Parkinson's Disease (PD)
One of the world’s fastest-growing brain disorders, Parkinson’s is a long-term progressive disease affecting movement capabilities. Discover 3 Early Signs of Parkinson’s, 4 Stages & 16 Symptoms. Exciting breakthrough on PD diagnosis.
Table of Contents
PD is a progressive neurodegenerative disorder characterized by muscle stiffness, tremors, and general inability to control voluntary movements. Parkinson’s may also affect involuntary/autonomic controls, including swallowing, digesting, heart rate, blood pressure, and urinary continence.
Here are the key statistics about PD:
- Globally, PD affects about 10 million people.
- About one million people in America are living with Parkinson’s Disease.
- An additional 60,000 Americans receive a Parkinson’s diagnosis each year.
- This disease is more prevalent among people aged 80+, nearly 1,900 people per 100,000.
- Early-onset is relatively rare. Estimated about 4% of people are diagnosed before age 50
- Men are 1.5X more likely to develop Parkinson’s than women.
What Causes Parkinson's?
The cause of Parkinson’s is still under intense investigation. However, research shows that the disease is related to the protein Synuclein.
When normal Synuclein misfolds into toxic shapes, they become prions. The misfolded Synuclein causes damage to the brain.
Three Early Signs of Parkinson's
Some key early signs are distinct from the typical PD motor symptoms including:
- Constipation (not linked to other known problems)
- Sleep disorders (mainly associated with REM sleep)
- Loss of smell and taste
About 60% of people with Parkinson’s symptoms go on to develop the disease within 10 years.
Parkinson's Four Stages
There are four major stages.
During this early stage, symptoms are atypical of PD motor symptoms, as mentioned above.
However, these initial PD symptoms are also found in other disorders. Therefore using conventional methods, accurate diagnosis at this stage is tremendously challenging.
This phase presents the earliest measurable motor control changes. Unfortunately, the person is likely to be the only one noticing these new signs. The disease can be found in the brainstem.
Early-stage symptoms often overlap with normal brain aging as well as other non-progressive motor disorders. Therefore, biometric detection and molecular testing are the best methods for accurate diagnosis here.
In particular, biometric tracking of eye movements, keyboard typing, and vocalization shows promise as an early-stage PD indicator.
Furthermore, thanks to advancements in molecular science, biomarker testing is finally here. Our SYNTap™ Test identifies misfolded Synuclein aggregates in cerebrospinal fluid (CSF) at the early stages. This test aids doctors in PD diagnosis.
Here, the symptoms include more noticeable motor disorders, such as tremors, rigidity, and shuffling.
Advanced stage patients may show evidence of the disease in the hippocampus and the cerebral cortex. These brain regions control memories as well as thinking and planning, respectively.
Here, the person shows rapidly declining motor symptoms, as well as progressive dementia symptoms.
If dementia and memory loss appear at earlier PD stages, doctors might diagnose Lewy Body Dementia (LBD).
Parkinson's 16 Key Symptoms
PD is known for its movement disorders at first. However, in later stages, the permanent damage extends beyond the substantia nigra to memory areas in the hippocampus and cerebral cortex. As these additional brain regions degenerate, dementia symptoms may follow.
Here are details of each key symptom:
The person may develop micrographia, aka small handwriting. Therefore, it’s a good idea to regularly take and compare writing samples to detect if the writing is shrinking.
One of the most recognizable signs of Parkinson’s is tremors. Watch for twitching of hands, fingers, or feet. The person will notice this first sign before others do.
As the disease progresses, the shaking could become worse. Others will likely notice the tremors at this point. It’s worth noting that medicine, stress, injuries, and extreme physical work-out can also cause tremors.
Sleep problems are normal from time to time. However, excessive tossing and turning could be an early sign of PD. Here are some examples:
- Flailing arms
- Falling out of bed
PD damages nerve cells in the brain controlling body movement, affecting daily activities. For example:
- Stiffness in the arms, legs or even the entire body could lead to movement troubles, usually beginning with the shoulders or hips
- Bradykinesia or slowed movement
- Difficulty getting out of a chair
- Dragging feet
- Shorter steps when walking
- Automatic movements, like blinking or smiling, may become more difficult.
Other diseases can cause movement symptoms besides Parkinson’s. So it’s challenging for doctors to accurately diagnose based only on these problems.
The following voice changes can be early signs of Parkinson’s:
- Speaking faster or softer
- Increased hesitation before speaking
- Slurring of words
- Speaking in monotone instead of with inflection
- Less dramatic voice changes, such as excessive enunciation, voice pitching lower, or sounding hoarse
The human face has 43 muscles to help express emotions. The brain controls these muscles via the nervous system. Unfortunately, people with Parkinson’s often develop an expressionless face, known as hypomimia or Parkinson’s mask.
Small posture changes sometimes occur, causing leaning or slouching. Troubles with coordination and balance problems may also happen.
Between 80-90% of PD patients also develop non-motor symptoms. These include fatigue, cognitive decline, and mood changes. Here are a few examples:
Dizziness or Fainting
Severe lightheadedness could cause fainting or blackout. Increased dizziness could be a sign of Parkinson’s.
Loss of Smell
Some patients develop hyposmia (reduced sensitivity to scents) or anosmia (loss of smell). For some people, these are early signs of Parkinson’s. For others, these symptoms don’t develop until years after the traditional motor symptoms emerge.
Some patients also experience gastrointestinal issues, including constipation. It occurs when the disease slows the digestive system’s automatic movements.
Loss of Bladder Control
Parkinson’s can cause bladder problems, leading to urine control difficulty.
Fatigue is a common PD symptom.
Some patients also experience weight loss, which often occurs in the later stages.
Older or advanced PD patients sometimes experience cognitive decline, including:
- Difficulty finding the right words
- Making sound judgments
- Clear thinking
Parkinson’s could bring mood disorders, such as depression, fear, or anxiety. Some patients also experience personality changes, including impulsive behaviors and hypersexuality.
Parkinson’s could diminish eye movement abilities, such as slow blinking, which leads to dry eyes.
Understanding PD warning signs can help people know when to seek early care. In addition, there is a useful Parkinson’s research/treatment center directory that we created for the community.
What Drives Parkinson's Progression?
PD is driven by an accumulation of alpha-Synuclein aggregates in the brain called Lewy Bodies.
What is a Lewy Body?
A Lewy Body is composed of misfolded Synuclein plus other cellular proteins and lipids.
Bottom line: Lewy Bodies cause cell death.
What causes movement difficulty in Parkinson’s? Substantia Nigra, the brain region controlling motor ability, has suffered irreversible damage.
Synuclein is a biomarker for PD. Produced by most brain cells, Synuclein is found abundantly throughout the brain.
With PD, the initial damage takes place in the substantia nigra region, where high concentrations of the neurotransmitter dopamine are produced. Dopamine helps initiate and control voluntary movements.
As the disease progresses, the first wave of prions corrupts other healthy proteins, causing widespread misfolding.
During this asymptomatic stage, misfolded Synuclein damages the brain silently. This goes on for years, sometimes even decades!
The long asymptomatic stage makes early detection of misfolded Synuclein crucial. Knowing early helps patients. Identifying this critical biomarker accelerates drug development.
To end Parkinson’s, we must stop what drives it.
Parkinson's Risk Factors
Research shows the following as risk factors.
Approximately 10-15% of PD patients carry genes that may be responsible for the disease. In addition, these individuals may have one or more first-degree family members with PD. Such a family history increases the risk.
Now let’s go deeper. 🤓
Genes that can increase the disease’s probability include SNCA, LRRK2, PARKIN, PINK1, and GBA.
Specifically, for people carrying mutations in the GBA-1 or LRRK2 genes, their risk increases significantly. The action mechanism for these genes is not yet entirely understood. However, both of these genes may be involved in the accumulation of misfolded proteins.
- Mutations in GBA-1 cause the accumulation of specific lipids in the brain that trigger Synuclein misfolding.
- Mutations in LRRK2 may impair the removal and degradation of misfolded Synuclein in nerve cells.
Both mutations increase the level of Misfolded Synuclein, upping the risk of Parkinson’s.
Traumatic Head Injuries
Athletes who suffer from multiple head injuries have an increased risk of PD. Particularly professional players in basketball, boxing, and football.
Both internal and external environmental factors play a role in Parkinson’s risk.
For some people, the disease originates from toxic bacteria in the gastrointestinal (GI) tract. Certain bacterial strains may promote Synuclein misfolding in the gut. The misfolded Synuclein travels via the vagus nerve from the intestines to the brain. People who have had their vagus nerve removed show a decreased risk or delayed onset of Parkinson’s.
Long-term exposure to environmental toxins may increase the risk of Parkinson’s. Here are some examples:
- Toxic metals such as lead, mercury, barium, zinc, etc. ☠️
Is PD an Old Person's Disease?
People in their 70’s experience PD symptoms over 100X more than those in their 40’s. However, the process of brain protein misfolding began in early adulthood.
During this asymptomatic phase, brain cell damage spreads silently and undetected. Physical symptoms appear many years later. Consider the following:
Check the Appendix
Researchers examined teenage appendectomies and discovered misfolded Synuclein aggregates within.
This indicates PD develops early in life!
Repeated Head Traumas
Athletes with multiple head injuries in their 20’s and 30’s have increased risks.
Muhammad Ali is a notable example.
About 5% of all Parkinson’s patients are diagnosed with early-onset. For example, the NBA player, Brian Grant, was diagnosed at age 36.
His organization inspires people living with PD to exercise as part of their treatment plan.
Traditional PD Diagnosis
Currently, doctors diagnose Parkinson’s only after clinical symptoms appear.
Ironically, PD’s symptoms appear after much of the brain has been irreversibly damaged. Therefore, clinical diagnosis is at a late stage.
It’s no surprise that Parkinson’s looks like a disease of the elderly.
Beginning of the End PD
Conservatively, 1 in 4 PD patients is misdiagnosed initially. So why is diagnosing PD such a daunting challenge?
A critical factor is that many symptoms of other movement disorders also look like PD early symptoms:
- Balance disorders
In addition, these symptoms overlap with normal aging signs. This confusion makes a molecular-based diagnosis of the utmost importance. It gives us a fighting chance to detect and treat PD before the brain suffers widespread damage.
Biomarker testing empowers doctors to diagnose PD accurately and early.
Parkinson’s Treatment Options
PD patients diagnosed at early and intermediate stages respond initially to drugs such as Levodopa and Carbidopa.
Sadly, long-term treatment using these drugs leads to severe side effects, including nausea, confusion, and involuntary movements. Also, they have diminishing benefits over time.
Deep brain stimulation (DBS) improved voluntary movement in a subset of patients.
So far, there is no cure yet for Parkinson’s. So the key lies in early detection and preventive care through exercise, diet, and lifestyle changes. Effective disease management gives people quality of life!
With biomarker testing, we’re now racing to a cure!
Who Gets Parkinson’s?
PD affects men more frequently and severely than women. For instance, about 65% of patients are men.
Who Gets Parkinson’s?
Parkinson’s affects men more frequently and severely than women. About 65% of Parkinson’s patients are men.
On the flip side, this PD gender bias is reversed in Alzheimer’s, affecting women more frequently and severely.
A Healthy Diet Helps Delay PD Onset
Did you know that a diet rich in vitamins C and E may reduce the risk of Parkinson’s?
A Healthy Diet Helps Delay PD Onset
Parkinson's Frequently Asked Questions
Can Parkinson's be cured or treated?
At present, there are no treatments that can restore the neurons or their connections. However, several treatments can substitute for the lost cells temporarily.
Substantia nigra cells produce and release large amounts of dopamine. L-DOPA is a precursor drug converted in the brain to dopamine. Thus, they can restore some lost functions.
In addition, the cells' electrical activity in substantia nigra can be mimicked. This is done by embedding thin wires in the region where signals have been lost.
Can Parkinson's cause dementia?
Short answer - Yes. PD patients can progress over time to dementia which further complicates the motor symptoms. In addition, some patients show early dementia signs when motor symptoms appear. In some patients, dementia associated with PD is difficult to distinguish from Alzheimer's. This is why we view Parkinson's and Alzheimer's as the Parkinzheimer Spectrum disease.
What are the early signs of Parkinson's?
The earliest PD signs are distinct from the typical Parkinson's motor symptoms. These include constipation (not linked to other known problems), sleep disorders (mainly associated with rapid-eye-movement REM sleep), and loss of smell and taste. For individuals with one of these symptoms, about 60% go on to develop PD within 10 years.