1 Linda Pituch, Patient Services Manager, Parkinson’s Disease Foundation Maria De Leon, M.D., Parkinson’s specialist and member, Parkinson’s Disease Foundation, People with Parkinson’s Advisory CouncilLinda Pituch, Patient Services Manager, Parkinson’s Disease Foundation
2 Goals and Objectives: Understand Parkinson’s disease List the main symptomsUnderstand the benefits and challenges of medicationsLearn other strategies for managing PD at all stagesUnderstand 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 AmericansSeven to 10 million people worldwideMostly (but not all) people over age 60About two percent of population over 60Average age of onset is 57Four 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 difficultA 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 tremorBradykinesia (Slowness)RigidityPostural instability (balance)A Manual Of Diseases Of The Nervous System, Gowers, 1896Often confused with Essential Tremor in the elderlyNutt & Wooten, NEJM 2005
7 Other Common Movement Symptoms FreezingMicrographia (shrinkage in handwriting)Mask-like Facial ExpressionUnwanted AccelerationsStooped posture, a tendency to lean forwardDystoniaImpaired fine motor dexterity and motor coordinationImpaired gross motor coordinationPoverty of movement (decreased arm swing)AkathisiaSpeech problems, such as softness of voice or slurred speech =Difficulty swallowingSexual dysfunctionCrampingDrooling
8 More Symptoms: Non-movement SleepRestless Leg SyndromeREM Sleep Behavior DisorderCognitiveMild ImpairmentDementiaAutonomicGI MotilityPerspirationHeart/Blood PressurePsychosisHallucinationsMoodDepressionAnxietySensoryPain (shoulder)HyposmiaFatigue/weaknessOften due to rigiditySleep 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 origin10 percent are inherited because of known to cause Parkinson’s
10 Parkinson’s Disease Loss of neurons in the substantia nigra Substantia nigra,gross -> sections -> lewy bodies with dense core and halo (upper); lewy bodies elsewhere in CNSMadame Curie Bioscience Database
11 But Parkinson’s is more than a loss of dopamine neurons in the substantia nigra…
12 How Does Parkinson’s Progress? Differently for everyoneRating scales?
13 How Can You Treat Parkinson’s? Prescription MedicationsSurgical TreatmentsThe “Pipeline” and Clinical Trials
14 How Can You Treat Parkinson’s? Prescription Medications Most common is dopamine replacement/augmentation therapyCarbidopa/LevodopaDopamine AgonistsAnticholinergicsMAO-B InhibitorsCOMT InhibitorsOther medications
15 How Can You Treat Parkinson’s? Surgical Options Deep Brain Stimulationreserved for later stages of diseaseMotor CortexMotor Cortex
16 How Can You Treat Parkinson’s? “Pipeline” and Clinical Trials Gene TherapyCERE-120 (neurturin), ProSavin, NLX-P101, GDNFStem Cell TherapyeSC, iPS, adult stem cellsNew Drugshelp with non-motor symptomshelp with side effects of levodopa
17 How Can You Treat Parkinson’s How Can You Treat Parkinson’s? Side Effects and Limitations of MedicationsSide effects: DyskinesiaLimitations: depression, constipation, sexual dysfunction , fatigue, sleep disorder etc.
18 Managing Parkinson’s Finding a Specialist Managing Medications Coping with SymptomsExerciseNutritionFinding SupportStaying IndependentHospital visits and other special issues
19 Some Myths: There are “exacerbations” in PD? Common assumptionPotentially very dangerousReality: PD changes slowly, not over days or weeksSomething else must be going on!This cannot be attributed to the PDNeed to find the underlying causeNirenberg, PDF Webinar Sep 29, 2009
20 Some symptoms should not be attributed to PD FeverWeight LossHeadacheAcute or Sudden WeaknessVision LossBack PainNirenberg, PDF Webinar Sep 29, 2009
21 What can cause rapid worsening of PD symptoms? InfectionOther illnessMedicationsNirenberg, PDF Webinar Sep 29, 2009
22 Urinary tract infection Secret: What is one of the most common silent causes for a “PD exacerbation?”Urinary tract infectionNirenberg, PDF Webinar Sep 29, 2009
23 Some medication changes can worsen PD symptoms Nausea medicationsAntipsychotic medicationsReduction of PD medicationsNirenberg, PDF Webinar Sep 29, 2009
25 Parkinson’s Disease Foundation PDF was founded in We support the research and ideas that will improve the lives and futures of people touched by Parkinson’s.Supporting research and ideas where they can make the biggest difference for people living with Parkinson’s—today and tomorrow
26 Parkinson’s Disease Foundation $96 million in scientific research funding$40 million to education & advocacy programsReached and helped millions of people withParkinson’s and their families
27 Parkinson’s Disease Foundation How We Can Help How can we help you?Continuing Education for Health Care ProfessionalsCourse for physical therapistsCourse for nursesCEUs through our webinarsFree publications for your patientsA HelpLine for you and your patients to find doctors, resources, support groups and more.