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