blood tests etc. However just because these tests may have an inconclusive answer, it doesn't always mean the person is definitely suffering from Parkinson's disease. Regrettably some doctors think this is the case, and will automatically offer a diagnosis of Parkinson's disease.

Tests that can be carried out to test for Parkinson's disease involve systematic neurological assessments that comprise testing the person's reflexes, balance, muscle strength walk and common movement. Because there are a range of neurological disorders that have similar characteristics to Parkinson's disease, it's not very surprising that Parkinson's disease is so regularly misdiagnosed. If you or a loved one has been diagnosed with Parkinson's disease, it doesn't always hurt to ask your doctor for a second opinion or even better to request to be referred to a physician who specialises in this kind of disease.

An early accurate diagnosis of Parkinson's disease is normally the key to the sufferer being able to preserve their independence and a decent quality of life for fairly a long time.

Some neurological conditions that are regularly confused with Parkinson's disease include: -

Multiple system atrophy

Supranuclear palsy

Benign Essential Tremor

Multiple Sclerosis

Huntington's disease

Striato-Nigral Degeneration

Brain tumour

Remaining as independent as feasible is vital to the wellbeing of most sufferers of Parkinson's disease, and ensuring the symptoms are kept to a minimum by both an accurate diagnosis and treatment is the key to achieving this.

By Roger Overanout