09192017Headline:

The causes of Parkinson’s disease remain in doubt, but advances in treatment can ease its effects

Dr. Barbara Changizi is co-director  of the Center for Neuromodulation at Mount Sinai.

The specialist:

As co-director of the Center for Neuromodulation at Mount Sinai, Dr. Barbara  Changizi specializes in treating movement disorders ranging from Parkinson’s  disease and tremors to Tourette’s and restless leg syndrome. Her clinic sees  more than 500 new Parkinson’s patients a year.

Who’s at risk:

Michael J. Fox famously made awareness of Parkinson’s disease part of  popular culture, but his case is only singular in terms of his celebrity — doctors estimate that 1% of all people over age 60 have the disease.

“Parkinson’s disease is a degenerative nerve disorder characterized by  stiffness, slowness and tremor,” says Changizi. “If left untreated, these  symptoms worsen over time and can become extremely debilitating — however,  correct medical management tailored to the individual can largely hold  Parkinson’s in check.” About 500,000 Americans are living with the disease.

The cause of Parkinson’s remains unknown. “We think it’s a complicated  combination of genetic dispositions plus environmental insult,” says Changizi. “The commonest risk factor is aging, with most patients developing symptoms  after age 50.” A minority of patients do have a form of Parkinson’s caused by  rare genetic mutations.

Doctors have identified a group of exposures that increase the risk of  Parkinson’s. “Drinking well water, high iron intake and exposure to manganese  and pesticides may all increase your risk of developing Parkinson’s,” says  Changizi. “Conversely, drinking coffee and smoking cigarettes may be protective,  though the other health risks of smoking outweigh the potential benefit.” Children or siblings of patients with Parkinson’s disease are 2.3 times more  likely to develop the disease themselves.

Signs and symptoms:

The hallmarks of Parkinson’s disease are well defined and worsen gradually  over time. “Slowness is always present, often in combination with stiffness,  tremor and balance problems,” says Changizi.

“When patients describe Parkinsonian ‘slowness,’ they often say they’re  getting clumsy — they have trouble doing buttons, putting on a coat or using  utensils.” Other warning signs include tremor in the hand or leg, small  handwriting, constipation, loss of smell, and dragging a leg or shuffling while  walking.

Parkinson’s-related symptoms often start asymmetrically. “In classic  Parkinson’s, it’s a slow process of degeneration that goes on insidiously for 10  to 20 years,” says Changizi. “The slowness and tremor start on one side of the  body, but they will eventually spread to the other side.”

Traditional treatment:

Because Parkinson’s disease is associated with a lack of dopamine production  in the brain, the primary arsenal of drug regimes focus on replacing or  mimicking dopamine.

“Some medications help the brain keep making dopamine longer, or give  dopamine in drug form, or things like dopamine,” says Changizi. “Drugs like  Levadopa and dopamine agonists work to restore dopamine in the brain that’s  starved of it. Often these drugs act like magic pills when patients first use  them.”

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