September - October 2018

Written by Steven Burns
From his column To Your Health

As a child, when we visited my grandparents in Oklahoma, one of my joys was to go to work with my Grandpa Key. He worked all his life in the oil fields, and I would ride with him in his pickup, going to the oil derrick and storage tanks. He would clear the lines of excess water, take measurements, and record them in books in small sheds at various places on his route.

His writing was so very precise. Each number was perfect. And each number took him a little longer than for most people. You see, he had a tremor that required him to take more care, so others would be able to read his writing. He’d had the tremor for as long as I could remember, as did my mother. I inherited his tremor (familial essential tremor), as have a couple of my kids.

So, when I started medical school in Oklahoma, I had the opportunity to live close to him. It was then that I noticed he had a new tremor. This one happened not just when he wrote or did other fine movements; instead, it occurred when his hands were at rest. Within my first year of medical school, Grandpa Key was diagnosed with Parkinson’s disease (PD).

Nearly one million Americans are living with Parkinson’s disease.

Over the next six years, I saw changes in my grandfather as his condition progressed. He still had a great sense of humor but didn’t smile much. He didn’t swing his arms when he walked, and he became more unsteady. Eventually he had to be placed in a care center, and the disease took his life at age 83.

Nearly one million Americans are living with PD. The Parkinson’s Prevalence Project, from the Parkinson’s Foundation, estimates that 930,000 people will be living with the disease in 2020, and 1.2 million by 2030. PD is more common than multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), and muscular dystrophy (MD) combined. It affects men about 1.5 times as often as women.

Overall costs of the disease, including lost wages and treatment, exceed $25 billion per year in the US. Worldwide, about 10 million people have PD.

Symptoms can be subtle at first, and can mimic other problems. Loss of accessory movements, such as swinging the arms while walking and failing to raise the feet when walking, can cause falls and unsteadiness. Changes in facial expressions may cause others to feel that the person with PD is upset or angry, or not listening, but these occur because movements of the muscles that control smiling and frowning no longer work well. The Mayo Clinic website gives seven early signs of Parkinson’s disease:

  1. Tremor at rest. A common form is called “pill-rolling,” a rubbing motion of the thumb against the forefinger. It can occur in one or both hands, and is a slower tremor than familial essential tremor. It occurs while the hands are completely at rest, and stops with intentional movement.
  2. Slowed movements (bradykinesia). It may take much longer to get up from a seated position, and walking is slower, with shorter steps. PD patients may complain that their feet feel “stuck to the floor.” This, combined with the loss of arm swinging, can make falls much more likely.
  3. Rigid muscles. It may be hard to relax muscles, to the point of pain, with PD. Stiffness can occur in any part of the body.
  4. Impaired posture and balance. Some with PD will assume a stooped position when walking, or may list to one side with no reason.
  5. Loss of automatic movements. These can include swinging the arms while walking, smiling, and blinking the eyes.
  6. Speech changes. The PD patient may speak very softly and quickly, making it hard for others to understand them. Speech may be a monotone, with loss of inflection.
  7. Small writing (micrographia). Writing may become more difficult, with letters becoming much smaller. I hear that complaint from my PD patients.

Other symptoms include severe constipation, loss of the sense of smell, and wide swings in blood pressure, usually occurring later in the progress of the disease.

Loss of memory may occur variably with Parkinson’s disease. Those who develop PD at a young age (think Michael J. Fox) usually retain normal mental function, including memory and judgment. By the way, 4% of those with PD start having symptoms before age 40. For those who develop it later in life, memory loss can be much more serious. One form of dementia known as Lewy body dementia (LBD) can mimic PD early on, but it occurs more quickly in LBD patients.

What causes Parkinson’s disease? That is not completely clear. There are many associations, but causes are less obvious. Genes affect risk, although the genetic component is small for most. Aging affects development of PD. Exposure to toxins such as pesticides and herbicides appear to increase risk somewhat. Conversely, caffeine appears to be protective.

Medications for PD are beyond the scope of this article. Physical, occupational, and speech therapies can help. Also, some patients benefit from deep brain stimulation, so seeing a neurologist at a major medical center with a movement disorders clinic can be very helpful.

If you are developing any of the symptoms listed above, see your personal physician right away. Most of the time, your primary care physician can make the diagnosis, with or without the involvement of a neurologist. My own custom is to send persons to a neurologist if they wish, as there may be new medications to help my patients that I may not know about.

Although there is no cure, after the diagnosis of Parkinson’s disease, most people continue to live fulfilling and productive lives; however, they do better if they are started on the correct medications right away. If you are experiencing some of the symptoms, don’t delay in seeking medical help.

Dr. Steven Burns is board-certified in family medicine and has been in practice for more than 30 years.