With increased age comes increased medical problems, and one of the most common age-related issues in the world is Parkinson’s Disease. The 2022 Incidence of Parkinson’s Disease in North America study found the rate of Parkinson’s diagnosis in the United States of America increased 50% more than anticipated, making it the second largest neuro-degenerative diagnosis in the U.S., second only to Alzheimer’s Disease.
More than 90,000 new Parkinson's diagnoses are made annually in the US, up from 60,000 in 2011, with treatment and related costs estimated at nearly $52 billion per year as the median age rises and Baby Boomers age. This article will discuss Parkinson’s Disease and what it means for you and your family.
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Parkinson’s Disease and Aging
The Population Reference Bureau reported that the American population aged 65 and older is projected to increase from 58 million in 2022 to 82 million by 2050, a 47% increase, which correlates with a rise in age-related illnesses, including neurodegenerative diseases like Alzheimer’s and Parkinson’s.
This recent report, the most comprehensive assessment of Parkinson’s in the US, showed:
- Parkinson’s incidence estimates increase with age in the 65+ range.
- The primary risk factor for Parkinson’s is age.
- Parkinson’s incidence estimates are higher in men compared to women of all ages.
- The increase in the incidence of Parkinson’s aligns with the growth of an aging population.
- Parkinson’s incidence rates are higher in certain geographic regions: the “Rust Belt” (parts of the northwestern and midwestern U.S. previously regulated by industrial manufacturing), Southern California, Southeastern Texas, Central Pennsylvania, and Florida.
Symptoms of Parkinson’s Disease
While the motor disturbances of shaking and a shuffled walking gait are the most recognizable symptoms of Parkinson’s, the disease presents with many non-physical symptoms that can be overlooked. According to Stanford University, non-physical symptoms of Parkinson’s Disease include:
- Anxiety
- Apathy
- Cognitive problems
- Constipation
- Depression
- Fatigue
- Hallucinations and delusions (psychosis)
- Incontinence
- Low blood pressure (orthostatic hypotension)
- Pain
- Sexual dysfunction
- Sleep problems
- Speech and swallowing problems (dysphagia)
- Sweating and temperature regulation
- Vision problems
This is important in the early stages of the disease, as initial symptoms such as general fatigue combined with cramped handwriting are easy to overlook. A patient rarely complains to a physician that it is becoming difficult to write in small letters, but a combination of such nonmotor symptoms with motor symptoms should encourage a healthcare provider to look deeper.
For example, according to The National Institutes of Health (NIH), a patient complaining of restless legs, changes in sleep patterns, constipation, and syncope upon standing (getting dizzy or blacking out because you “stood up too quickly”) should be evaluated for Parkinson’s as these are all early symptoms that many professionals overlook.
While Parkinson’s cannot yet be cured, early diagnosis and treatment can delay the effects of the disease and allow a patient to progress smoothly into a successful and fulfilling post-diagnosis lifestyle.
Diagnosis of Parkinson’s Disease
Parkinson’s develops as the brain loses its ability to create the neurotransmitter dopamine. Dopamine is part of how our brain learns, expresses, and understands pleasure and is responsible in large part for the feeling of motivation. It is created in a very specific part of the brain called the substantia nigra.
While it is well-known where dopamine comes from and what happens in Parkinson’s Disease progression, there is no specific test for Parkinson’s. No blood test or other standardized exam is considered the “gold standard,” and diagnosis must be made on symptomology and health history.
However, experts agree there is a constellation of symptoms that can be used to best make the diagnosis. For example, the Johns Hopkins Parkinson’s Disease and Movement Disorders Center suggests patients, their families, and the medical care team look for:
- Resting tremor or shaking. It is important the tremor is at rest, not when trying to move or be active.
- A slowing of movement when walking or engaging in activity. This is called Bradykinesia.
- Stiffness in the arms or legs.
- Trouble with balance and possible falling.
If a patient is suspected of having Parkinson’s, a physician will perform a series of neurological exams and tests. They will usually then refer the patient to a neurologist who will perform more detailed movement testing. The neurologist will often try a small amount of medication to see if the symptoms go away with treatment.
The successful treatment of symptoms with medication is often seen as confirmation of a Parkinson’s diagnosis. However, some related neurological disorders will respond to dopamine medication, and medication response alone should not be the determinant of a Parkinson’s diagnosis.
DaTscans for Confirmation and Diagnosis
While there are no specific tests for Parkinson’s Disease, in 2011 the US Food and Drug Administration approved DaTscans for use in the diagnosis of Parkinson’s. Similar to an MRI or CT Scan, a DaTscan uses computer imaging to look at specific parts of the brain.
For a DaTscan, a patient will be injected with a small amount of a radioactive drug that binds to dopaminergic neurons in the brain. These are the specific parts of the brain where the loss of tissue leads to Parkinson’s. The scan can then look for where the drug attaches and measure any loss of dopaminergic neurons. Such a loss would be indicative of Parkinson’s Disease and a strong indicator of the disease.
This would be similar to an electrician scattering metal dust in an area of bad wiring to find exposed wires that have become magnetized. While the dust does not show damage, it shows where the damaged wires might be so the electrician can replace or fix them.
In the same way, the DaTscan can show a physician where there is a loss of dopamine neurons and determine ways to treat Parkinson’s. The DaTscan, while not conclusive by itself, can help physicians either confirm or rule out a Parkinson’s diagnosis.
Restless Leg Syndrome, Essential Tremor, and Parkinson’s
While there are several neurological disorders that mimic Parkinson’s, the ones patients most commonly mistake for Parkinson’s are Essential Tremor and Restless Leg Syndrome. The primary differences between essential tremor and Parkinson’s can be seen in Table 1 taken from an essential tremor versus Parkinson’s comparative study published in Practical Neurology.
Restless Leg Syndrome can be closely related to Parkinson’s, as both stem from a lack of dopamine. However, the primary difference is that movement can help alleviate the symptoms of Restless Leg Syndrome, while the same is not true for Parkinson’s. Since both are affected by a lack of dopamine, they can present together, and one should not be used to solely rule out the other.
Benefits of Early Detection
A diagnosis of Parkinson’s can be frightening. Images of the great Mohammed Ali shaking non-stop or Michael J. Fox having difficulty speaking leap to mind along with the fear that any brain-related diagnosis can bring to a patient and their family. However, Parkinson’s is not a death sentence, and those diagnosed with the disease can live long and productive lives. The quality of life for those with Parkinson’s can be greatly enhanced by early detection of the disease, and early treatment can considerably slow the progression of Parkinson’s.
Parkinson’s usually progresses slowly, but that does not mean patients and their families should ignore a diagnosis. It is still a serious disease that, over time, increases in severity.
Living with Parkinson’s Disease
The United States National Council on Aging suggests five steps for those living with Parkinson’s:
- Do activities that provide you with the most meaning
- Care for your emotional health by talking to someone
- Create a routine with healthy habits, like small changes in your nutrition
- Be physically active in whatever way works for you
- Find a doctor who specializes in PD
In particular, a solid exercise program has been repeatedly shown to help control the symptoms of Parkinson’s. There are several Parkinson’s-specific exercise programs, that have been clinically proven to help Parkinson’s patients maintain their independence. Examples of exercise programs include:
- Intensive sports training (such as non-contact boxing classes)
- Treadmill training (with body weight support)
- Resistance training (with bands)
- Aerobic exercise (walking, jogging, swimming)
- Alternative forms of exercise (yoga)
- Home-based exercise programs
- Stretching
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Key Takeaways
- Parkinson’s is an age-related disease.
- Americans are living longer, and the median age is rising.
- With advanced age comes an increased chance of developing Parkinson’s Disease.
- There’s more to Parkinson’s than the well-known tremors and shaking.
- Early Identification is important for continued independence and for slowing the progression of Parkinson’s.
- New testing and medications continue to emerge as research is completed in Parkinson’s and related disorders.
- While significant, a diagnosis of Parkinson’s is just the beginning of a journey that can last for decades.
Additional Resources for Practitioners and Patients
4 Possible Causes of Parkinson’s 5 Things That Make it Worse
Top Labs to Run Bi-Annually on Your Patients Who Suffer from Parkinson’s Disease
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