The first day of the Dance for PD workshop included an informative overview of Parkinson’s Disease by neuropsychiatrist Melissa Frumin of Brigham and Women’s Hospital in Boston, MA. She spoke to us not just as a doctor, but also as a caretaker who had first hand experience after caring for her father who had Parkinson’s. Melissa’s talk was illuminating, as it was the first time I had an understanding of some of what was going on inside my Dad’s brain and body, and I began to have a medical understanding of what he must have dealt with.
Everything that follows is from Melissa’s talk, and I was so intent on taking down the information that much of the medical description is her exact wording.
It turns out that the cardinal symptom of PD is the tremor, which typically begins on one side in one hand with the fingers rolling in towards the palm. The tremor is a resting tremor, which means when the hand is engaged in movement the tremor seems to disappear. While asymmetrical at the start, the tremor can become bilateral, impacting the other side.
Another symptom is the slowness of movement, often manifested by a dragging of the feet and resulting in a shuffling gait. Rigidity can set in, causing a stooped posture. And the final major symptom is postural instability, making it difficult to self-respond to imbalance.
All of these symptoms are neurological. The body part is still fully functional; it is the brain’s messaging system that is no longer sending the appropriate signals to the body part. In other words, the hands and the legs could still work just fine if the brain were able to get the messages out to those body parts.
There are a number of motor symptoms, in addition to the tremor and movement issues. Faces begin to no longer exhibit expression, causing a disconnect between what a person says they feel and what their face displays. Handwriting can become very tiny, resulting in what is called micrographia. Vision can become blurred due to contrasts no longer being discernible. Therefore, large print does not help but books on tape could be quite useful. Constipation and difficulty swallowing are other motor issues that are due, as with all the previous symptoms, to a lack of internal coordination.
Imagine how you might feel if these symptoms began to invade your existence. Now add to the mix the non-motor component of Parkinson’s – cognitive dysfunction resulting in dementia that impacts executive functioning. I have written a number of posts about executive functioning, which has to do with decision making, organization, and self-management functions. With Parkinson’s, the dementia takes a toll on the ability to multitask – the ability to tend to more than one item or activity at a time, in other words, the ability to rapidly switch between multiple activities.
The result of all of these symptoms is typically depression, though not because the person has Parkinson’s and feels bad about it (though they may, indeed, feel badly), but rather because Parkinson’s is a brain disorder that effects the ability to initiate activity. The inability to initiate can cause anxiety. Additionally, there can by psychosis manifested by hallucinations that are usually visual or auditory or smell-based, but can also be paranoid.
Couple this with sleep disturbance due to getting up in the middle of a dream to act out that dream (which can lead to falls in the night), genuine fatigue (as opposed to fatigue from depression), and drooling, and you have a sense of the toll that Parkinson’s symptoms takes on a human body.
What is happening in the brain?
The basal ganglia, a compilation of neurons that function as a unit and assists with coordinating movement, contains the substantia nigra, an area of the brain that produces dopamine. With Parkinson’s, 50 to 60 percent of the neurons in the substantia nigra begin to deteriorate, resulting in a loss of dopamine. This loss of dopamine impacts the balance of excitation and inhibition of neurons. And this loss of balance in neuron firing means that signals sent from the brain are not being executed properly. Since the basal ganglia deals with movement, sure signs of Parkinson’s are the primary symptoms detailed at the start of this post.
In general, Parkinson’s is not a genetic disorder and is rare before the age of 40, though Michael J. Fox was an exception at age thirty-two. Worldwide some five million people are diagnosed with Parkinson’s, for which the largest risk factor is old age. And I found out just this afternoon, from a new acquaintance who is active in local and national Parkinson’s organizations, two-thirds of PD individuals are men, one-third are women.
• The PD Partnership – words of wisdom, from a caregiver, for caregivers and the people they care for