Parkinson’s Disease 101

1. Parkinson’s Disease 101 Maria De Leon, M.D., Parkinson’s specialist and member, Parkinson’s Disease Foundation, People with Parkinson’s Advisory Council Linda Pituch, Patient Services Manager, Parkinson’s Disease Foundation www.pdf.org

2. Goals and Objectives: • Understand Parkinson’s disease • List the main symptoms • Understand the benefits and challenges of medications • Learn other strategies for managing PD at all stages • Understand how PDF can help you and your patients

3. What is Parkinson’s Disease? A chronic and progressive movement disorder, meaning that symptoms continue and worsen over time. The cause is unknown, and although there is presently no cure, there are treatment options such as medication and surgery to manage its symptoms.

4. Who Has Parkinson’s Disease? • Approximately 1,000,000 Americans • Seven to 10 million people worldwide • Mostly (but not all) people over age 60 • About two percent of population over 60 • Average age of onset is 57 • Four percent are diagnosed before age 50

5. How is Parkinson’s diagnosed? • There is no test yet for Parkinson’s disease. • Making an accurate diagnosis is difficult • A skilled practitioner (PDF recommends a movement disorders specialist) must observe a person’s symptoms, to diagnose Parkinson’s

6. What are the Symptoms of Parkinson's? Primary Movement Symptoms: • Resting tremor • Bradykinesia (Slowness) • Rigidity • Postural instability (balance) Nutt & Wooten, NEJM 2005 ‪A Manual Of Diseases Of The Nervous System, Gowers, 1896

7. Other Common Movement Symptoms • Freezing • Micrographia (shrinkage in handwriting) • Mask-like Facial Expression • Unwanted Accelerations • Stooped posture, a tendency to lean forward • Dystonia • Impaired fine motor dexterity and motor coordination • Impaired gross motor coordination • Poverty of movement (decreased arm swing) • Akathisia • Speech problems, such as softness of voice or slurred speech = • Difficulty swallowing • Sexual dysfunction • Cramping • Drooling

8. More Symptoms: Non-movement • Sleep • Restless Leg Syndrome • REM Sleep Behavior Disorder • Cognitive • Mild Impairment • Dementia • Autonomic • GI Motility • Perspiration • Heart/Blood Pressure • Psychosis • Hallucinations • Mood • Depression • Anxiety • Sensory • Pain (shoulder) • Hyposmia • Fatigue/weakness • Often due to rigidity • Sleep issues too

9. What Causes Parkinson’s Disease? • Scientists believe Parkinson’s is due to a combination of genetic and environmental factors. • 90 percent of cases are of unknown origin • 10 percent are inherited because of known to cause Parkinson’s

10. Parkinson’s DiseaseLoss of neurons in the substantia nigra http://www.urmc.rochester.edu/neuroslides/slide199.html Madame Curie Bioscience Database

11. But Parkinson’s is more than a loss of dopamine neurons in the substantianigra…

12. How Does Parkinson’s Progress? • Differently for everyone • Rating scales?

13. How Can You Treat Parkinson’s? • Prescription Medications • Surgical Treatments • The “Pipeline” and Clinical Trials

14. How Can You Treat Parkinson’s?Prescription Medications • Most common is dopamine replacement/augmentation therapy • Carbidopa/Levodopa • Dopamine Agonists • Anticholinergics • MAO-B Inhibitors • COMT Inhibitors • Other medications

15. How Can You Treat Parkinson’s?Surgical Options • Deep Brain Stimulation • reserved for later stages of disease Motor Cortex Motor Cortex

16. How Can You Treat Parkinson’s? “Pipeline” and Clinical Trials • Gene Therapy • CERE-120 (neurturin), ProSavin, NLX-P101, GDNF • Stem Cell Therapy • eSC, iPS, adult stem cells • New Drugs • help with non-motor symptoms • help with side effects of levodopa

17. How Can You Treat Parkinson’s?Side Effects and Limitations of Medications • Side effects: Dyskinesia • Limitations: depression, constipation, sexual dysfunction , fatigue, sleep disorder etc.

18. Managing Parkinson’s • Finding a Specialist • Managing Medications • Coping with Symptoms • Exercise • Nutrition • Finding Support • Staying Independent • Hospital visits and other special issues

19. Some Myths: There are “exacerbations” in PD? • Common assumption • Potentially very dangerous Reality: PD changes slowly, not over days or weeks • Something else must be going on! • This cannot be attributed to the PD • Need to find the underlying cause Nirenberg, PDF Webinar Sep 29, 2009

20. Some symptoms should notbe attributed to PD • Fever • Weight Loss • Headache • Acute or Sudden Weakness • Vision Loss • Back Pain Nirenberg, PDF Webinar Sep 29, 2009

21. What can cause rapid worsening of PD symptoms? Medications Infection Other illness Nirenberg, PDF Webinar Sep 29, 2009

22. Secret: What is one of the most common silent causes for a “PD exacerbation?” Urinary tract infection Nirenberg, PDF Webinar Sep 29, 2009

23. Some medication changes can worsen PD symptoms • Nausea medications • Antipsychotic medications • Reduction of PD medications Nirenberg, PDF Webinar Sep 29, 2009

24. About the Parkinson’s Disease Foundation

25. Parkinson’s Disease Foundation PDF was founded in 1957. We support the research and ideas that will improve the lives and futures of people touched by Parkinson’s.

26. Parkinson’s Disease Foundation • $96 million in scientific research funding • $40 million to education & advocacy programs • Reached and helped millions of people with • Parkinson’s and their families

27. Parkinson’s Disease FoundationHow We Can Help • How can we help you? • Continuing Education for Health Care Professionals • Course for physical therapists • Course for nurses • CEUs through our webinars • Free publications for your patients • A HelpLine for you and your patients to find doctors, resources, support groups and more.