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 Council
Linda Pituch, Patient Services Manager, Parkinson’s Disease Foundation

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)
‪A Manual Of Diseases Of The Nervous System, Gowers, 1896
Often confused with Essential Tremor in the elderly
Nutt & Wooten, NEJM 2005

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 Disease Loss of neurons in the substantia nigra
Substantia nigra,gross -> sections -> lewy bodies with dense core and halo (upper); lewy bodies elsewhere in CNS
Madame 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 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
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 not be 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?
Infection
Other illness
Medications
Nirenberg, 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 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 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 programs
Reached and helped millions of people with
Parkinson’s and their families

27. 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.