Parkinson's disease is a progressive neurodegenerative disorder that causes motor impairment due to the loss of dopaminergic neurons. The main symptoms are tremors, muscular rigidity, and slow, imprecise movements. It occurs due to the death of dopamine-producing brain cells, leading to imbalances in neurotransmitters. While there is no cure, treatments can provide relief from symptoms and slow progression through medications, surgery, therapy, and lifestyle management.

1. ROHAN DEOKAR

2.  DEFINITION
 OUTLINE
 STAGES
 SYMPTOMS
 CAUSES
 EVALUATION
 PROGRESSION
 PATHOLOGY
 PATHOPHYSIOLOGY
 MANAGEMENT
 TREATMENT
OPTIONS
 PROGNOSIS
 SIDE EFFECTS
 HISTORY
 NOTABLE CASES
 RESEARCH
 SUMMARY

3.  Parkinson’s Disease can be defined as
a progressive disease of the brain and
nervous system which is marked by
tremors, muscular rigidity, and slow,
imprecise movements.
 Movement is normally controlled by
dopamine, a chemical that carries
signals between the nerves in the
brain.
 When up to 90% of the cells producing
dopamine die, the symptoms of
Parkinson’s appear.
 The disease is named after the English
doctor James Parkinson.

4.  Parkinson’s is a neurogenerative disorder that
impairs motor movement due to the loss of
dopaminergic neurons. It occurs mainly in elders
over the age of 60.
 This neurogeneration is due to genetic as well as
environmental factors, such as toxins and drugs.
 Main symptoms are MIST-Muscular rigidity, Impaired
balance, Slow/Stiff and Tremors.
 There is no cure. Treatment targets the alleviation of
symptoms only.
 Non-pharmacological therapy includes speech,
occupational, physical therapy.
 Pharmacological treatment includes dopamine

5. STAGES OF PARKINSON'S DISEASE
Parkinson's disease is described as early, moderate, or advanced.
 Early disease describes the stage when a person has a mild tremor
or stiffness but is able to continue normal daily activities. This refers
to a person who has been newly diagnosed.
 Moderate disease describes the stage when a person begins to
experience limited movement. A person with moderate Parkinson's
disease may have a mild to moderate tremor with slow movement.
 Advanced disease describes the stage when a person is
significantly limited in his or her activity, despite treatment. Daily
changes in symptoms, medicine side effects that limit treatment,
and loss of independence in activities of daily living are common.
Parkinson's disease may also be described by five stages:
 Stage I: Symptoms affect only one side of the body.
 Stage II: Both sides of the body are affected, but posture remains
normal.
 Stage III: Both sides of the body are affected, and there is mild
imbalance during standing or walking. But the person remains
independent.
 Stage IV: Both sides of the body are affected, and there is disabling
instability while standing or walking. The person in this stage
requires substantial help.

6.  Soft speech
 Small handwriting
 Muscle pain
 Stooped posture
 Lack of facial
expression
 Stooping
 Slowed activity

7.  Constipation
 Fatigue
 Dizziness
 Depression
 Memory problems
 Bladder urgency and frequency
 Increased sweating

8.  Results from the loss of
dopaminergic neurons of
the basal ganglia
 As with most brain tissue,
the neurons atrophy with
age.
 This results in increased
difficulty in initiating
movements.
 Imbalance primarily
between excitatory
neurotransmitter
acetylcholine, and
inhibitory
neurotransmitter
Dopamine in the basal

9.  The severity of Parkinson’s is
rated by trained observers on
a scale of 0(normal) to 17
(severe) which includes-
 Movement
 Attention and Blinking
 posture
 Balance and Coordination
 Reactions
 Vocalizations

10.  Currently, there is no cure.
 progresses at different rates for each person.
 Medications need to be adjusted as symptoms
change.
 May progress more quickly in elder people.
 May progress slowly when main symptom is
tremors.
 Parkinson’s is not a mental disease, although
30% will eventually develop dementia.

11.  Anatomical
 The basal ganglia innervated by the
dopaminergic system, are the most
seriously affected brain areas in PD.
The main pathological characteristic
of PD is cell death in the substantia
nigra.
 Macroscopic alterations can be
noticed on cut surfaces of the
brainstem, where neuronal loss can
be inferred .The histopathology of
the substantia nigra and several
other brain regions shows neuron
loss and Lewy bodies in many of the
remaining nerve cells.
 Neuronal loss is accompanied by
death of astrocytes and activation of
the microglia. Lewy bodies are a key
pathological feature of PD.

12.  Brain cell death
 There is speculation of several mechanisms by which
the brain cells could be lost.
 Lewy bodies first appear in the olfactory lobe and
medulla with individuals at this stage being
asymptomatic. As the disease progresses, Lewy bodies
later develop in the substantia nigra, areas of
the midbrain and basal forebrain. These brain sites are
the main places of neuronal degeneration in PD;
however, Lewy bodies may not cause cell death and
they may be protective.
 In patients with dementia, a generalized presence of
Lewy bodies is common in cortical areas.
 Other cell-death mechanisms include lysosomal system
dysfunction and reduced mitochondrial activity. It may
be related to oxidative stress and neuronal death.

13.  There is no cure for Parkinson's disease, but
medications, surgery and multidisciplinary
management can provide relief from the symptoms.
 The main families of drugs useful for treating motor
symptoms are levodopa, dopamine agonists
and MAO-B inhibitors.
 The stage of the disease determines which group is
most useful. Two stages are usually distinguished: an
initial stage in which the individual with PD has
already developed some disability for which he
needs pharmacological treatment, and a second
stage in which an individual develops motor
complications related to levodopa usage.
 Treatment in the initial stage aims for an optimal
tradeoff between good symptom control and side-effects
resulting from enhancement of dopaminergic

14.  Drug therapy is only for symptom
management, only to slow the
progression of the disease.
 Physical therapy helps mobility,
flexibility and balance.
 Occupational therapy helps with
daily routine.
 Speech therapy helps with voice
control.
 Dopamine agonists directly
stimulate dopamine receptors.
Used for a relatively young patient.
 Dopamine replacement therapy.
 Anticholinergics block increased
acetylcholine effects.
 Surgery deep brain stimulation for
severe disabling dyskinesias.

15.  Treating PD by surgery was
a common practice before
the introduction of
Levodopa, and is done by
deep brain stimulation or
implanting brain
pacemaker.
 Dopamine agonists are
used which reduce the
symptoms and reduce the
death of brain cells.

16.  Regular physical exercise can
be beneficial to maintain and
improve mobility, flexibility,
strength, gait speed, and
quality of life.
 Muscles and nerves that
control the digestive process
may be affected by PD,
resulting in constipation.
 A balanced diet is
recommended to avoid weight
loss or gain and minimize
consequences of GI
dysfunction.

17.  PD invariably progresses with time.
 Motor symptoms, if not treated, advance aggressively in the
early stages of the disease and more slowly later.
Untreated, individuals are expected to lose
independent ambulation after an average of eight years and
be bedridden after ten years.
 As the disease advances, disability is more related to motor
symptoms, such as swallowing/speech difficulties, and
gait/balance problems; and also to motor complications.
 The life expectancy of people with PD is reduced. Mortality
ratios are around twice those of unaffected people.
 Cognitive decline and dementia, old age at onset, a more
advanced disease state and presence of swallowing
problems are all mortality risk factors.

18.  L-Dopa is effective in elimination of symptoms
of Parkinson’s, but is less effective in treating
gait and postural instability.
 It increases patient sense of well-being.
 Can lead to cardiovascular problems like
tachycardia or hypertension.
 It can also induce psychosis, delusions, etc.

19.  In 1817 an English doctor, James Parkinson,
published his essay An Essay on the Shaking
Palsy describing the characteristic resting tremor,
abnormal posture and gait, paralysis and diminished
muscle strength, and the progression over time.
 Jean-Martin Charcot made the distinction between
rigidity, weakness and bradykinesia.
 In 1912,Frederick Lewy described microscopic
particles in affected brains, later named “Lewy bodies
“.
 In 1919, Konstantin Tretiakoff reported the substantia
nigra as the main cerebral structure affected.
 Levodopa was first synthesized in 1911 by Casimir
Funk but it entered clinical practice in 1967.
 By the late 1980s deep brain stimulation emerged as
a possible treatment.

20.  The costs of PD to society are high,
but precise calculations are difficult
due to methodological issues in
research and differences between
countries.
 In addition to economic costs, PD
reduces quality of life of those with the
disease and their caregivers.
 April 11, the birthday of James
Parkinson, has been designated as
Parkinson's disease day.
 A red tulip was chosen by international
organizations as the symbol of the
disease in 2005.
 Advocacy organizations include the
National Parkinson’s Foundation and
Parkinson’s Disease Foundation.

21.  Actor Michael Fox has greatly
increased the public
awareness of the disease.
Fox was diagnosed at 30.
 Cyclist and Olympic
medalist Davis Phinney, was
diagnosed with young onset
Parkinson's at 40.
 Muhammad Ali has been
called the "world's most
famous Parkinson's patient.
 Other notable cases are
Yasser Arafat and Pope John
Paul II.

22.  There is little prospect of dramatic new
PD treatments expected in a short time
frame.
 Currently active research directions
include the search for new animal
models of the disease and studies of the
potential usefulness of gene
therapy, stem cells transplants
and neuroprotective agents.
 Investigations on neuroprotection are at
the forefront of PD research. Several
molecules have been proposed as
potential treatments . However, none of
them have been conclusively
demonstrated to reduce degeneration.

23.  1-2% of general population are the sufferers.
 Occur due to imbalance in neurotransmitters
 Muscular rigidity, Impaired balance, Slow/Stiff
and Tremors are main symptoms.
 Levodopa and other dopaminergic drugs are
used.
 No treatment possible, only reduction of
symptoms.