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 Council Linda Pituch, Patient Services Manager, Parkinson’s Disease Foundation www.pdf.org

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

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.

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

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

What are the Symptoms of Parkinson's? Primary Movement Symptoms: Resting tremor Bradykinesia (Slowness) Rigidity Postural instability (balance) ‪A Manual Of Diseases Of The Nervous System, Gowers, 1896 Often confused with Essential Tremor in the elderly Nutt & Wooten, NEJM 2005

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

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

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

Parkinson’s Disease Loss of neurons in the substantia nigra http://www.urmc.rochester.edu/neuroslides/slide199.html Substantia nigra,gross -> sections -> lewy bodies with dense core and halo (upper); lewy bodies elsewhere in CNS Madame Curie Bioscience Database

But Parkinson’s is more than a loss of dopamine neurons in the substantia nigra…

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

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

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

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

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

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

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

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

Some symptoms should not be attributed to PD Fever Weight Loss Headache Acute or Sudden Weakness Vision Loss Back Pain Nirenberg, PDF Webinar Sep 29, 2009

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

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

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

About the Parkinson’s Disease Foundation

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. Supporting research and ideas where they can make the biggest difference for people living with Parkinson’s—today and tomorrow

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

Parkinson’s Disease Foundation How 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.