Parkinson's Disease: Causes, Symptoms, Treatment and Cost

Parkinson's disease is a neurological ailment that affects the brain and may cause issues with movement, balance, and coordination. It is a progressive disorder, meaning it will get worse over time.

There are various types of Parkinson's disease, and each presents its own particular pattern of signs and symptoms.

• Primary Parkinsonism: This is the most common type of Parkinson’s disease and usually affects people over the age of 60. It is caused by the gradual loss of brain cells that create dopamine, which aids with movement control.
• Dementia associated with Parkinson’s: This type of Parkinson’s occurs when dementia-like symptoms appear along with other motor symptoms such as tremor and slow movements.
• Atypical Parkinsonism: This form of Parkinson’s affects younger people than usual (under 40) and has different symptoms than primary or dementia-associated forms of the disorder.
• Multiple System Atrophy (MSA): This rare form of atypical parkinsonism affects many systems in the body including movement but also disrupts autonomic functions like breathing or heart rate regulation as well as cognitive functions such as memory or attention span issues.

• Parkinson's Disease (PD) is a neurodegenerative disorder caused by the death of dopamine-producing neurons in the brain.
• The specific origin of Parkinson's disease is unknown, however it seems to be a mix of hereditary and environmental factors.
• There are several genes linked to PD, including SNCA and LRRK2, which are believed to be involved in the development of the disease.
• Environmental triggers such as exposure to toxins, head trauma or viral infections may also play a role in the development of PD.
• In addition, certain lifestyle choices such as smoking and lack of exercise have been linked with an increased risk for developing PD.

• Tremors: Uncontrollable shaking in hands, arms, legs, jaw, and face.
• Rigidity: Stiffness in the trunk and limbs.
• Bradykinesia: Slower movement and trouble starting or ending voluntary movement.
• Postural instability: Poor balance and coordination, which may lead to falls.
• Difficulty with speech and writing: Soft or slurred speech, changes in vocal volume or pitch, monotone voice or lack of facial expression when speaking, writing small or unusually spaced letters.
• Cognitive changes: Memory loss, trouble focusing, impaired judgement.

• Exercise regularly: Regular physical activity helps maintain mobility, flexibility, and balance.
• Eat a healthy diet: Eating a balanced diet rich in antioxidants, omega-3 fatty acids, and vitamins may help reduce the risk of developing Parkinson's disease.
• Avoid toxins: Cigarette smoking, exposure to pesticides and herbicides, and other environmental toxins can increase the risk of Parkinson's disease.
• Maintain good mental health: Stress management techniques such as yoga, meditation, and cognitive-behavioral therapy may help reduce the risk of developing PD.
• Get adequate sleep: Getting enough sleep is essential for overall health and may also reduce the risk of developing PD.
• Monitor medications: Certain medications such as antipsychotics or antiemetics have been linked to an increased risk of PD in some individuals; speak with your doctor about any potential risks associated with your medication regimen.

• Movement assessments: This includes detailed physical examinations where a doctor looks at posture, movement, speech, etc. as an initial method of evaluation for Parkinson’s Disease.
• Imaging studies: This involves using MRI, CT scans or PET scans to look at areas in the brain affected by PD in order to determine if there are any changes that may indicate damage from neurodegeneration associated with PD.
• Blood tests: Sometimes certain blood tests can help determine if there is a likelihood of developing Parkinson’s Disease such as measuring levels of copper, iron and other indicators in the blood which are related to PD prognosis.
• Genetic testing: Recent research into genetic testing has indicated certain genes which seem linked with PD risk with greater accuracy than before so this type of testing can also provide useful information when trying to diagnose Parkinson’s Disease.
• Cerebrospinal fluid (CSF) analysis: CSF analysis is a diagnostic procedure used to detect the presence of disease-causing agents in the cerebrospinal fluid. This procedure can be used to diagnose Parkinson's disease as it can detect the presence of alpha-synuclein, which is an abnormal protein found in the brains of individuals with Parkinson's.
• Electromyography (EMG): Electromyography (EMG) is a method for measuring the electrical activity of muscles. It is commonly used to diagnose neurological disorders such as Parkinson's disease and to assess muscular strength. EMG can help detect muscle weakness, twitching, or abnormal reflexes associated with Parkinson's disease.

• Difficulty with movement (e.g. slowness, tremor, rigidity).
• Autonomic dysfunction (e.g. changes in blood pressure, constipation, urinary incontinence).
• Cognitive impairment (e.g. memory problems, difficulty making decisions).
• Sleep disturbances (e.g., insomnia, vivid dreams).
• Speech and language difficulties (e.g., soft speech, monotone voice).
• Swallowing issues (dysphagia).
• Depression and anxiety
• Fatigue.

• A mixture of one-fourth teaspoon each of ashwagandha, brahmi, jatamansi and shankhapushpi should be taken with warm milk twice a day.
• Consuming an ounce of bitter gourd (karela) juice three times a day for two months is beneficial for people with Parkinson's disease.
• Consume ginger and black pepper on a daily basis in the form of a decoction, with honey or jaggery added to it to counter the bitterness.
• Include garlic and onions in your daily diet to reduce some symptoms associated with Parkinson's disease such as tremors and rigidity of limbs.
• Eat one teaspoon every day of powder made from three herbs - Bhringraj, Guduchi et Ashwagandha - mixed with half a spoon each of powdered coriander seeds and fennel seeds (saunf).

A few top recommendations include:

• Eating plenty of fruits and vegetables, as well as fresh whole wheat breads and cereals to provide fiber.
• Incorporating healthy oil sources such as olive or avocado oil into meals.
• Consuming lean proteins such as fish (especially tuna, salmon, mackerel or sardines) and white meat poultry.
• Consuming a lot of water all day.
• Including foods high in potassium in your diet, such as bananas or yoghurt.
• Choosing low fat dairy products if consuming dairy.
• Additionally, persons who have Parkinson's disease may benefit from consuming foods rich in vitamin B12.

• High-fat, fried and processed foods: These are not recommended as they can worsen motor symptoms.
• Caffeine: Avoiding or limiting intake of caffeine can help reduce tremors, anxiety and other motor symptoms.
• Dairy products: Producing more mucus, dairy products may exacerbate breathing difficulties in those with Parkinson's disease.
• Alcohol: Alcohol should be limited or avoided as it may worsen motor symptoms, disrupt sleep and increase risk of falls.
• Foods high in salt: Salt should be avoided as it can increase blood pressure and lead to the worsening of existing health conditions related to Parkinson’s disease such as heart failure or stroke.

• Medications: These are the primary mode of treatment for Parkinson's disease and aim to reduce symptoms. Examples include levodopa, dopamine agonists, etc.
• Deep Brain Stimulation (DBS): A surgical technique in which electrodes are used to provide electrical impulses to particular regions of the brain related with movement control. It is used to alleviate symptoms like tremor, stiffness, and slow movement.
• Pallidotomy: This procedure involves destroying a part of the brain known as the globus pallidus, which plays an important role in controlling movement. Several motor symptoms, like tremor, stiffness, and slowness of movement, may be eased.
• Thalamotomy: This is a procedure that involves destroying a small area of the thalamus called the ventral intermediate nucleus (VIM). This is believed to alleviate some motor symptoms, including tremor and stiffness.
• Subthalamotomy: Similar to thalamotomy but it destroys part of a different area in the brain known as the subthalamic nucleus (STN). It may also help relieve movement problems linked with Parkinson's disease, including tremors and stiffness in the body.
• Speech therapy: A speech therapist can help people with Parkinson’s learn how to adjust their vocal cords to produce clearer speech and sound more natural when talking or singing.
• Occupational therapy: Occupational therapists can provide strategies to help people with daily tasks such as dressing, bathing, cooking, or housekeeping when they are having difficulty due to Parkinson’s disease-related mobility issues or cognitive decline.

• The most appropriate type of doctor to consult would be a neurologist, who is a specialist in diseases and conditions related to the brain and nervous system.
• A neurologist will diagnose symptoms, order tests, and provide treatments such as medications or therapies.
• In addition, they can refer patients to other specialists if needed.

• Levodopa (L-DOPA): This is the most commonly used medication for Parkinson’s and works by replacing dopamine in the brain.
• Dopamine agonists: These medications mimic the effects of dopamine in the brain and help control movement for those with mild to moderate Parkinson’s.
• Monoamine oxidase B inhibitors (MAO-B inhibitors): These drugs help slow down the breakdown of dopamine, allowing it to remain active longer in the brain.
• Catechol O-methyltransferase (COMT) inhibitors: These medications help make levodopa more effective and last longer by inhibiting an enzyme that breaks down dopamine.
• Anticholinergics: These drugs help reduce tremor, stiffness, and slow movement by blocking a neurotransmitter called acetylcholine from reaching its target in the brain.

• Generally speaking, people with mild to moderate Parkinson's Disease can maintain their quality of life and will not experience significant functional decline with adequate treatment and ongoing therapeutic intervention.
• However, it is important to keep in mind that each individual is different and recovery time may take longer or shorter than expected.

• The cost of Parkinson's Disease treatments in India vary depending on the type and severity of the condition, as well as the type of treatment chosen.
• Generally speaking, medications for Parkinson's Disease can range from a few hundred to several thousand rupees per month.
• Surgery for Parkinson's Disease can range from about Rs. 1 lakh to Rs. 3 lakhs or more, depending on the complexity of the procedure and other factors.
• Other treatments such as physiotherapy, occupational therapy, speech-language therapy and cognitive behavioral therapy may also be recommended and their costs vary accordingly.

Common side-effects of Parkinson's Disease treatments include:

• Dizziness
• Nausea
• Constipation
• Low blood pressure
• Dry mouth and eyes
• Sleeping problems
• Weight loss or gain.

Some less common but severe side effects could be:

• Hallucinations/delusions (especially with the use of dopamine agonists).
• Increased chance of experiencing depression, anxiety, and other mental health problems.
• Long-term use of medications can also lead to involuntary movements known as dyskinesia.

If you are suffering from any symptoms related to Parkinson's disease, you should see a doctor as soon as possible because they can cause complications such as 'difficulty with movement, autonomic dysfunction, cognitive impairment' in which treatment courses can range from a few months to years based on the extent of the condition.