April is Parkinson’s Disease awareness month. This is great time to learn more about Parkinson’s. Today we going to learn the basics of what Parkinson’ Disease is, who it affects, how the disease affects the body, where the symptoms happen and next steps.
You may know the very famous Canadian actor Michael J. Fox. Maybe you saw him in the show 'Family Ties’ or the movie series ‘Back to the Future’. And maybe you also know that he was diagnosed with early onset Parkinson’s disease in the 1990’s. He has since become a strong advocate for Parkinson’s disease research with his foundation – ‘The Michael J Fox Foundation’. Perhaps you have seen him having Parkinson’s symptoms and wondered what was happening or why it was happening. Well, we are going to learn!
So what is Parkinson’s disease (PD)?
Parkinson’s disease is a neurological disorder that is related to the production of certain neurotransmitters – in particular, dopamine. The neurotransmitters that are affected, assist with various things but the most observable effect being voluntary movement. We will get into the symptoms later on.
Neurotransmitters are chemicals that are released by nerves to send a message to the next nerve over a synapse (the connection point between 2 nerves) and then to the next one and so on until it reaches its destination.
In Parkinson’s disease, there is a loss in the production of dopamine. Scientists still do not know the cause but suspect that it may be a combination of genetics and environmental factors. PD is a degenerative disease, meaning that it develops and worsens over time. PD itself is not fatal but some resulting complications of the disease can be. Although there is no cure for PD, there are various treatment options available to help to manage or reduce symptoms.
If we are talkin’ money here – in Canada, Parkinson’s has the third highest direct healthcare costs annually. Direct healthcare costs are costs that are directly related to patient care such as medication, rehabilitation and supplies.
The patient group with the highest annual out of pocket expenses are those with a spinal cord injury and second highest is those with Parkinson’s disease. Out of pocket expenses are those costs that are not covered by provincial health insurance and are paid directly by the patient.
This shows just how much an impact Parkinson’s disease can have on a person as well shows how much time that person will spend within the healthcare system.
Where are Parkinson symptoms seen?
There are no two people who will experience Parkinson’s disease the same way but there are some similarities. As there is not a lab test, diagnosis relays on observation of symptoms as well as conducting a neurological exam and reviewing medical history.
Parkinson’s disease symptoms can be placed into two categories – 1. Movement symptoms. 2. non-movement symptoms. These categories are just as they sound. Movement symptoms are those that are directly seen in the person’s movement patterns and non-movement symptoms are those that are not directly related to how the body move.
Movement symptoms can be further divided into primary and secondary movement symptoms.
The primary movement symptoms often develop first and diagnosis regularly relies on their presence. These symptoms are:
a) Bradykinesia - a slowness of movement or lack of speed of movement
b) Rigidity - stiff or inflexible muscles.
c) Tremor – a rhythmic shaking that often starts in the hands
Secondary movement symptoms are other symptoms that an develop and change throughout the course of the disease. Some secondary movement symptoms are
a) Smaller arm swing when walking
b) Slurring of speech
c) Freezing – the feeling of not being able to move. May happen when starting to walk or when going through smaller spaces (such as a doorway)
d) Small handwriting
e) Etc
The second category of symptoms, non-movement symptoms, are ones that affect other parts of the person’s being. Some non-movement symptoms are
a) Mental health challenges – PD symptoms can affect your mood, cognition, sleep which in turn can affect the person’s mental health. People with PD tend to experience more anxiety, depression and apathy
b) Breathing and respiratory problems
c) Fatigue
d) Pain
e) Speech and swallowing issues
f) Cognitive changes and dementia – according to Parkinson’s Canada; 40% of the Parkinson’s community experience thinking and problem-solving limitations and 50% experience memory limitations
g) Digestive issues
h) Etc
How does Parkinson’s Disease occur?
Dopamine is the star of the Parkinson show. Dopamine is a neurotransmitter made by the body to send messages around the nervous system. There are other neurotransmitters affected by PD but dopamine is the most significant.
Dopamine has a role in many things such as
a) Learning
b) Motivation
c) Heat rate
d) Kidney function
e) Sleep
f) Mood
g) Attention
h) Movement
i) Etc
The current understanding of Parkinson’s disease is that there is not enough dopamine being created and so the brain doesn’t have a signal to send. PD is a disorder of the cells that create dopamine; these cells are dying. Scientists don’t know why this happens but finding out is important for finding a cure.
When 80% of these dopamine producing cells have been lost, symptoms of Parkinson’s start to arise. As the level of dopamine declines, the disease progresses.
Who does Parkinson’s Disease affect?
Although Parkinson’s is not a normal part of aging, the incidence rate increases as age increases. 85% are diagnosed after the age of 65. The average age of diagnosis is 60-65 years old. Parkinson’s disease affects both men and women with slightly more men being diagnosed. Young onset of PD refers to those who were diagnosed before the age of 40.
Approximately, 4 million people in the world have PD with more than 100 000 being Canadian.
What’s next?
After diagnosis comes treatment. Treatment may include things like medication, physical therapy, occupational therapy, speech therapy, surgery and so on depending on the symptoms, and needs of the person.
There is no cure for Parkinson’s disease and so the treatments currently available will manage symptoms.
Medication
PD symptoms are caused by lack of dopamine in the brain and so many medications target the action of dopamine or increasing the amount of dopamine in the system. These are called dopaminergic medications. These medications can help with rigidity, movement speed and tremor.
Surgery
There are two surgeries related to PD treatment – deep brain stimulation (DBS) and Duopa. Surgery often becomes an option for those who have done what they can with medications or who have large motor fluctuations.
DBS can address most movement symptoms of PD and some non-movement symptoms like pain and sleep. In a DBS surgery, electrodes are inserted into a targeted area of the brain and an impulse generator battery (IPG) is placed under the collarbone. An IPG is similar to a heart pacemaker in that it delivers an electrical stimulation to the area of brain that controls movement.
In Duopa therapy, first, surgery takes place to create a stoma in the abdomen to place a tube in the intestine. Similar to an insulin pump for those with diabetes, a pump delivers the medication Duopa, directly into the intestine via this tube rather than orally by pill. By having the medication given directly through the intestine, absorption is improved and times of increased movement symptoms are lessened.
In conjunction with medication, other therapies like kinesiology, occupational therapy, physiotherapy, and speech therapy can help with other symptoms. For example speech therapy classes or one-on-one can target things like speech volume and clarity, fascial masking and swallowing function.
Exercise
The Canadian guideline for Parkinson’s states that exercise not only helps how people living with PD feel but also improves their ability to perform activities of daily living. There is clear evidence showing that benefits are seen in those who exercise at the time of their diagnosis and in those with well-established disease. Specifically, increasing physical activity to 2.5 hours a week in the early stages can slow the decline of quality of life.
Exercise can improve movement symptoms such as walking ability, balance and flexibility, increased aerobic capacity and strength, better movement initiation (less freezing), better overall mobility and performance of activities of daily living.
It may be more obvious that exercise will help the movement symptoms but exercise can also help with non- movement symptoms such as
a) Constipation – moving the body in all ways, can help the bowels to move
b) Depression, anxiety and stress – even shorter duration of exercise can help decrease the risk of depression (you can read more here)
c) Group exercise classes have the added benefit of creating connections, community, common interests, laughter, novelty, and avoiding isolation.
d) Exercising regularly can help give you more energy
e) Keeping the body moving and strong can help with pain. Increased strength and mobility/flexibility can increase pain tolerance and decrease the amount of pain
It has been found that those who do not exercise early in their diagnosis, or often enough, tend to have less joint flexibility, less balance, less strength, less cardiovascular fitness and are generally deconditioned.
The Parkinson’s Foundation and the ACSM (American College of Sports Medicine) have created the following exercise recommendations:
- Best time to exercise is during ‘on’ periods – meaning the time in which the medication is working to decrease symptoms such as tremor and freezing
- Minimum 150 minutes of moderate to vigorous physical activity a week
- Participate in minimum 30minutes of continuous or intermittent strength training 3 times per week
- Participate in minimum 30minutes of continuous aerobic activity 3 times per week
- Participate in balance, agility and multitasking training 2-3 times per week with daily integration
- Stretching 2-3 days per week with daily being most effective
There are a variety of organized exercise programs created specifically for those who have PD. Some are free, some are in person, some are virtual (live or YouTube) and many are group based. There are programs influenced by dance, boxing, yoga and so on. Every program is going to be a bit different, not one better than another.
What is most important is that the program you choose is one that you will enjoy and actually do. If you don’t like music or dancing than a dance program is maybe not for you, but if you have always liked going out for walks, then perhaps a walking program using urban poles might be a better fit. Try out different activities and see what you like and what you will stick to. In the resource section below, there is a link to a page on the Parkinson’s Canada website listing various programs for exercise, speech therapy and so on.
Each person will have different needs and things to focus on so it may be challenging for any one group exercise program to fill all of a person’s needs. This is where one- on-one sessions with your kinesiologist becomes a great tool in the disease management toolbelt. Working with a kinesiologist, you will get an individualized plan made just for you. It will address any areas that need more focus – balance, strength, mobility and so on. Some other benefits to adding a kinesiologist to your team are:
a) Accountability – I will be coming to your home to see you. It is easier to cancel and appointment you make with yourself, less so with someone else
b) Specificity – we will focus on the specific areas of movement that are affecting you. Group exercise classes tend to be more general for the benefit of all attending
c) Supervision with higher risk work – for example if balance is challenging, we can challenge the balance more and safely having your kinesiologist there to set up safety measures and progress the exercises
d) Direct translation – as I come to your home, we are able to work directly on the physical areas that are challenging. For example, if you have some steps in your home that you must navigate, we can work directly with those steps instead of trying to recreate the steps in the clinic and then try to translate that into your own environment
e) Resources – I may be able to connect you with resources you have yet to find. Be it group classes, equipment suggestions, home environment assessment and so on
f) Cues and modifications – I will be able to give cues, guidelines and modifications that work for you and your body and environment.
I was listening to a Parkinson’s podcast and the guest who was a Parkinson’s expert said that if he was diagnosed with Parkinson’s disease, he would never get off the treadmill. This just shows how strong and important the connection is between Parkinson’s management and exercise. The more and the more frequent the better.
Below are links to some helpful resources to learn more about Parkinson’s and ways to get your exercise in:
Parkinson Canada Educational Publications including the ‘Every Victory Counts Canadian edition’ – a guide with essential information about Parkinson’s plus many topics that are sometimes overlooked but critical
Parkinson Canada’s list of exercise programs for motor and non motor symptoms
Parkinson Society of Southwestern Ontario’s Mental health toolkit
Parkinson Society Southwestern Ontario – resources for clients and caregivers. Support groups, counselling and education
Interested in learning more about kinesiology sessions with Carrie? Reach out on the Contact us page to send a message or set up your complimentary Discovery Call.
Sources:
Canadian guideline for Parkinson’s - https://www.parkinsonclinicalguidelines.ca/wp-content/uploads/2019/10/guideline-executive-summary.pdf
Carrie Doll Kinesiology provides in-home Kinesiology services to Kitchener- Waterloo, St. Jacobs, Elmira and area