SlideShare a Scribd company logo
1 of 27
Parkinson's Disease
Ms. Hemangi Narvekar
Clinical Psychologist
National Institute for Empowerment of Persons with
Multiple Disabilities (NIEPMD), Chennai
CONTENTS
 Introduction
 Symptoms
 Stages
 Causes & Risk Factors
 Treatment
 Summary
 References
INTRODUCTION
 Parkinson's disease (PD) is a chronic and progressive
movement disorder, meaning that symptoms continue
and worsen over time.
 Parkinson's disease was first characterized extensively
by an English doctor, James Parkinson, in 1817.
 Described as early as 5000 B.C. in the Indian Ayurvedic
medicinal tradition and in the Nei Jing, the first Chinese
medical text 2500 years ago, Parkinson's disease is the
second most common neurodegenerative disorder after
Alzheimer disease.
 Parkinson's disease itself is not fatal. However,
complications from the disease are serious.
SYMPTOMS
Parkinson's disease symptoms and signs may vary from person to person.
Early signs may be mild and may go unnoticed. The Primary Symptoms
include:
 Tremors - Trembling in fingers, hands, arms, feet, legs, jaw, or head.
Tremors most often occur while the individual is resting, but not while
involved in a task.
 Rigidity - Stiffness of the limbs and trunk, which may increase during
movement. Rigidity may produce muscle aches and pain.
SYMPTOMS
 Bradykinesia - Slowness of voluntary movement. Over time, it may
become difficult to initiate movement and to complete movement.
 Postural instability - Impaired or lost reflexes can make it difficult
to adjust posture to maintain balance. Postural instability may lead
to falls.
 Parkinsonian gait - Individuals with more progressive Parkinson's
disease develop a distinctive shuffling walk with a stooped position
and a diminished or absent arm swing.
SYMPTOMS
Some of the secondary symptoms include:
 Anxiety, insecurity, and stress
 Confusion, memory loss, and dementia
 Constipation
 Change in handwriting
 Depression
 Difficulty swallowing and excessive salivation
 Diminished sense of smell
 Increased sweating
 Male erectile dysfunction
 Skin problems
 Slowed, quieter speech, and monotone voice
 Urinary frequency/urgency
STAGES OF PARKINSON’S DISEASE
 Stage 1:
During this initial stage, the person has mild symptoms that generally do not interfere with daily
activities. Tremor and other movement symptoms occur on one side of the body only. Friends and
family may notice changes in posture, walking and facial expressions.
 Stage 2:
In stage two of Parkinson’s, the symptoms start getting worse. Tremor, rigidity and other
movement symptoms affect both sides of the body. Walking problems and poor posture may
become apparent. In this stage, the person is still able to live alone, but completing day-to-day
tasks becomes more difficult and may take longer.
STAGES OF PARKINSON’S DISEASE
 Stage 3:
Stage three is considered mid-stage in the progression of the disease. Loss of balance and slowness of
movements are hallmarks of this phase. Falls are more common. Though the person is still fully independent,
symptoms significantly impair activities of daily living such as dressing and eating.
 Stage 4:
During this stage of Parkinson’s, symptoms are severe and very limiting. It’s possible to stand without
assistance, but movement may require a walker. The person needs help with activities of daily living and is
unable to live alone.
 Stage 5:
This is the most advanced and debilitating stage of Parkinson’s disease. Stiffness in the legs may make it
impossible to stand or walk. The person requires a wheelchair or is bedridden. Around-the-clock nursing care
is required for all activities. The person may experience hallucinations and delusions.
CAUSES
Genetic
Factors
Environmental
Factors
CAUSES
 Parkinson's disease results from the loss of cells in various parts of the brain, including a region
called the substantia nigra.
 The substantia nigra cells produce dopamine, a chemical messenger responsible for transmitting
signals within the brain that allow for coordination of movement.
 The substantia nigra contains neuronomelanin, pigment cells, which synapse to cells of the striatum.
 The striatum is responsible for balance, control of movements, and walking.
 Dopamine, produced in the substantia nigra, passes messages between the striatum and the
substantia nigra.
 When the cells of the substantia nigra deteriorate there is a corresponding decrease in the amount
of dopamine produced between these cells.
 Loss of dopamine causes neurons to fire without normal control, leaving patients less able to direct
or control their movement.
CAUSES
 When approximately 60 to 80% of the dopamine-producing cells are damaged, and do not produce
enough dopamine, the motor symptoms of Parkinson's disease appear.
 The intestines also have dopamine cells that degenerate in Parkinson’s, and this may be important in
the gastrointestinal symptoms that are part of the disease.
 When the level of dopamine decreases, another neurotransmitter, acetylcholine, is also adversely
affected.
 The motor function of the striatum is also dependent on the equilibrium reached between dopamine
and acetylcholine. This disrupted balance of neurotransmitters contributes to disease progression.
 It's not known why the loss of nerve cells associated with Parkinson's disease occurs, although
research is ongoing to identify potential causes.
 Currently, it's believed a combination of genetic changes and environmental factors may be
responsible for the condition.
CAUSES
 Approximately 15 percent of people with Parkinson disease have a family history of this disorder.
 Some gene mutations appear to disturb the cell machinery that breaks down (degrades)
unwanted proteins in dopamine-producing neurons.
 As a result, undegraded proteins accumulate, leading to the impairment or death of these cells.
 Other mutations may affect the function of mitochondria, the energy-producing structures within
cells.
 As a byproduct of energy production, mitochondria make unstable molecules called free radicals
that can damage cells.
 Cells normally counteract the effects of free radicals before they cause damage, but mutations
can disrupt this process.
 As a result, free radicals may accumulate and impair or kill dopamine-producing neurons.
CAUSES
 So far, five genes have been identified that are definitively associated with Parkinson's
disease.
1. SNCA (Alpha-synuclein): SNCA makes the protein alpha-synuclein. In brain cells of
individuals with Parkinson's disease, this protein aggregates in clumps called Lewy bodies.
Mutations in the SNCA gene are found in early-onset Parkinson's disease.
2. PARK2 (Parkin / E3 ubiquitin protein ligase parkin): The PARK2 gene makes the protein
parkin. Parkin normally helps cells break down and recycle proteins.
3. PARK7 (Protein DJ1): PARK7 mutations are found in early-onset Parkinson's disease. The
PARK7 gene makes the DJ-1 protein, which may protect cells from oxidative stress.
CAUSES
4. PINK1 (PTEN-induced putative kinase 1): Mutations of this gene are found in early-onset
Parkinson's disease. It protect structures within the cell called mitochondria from stress.
5. LRRK2 (Leucine-rich repeat kinase 2): LRRK2 makes the protein dardarin. It transmits
various signals to control cell activities. Mutations in the LRRK2 gene have been linked to late-
onset Parkinson's disease.
6. EIF4G1 (Eukaryotic translation initiation factor 4 gamma 1): It organizes a group of
proteins involved in translating pre-prepared genes into proteins.
7. VPS35 (Vacuolar protein sorting-associated protein 35): It’s one of a group of proteins that
selects proteins for recycling.
CAUSES
 Among familial cases of Parkinson disease, the inheritance pattern differs depending on
the gene that is altered. If the LRRK2 or SNCA gene is involved, the disorder is
inherited in an autosomal dominant pattern, which means one copy of an altered gene
in each cell is sufficient to cause the disorder. In most cases, an affected person has
one parent with the condition.
 If the PARK2, PARK7, or PINK1 gene is involved, Parkinson disease is inherited in an
autosomal recessive pattern. This type of inheritance means that two copies of the
gene in each cell are altered. Most often, the parents of an individual with autosomal
recessive Parkinson disease each carry one copy of the altered gene but do not show
signs and symptoms of the disorder.
RISK FACTORS
 Risk factors for Parkinson's disease include:
1. Age - Young adults rarely experience Parkinson's disease. It ordinarily begins in middle or late
life, and the risk increases with age. People usually develop the disease around age 60 or older.
2. Sex - Men are more likely to develop Parkinson's disease than are women.
3. Exposure to toxins - Ongoing exposure to herbicides and pesticides may put one at a slightly
increased risk of Parkinson's disease. Some studies have demonstrated that prolonged
occupational exposure to certain chemicals is associated with an elevated risk of PD. These
include the insecticides permethrin and beta-hexachlorocyclohexane (beta-HCH), the herbicides
paraquat and 2,4-dichlorophenoxyacetic acid and the fungicide maneb.
4. Stress
DIAGNOSIS
 There are currently no blood or laboratory tests that have been proven to help in diagnosing PD.
 A neurologist who specializes in movement disorders will be able to make the most accurate diagnosis. An
initial assessment is made based on medical history, a neurological exam, and the symptoms present.
 For the medical history, it is important to know whether other family members have Parkinson's disease,
what types of medication have been or are being taken, and whether there was exposure to toxins or
repeated head trauma in the past.
 A neurological exam may include an evaluation of coordination, walking, and fine motor tasks involving the
hands.
 Tests such as the Hoehn and Yahr scale and the Unified Parkinson's Disease Rating Scale are used to measure
mental capacity, behavior, mood, daily living activities, and motor function. They can be very helpful in the
initial diagnosis, to rule out other disorders, as well as in monitoring the progression of the disease to make
therapeutic adjustments.
 Brain scans and other laboratory tests are also sometimes carried out, mostly to detect other disorders
resembling Parkinson's disease.
TREATMENT
There's currently no cure for Parkinson's disease, but treatments are available to help relieve the
symptoms and maintain your quality of life.
 Medication
Usually, affected individuals are given levodopa combined with carbidopa. Carbidopa delays the
conversion of levodopa into dopamine until it reaches the brain. Nerve cells can use levodopa to make
dopamine and replenish the brain's dwindling supply.
Other drugs, such as bromocriptine, pramipexole, and ropinirole, mimic the role of dopamine in the
brain, causing the neurons to react as they would to dopamine.
An antiviral drug, amantadine, also appears to reduce symptoms.
 Surgery
In some cases, surgery may be appropriate if the disease doesn't respond to drugs. Procedures such as
cryothalamotomy eliminate the area of the brain that produces tremors.
TREATMENT
 Physiotherapy
A physiotherapist can work with patient to relieve muscle stiffness and joint pain through movement
(manipulation) and exercise. The physiotherapist aims to make moving easier, and improve walking
and flexibility. They also try to improve fitness levels and ability to manage things for oneself.
 Occupational therapy
An occupational therapist can identify areas of difficulty in everyday life – for example, dressing or
getting to the local shops. They can help one work out practical solutions, and ensure home is safe
and properly set up. This will help maintain independence for as long as possible.
TREATMENT
 Speech and language therapy
Many people with Parkinson's disease have swallowing difficulties (dysphagia) and problems with their
speech. A speech and language therapist can often help improve these problems by teaching speaking
and swallowing exercises, or by providing assistive technology.
 Deep brain stimulation (DBS)
In DBS, electrodes are implanted into the brain and connected to a small electrical device called a pulse
generator that can be externally programmed. DBS can reduce the need for levodopa and related drugs,
which in turn decreases the involuntary movements called dyskinesias that are a common side effect of
levodopa. It also helps to alleviate fluctuations of symptoms and to reduce tremors, slowness of
movements, and gait problems.
REFERENCES
 http://www.pdf.org/about_pd
 http://www.ninds.nih.gov/disorders/parkinsons_disease/parkinsons_disease.htm
 http://www.movementdisorders.org/MDS/About/Movement-Disorder-Overviews/Parkinsons-
Disease--Parkinsonism.htm
 http://www.parkinson.org/understanding-parkinsons/10-early-warning-signs
 https://www.michaeljfox.org/understanding-parkinsons/living-with-pd/topic.php?causes
 http://www.pdf.org/en/genetics__parkinsons_gwinn
 https://www.genome.gov/10001217/learning-about-parkinsons-disease/
 https://www.michaeljfox.org/understanding-parkinsons/living-with-pd/topic.php?genetics
 http://www.nature.com/nrneurol/journal/v2/n3/full/ncpneuro0126.html
Parkinson disease

More Related Content

What's hot

Parkinson disease
Parkinson disease Parkinson disease
Parkinson disease Itsayesha
 
Parkinson's disease
Parkinson's diseaseParkinson's disease
Parkinson's diseaseHIRENGEHLOTH
 
Parkinsons Disease
Parkinsons DiseaseParkinsons Disease
Parkinsons Diseasetest
 
Parkinsons disease V Pharm.D
Parkinsons disease V Pharm.DParkinsons disease V Pharm.D
Parkinsons disease V Pharm.DDr.Sohel Memon
 
Parkinson’s disease
Parkinson’s diseaseParkinson’s disease
Parkinson’s diseaseRohan Deokar
 
Parkinson's Disease (PD)
Parkinson's Disease (PD)Parkinson's Disease (PD)
Parkinson's Disease (PD)Arwa M. Amin
 
Parkinsonism.ppt
Parkinsonism.pptParkinsonism.ppt
Parkinsonism.pptShama
 
pathophysiology of parkinsons disease
pathophysiology of  parkinsons disease pathophysiology of  parkinsons disease
pathophysiology of parkinsons disease Mirza Anwar Baig
 
Parkinson's disease
 Parkinson's disease Parkinson's disease
Parkinson's diseaseSunil Pahari
 
parkinsons disease recent updates
parkinsons disease recent updatesparkinsons disease recent updates
parkinsons disease recent updatesNeurologyKota
 
Parkinson's disease
Parkinson's diseaseParkinson's disease
Parkinson's diseaseraj kumar
 
Parkinsons Disease
Parkinsons DiseaseParkinsons Disease
Parkinsons Disease000 07
 
Parkinson's disease an overview
Parkinson's disease an overviewParkinson's disease an overview
Parkinson's disease an overviewMerqurio
 
Parkinson’S Disease
Parkinson’S DiseaseParkinson’S Disease
Parkinson’S Diseaseguest27ee33
 

What's hot (20)

Parkinson disease
Parkinson disease Parkinson disease
Parkinson disease
 
Parkinson's disease
Parkinson's diseaseParkinson's disease
Parkinson's disease
 
Parkinsons Disease
Parkinsons DiseaseParkinsons Disease
Parkinsons Disease
 
Parkinson's disease
Parkinson's diseaseParkinson's disease
Parkinson's disease
 
Parkinson's diseases
Parkinson's diseasesParkinson's diseases
Parkinson's diseases
 
Parkinsons disease V Pharm.D
Parkinsons disease V Pharm.DParkinsons disease V Pharm.D
Parkinsons disease V Pharm.D
 
Parkinson's disease by waheed javed
Parkinson's disease by waheed javedParkinson's disease by waheed javed
Parkinson's disease by waheed javed
 
Parkinson’s disease
Parkinson’s diseaseParkinson’s disease
Parkinson’s disease
 
Parkinson's Disease (PD)
Parkinson's Disease (PD)Parkinson's Disease (PD)
Parkinson's Disease (PD)
 
Parkinsonism.ppt
Parkinsonism.pptParkinsonism.ppt
Parkinsonism.ppt
 
pathophysiology of parkinsons disease
pathophysiology of  parkinsons disease pathophysiology of  parkinsons disease
pathophysiology of parkinsons disease
 
parkinson
parkinson parkinson
parkinson
 
Parkinson's disease
 Parkinson's disease Parkinson's disease
Parkinson's disease
 
parkinsons disease recent updates
parkinsons disease recent updatesparkinsons disease recent updates
parkinsons disease recent updates
 
Parkinson's disease
Parkinson's diseaseParkinson's disease
Parkinson's disease
 
Parkinsons Disease
Parkinsons DiseaseParkinsons Disease
Parkinsons Disease
 
Parkinson disease
Parkinson diseaseParkinson disease
Parkinson disease
 
Parkinson's Disease
Parkinson's DiseaseParkinson's Disease
Parkinson's Disease
 
Parkinson's disease an overview
Parkinson's disease an overviewParkinson's disease an overview
Parkinson's disease an overview
 
Parkinson’S Disease
Parkinson’S DiseaseParkinson’S Disease
Parkinson’S Disease
 

Similar to Parkinson disease

pksonsds-180320161607.pdf
pksonsds-180320161607.pdfpksonsds-180320161607.pdf
pksonsds-180320161607.pdfNatinderDhillon
 
PARKINSON’S DISEASE.pptx
PARKINSON’S DISEASE.pptxPARKINSON’S DISEASE.pptx
PARKINSON’S DISEASE.pptxAmeena Kadar
 
Document (3).docx
Document (3).docxDocument (3).docx
Document (3).docxSatendra35
 
Parkinson' disease
Parkinson' diseaseParkinson' disease
Parkinson' diseasealiciadiez
 
Parkinson’s: What Do We Know About the Disease and What Can Be Done About It?
Parkinson’s: What Do We Know About the Disease and What Can Be Done About It?Parkinson’s: What Do We Know About the Disease and What Can Be Done About It?
Parkinson’s: What Do We Know About the Disease and What Can Be Done About It?asclepiuspdfs
 
barkinson's disease
barkinson's diseasebarkinson's disease
barkinson's diseaseSadiiq Cabdi
 
PARKINSON'S DISEASE PATHOPHYSIOLOGY B.PHARM 2ND SEM.pptx
PARKINSON'S DISEASE PATHOPHYSIOLOGY B.PHARM 2ND SEM.pptxPARKINSON'S DISEASE PATHOPHYSIOLOGY B.PHARM 2ND SEM.pptx
PARKINSON'S DISEASE PATHOPHYSIOLOGY B.PHARM 2ND SEM.pptxsubham404717
 
Parkinson's Disease [Advanced Pharmacology]
Parkinson's Disease [Advanced Pharmacology]Parkinson's Disease [Advanced Pharmacology]
Parkinson's Disease [Advanced Pharmacology]Megh Vithalkar
 
Advances in Management of Parkinson's Disease
Advances in Management of Parkinson's DiseaseAdvances in Management of Parkinson's Disease
Advances in Management of Parkinson's DiseaseSultana Shaikh
 
Dissertation work ppt
Dissertation work pptDissertation work ppt
Dissertation work pptMandara V M
 
PARKINSONS PHARM PAPER
PARKINSONS PHARM PAPERPARKINSONS PHARM PAPER
PARKINSONS PHARM PAPERMary Cameron
 

Similar to Parkinson disease (20)

PARKINSON'S DISEASE.pptx
PARKINSON'S DISEASE.pptxPARKINSON'S DISEASE.pptx
PARKINSON'S DISEASE.pptx
 
pksonsds-180320161607.pdf
pksonsds-180320161607.pdfpksonsds-180320161607.pdf
pksonsds-180320161607.pdf
 
PARKINSON'S DISEASE
PARKINSON'S DISEASEPARKINSON'S DISEASE
PARKINSON'S DISEASE
 
Parkinson's disease
Parkinson's diseaseParkinson's disease
Parkinson's disease
 
Prakash park
Prakash parkPrakash park
Prakash park
 
PARKINSON’S DISEASE.pptx
PARKINSON’S DISEASE.pptxPARKINSON’S DISEASE.pptx
PARKINSON’S DISEASE.pptx
 
Neurodegeneration ppt
Neurodegeneration pptNeurodegeneration ppt
Neurodegeneration ppt
 
Document (3).docx
Document (3).docxDocument (3).docx
Document (3).docx
 
Parkinson' disease
Parkinson' diseaseParkinson' disease
Parkinson' disease
 
Parkinson’s: What Do We Know About the Disease and What Can Be Done About It?
Parkinson’s: What Do We Know About the Disease and What Can Be Done About It?Parkinson’s: What Do We Know About the Disease and What Can Be Done About It?
Parkinson’s: What Do We Know About the Disease and What Can Be Done About It?
 
barkinson's disease
barkinson's diseasebarkinson's disease
barkinson's disease
 
Parkinson
ParkinsonParkinson
Parkinson
 
Parkinson’s disease
Parkinson’s diseaseParkinson’s disease
Parkinson’s disease
 
Parkinson Disease
Parkinson DiseaseParkinson Disease
Parkinson Disease
 
PARKINSON'S DISEASE PATHOPHYSIOLOGY B.PHARM 2ND SEM.pptx
PARKINSON'S DISEASE PATHOPHYSIOLOGY B.PHARM 2ND SEM.pptxPARKINSON'S DISEASE PATHOPHYSIOLOGY B.PHARM 2ND SEM.pptx
PARKINSON'S DISEASE PATHOPHYSIOLOGY B.PHARM 2ND SEM.pptx
 
Parkinson's Disease [Advanced Pharmacology]
Parkinson's Disease [Advanced Pharmacology]Parkinson's Disease [Advanced Pharmacology]
Parkinson's Disease [Advanced Pharmacology]
 
Advances in Management of Parkinson's Disease
Advances in Management of Parkinson's DiseaseAdvances in Management of Parkinson's Disease
Advances in Management of Parkinson's Disease
 
Dissertation work ppt
Dissertation work pptDissertation work ppt
Dissertation work ppt
 
Parkinsons paper
Parkinsons paperParkinsons paper
Parkinsons paper
 
PARKINSONS PHARM PAPER
PARKINSONS PHARM PAPERPARKINSONS PHARM PAPER
PARKINSONS PHARM PAPER
 

More from Hemangi Narvekar

Psychological and Social Aspects of Adolescents' Life
Psychological and Social Aspects of Adolescents' LifePsychological and Social Aspects of Adolescents' Life
Psychological and Social Aspects of Adolescents' LifeHemangi Narvekar
 
Stress Management for Teachers
Stress Management for TeachersStress Management for Teachers
Stress Management for TeachersHemangi Narvekar
 
Ravens Progressive Matrices
Ravens Progressive MatricesRavens Progressive Matrices
Ravens Progressive MatricesHemangi Narvekar
 
How Play is affected in Children with Disabilities
How Play is affected in Children with DisabilitiesHow Play is affected in Children with Disabilities
How Play is affected in Children with DisabilitiesHemangi Narvekar
 
Using Play Therapy for Children
Using Play Therapy for ChildrenUsing Play Therapy for Children
Using Play Therapy for ChildrenHemangi Narvekar
 
Creativity & Innovation at Work
Creativity & Innovation at WorkCreativity & Innovation at Work
Creativity & Innovation at WorkHemangi Narvekar
 
The Social Psychological Theory by Karen Horney
The Social Psychological Theory by Karen HorneyThe Social Psychological Theory by Karen Horney
The Social Psychological Theory by Karen HorneyHemangi Narvekar
 
The Wechsler Adult Intelligence Scale (WAIS)
The Wechsler Adult Intelligence Scale (WAIS) The Wechsler Adult Intelligence Scale (WAIS)
The Wechsler Adult Intelligence Scale (WAIS) Hemangi Narvekar
 
The Diagnostic and Statistical Manual of Mental Disorders (DSM)
The Diagnostic and Statistical Manual of Mental Disorders (DSM)The Diagnostic and Statistical Manual of Mental Disorders (DSM)
The Diagnostic and Statistical Manual of Mental Disorders (DSM)Hemangi Narvekar
 
Classificatory systems - Advantages & Disadvantages
Classificatory systems - Advantages & DisadvantagesClassificatory systems - Advantages & Disadvantages
Classificatory systems - Advantages & DisadvantagesHemangi Narvekar
 

More from Hemangi Narvekar (17)

Psychological and Social Aspects of Adolescents' Life
Psychological and Social Aspects of Adolescents' LifePsychological and Social Aspects of Adolescents' Life
Psychological and Social Aspects of Adolescents' Life
 
Stress Management for Teachers
Stress Management for TeachersStress Management for Teachers
Stress Management for Teachers
 
Historical Research
Historical ResearchHistorical Research
Historical Research
 
Psychological Assessment
Psychological AssessmentPsychological Assessment
Psychological Assessment
 
Ravens Progressive Matrices
Ravens Progressive MatricesRavens Progressive Matrices
Ravens Progressive Matrices
 
Psychosocial Development
Psychosocial DevelopmentPsychosocial Development
Psychosocial Development
 
How Play is affected in Children with Disabilities
How Play is affected in Children with DisabilitiesHow Play is affected in Children with Disabilities
How Play is affected in Children with Disabilities
 
Using Play Therapy for Children
Using Play Therapy for ChildrenUsing Play Therapy for Children
Using Play Therapy for Children
 
Preparing for Amputation
Preparing for AmputationPreparing for Amputation
Preparing for Amputation
 
Dental Anxiety
Dental AnxietyDental Anxiety
Dental Anxiety
 
Creativity & Innovation at Work
Creativity & Innovation at WorkCreativity & Innovation at Work
Creativity & Innovation at Work
 
The Social Psychological Theory by Karen Horney
The Social Psychological Theory by Karen HorneyThe Social Psychological Theory by Karen Horney
The Social Psychological Theory by Karen Horney
 
The Wechsler Adult Intelligence Scale (WAIS)
The Wechsler Adult Intelligence Scale (WAIS) The Wechsler Adult Intelligence Scale (WAIS)
The Wechsler Adult Intelligence Scale (WAIS)
 
Disorders of Emotions
Disorders of EmotionsDisorders of Emotions
Disorders of Emotions
 
Brief Psychotherapy
Brief PsychotherapyBrief Psychotherapy
Brief Psychotherapy
 
The Diagnostic and Statistical Manual of Mental Disorders (DSM)
The Diagnostic and Statistical Manual of Mental Disorders (DSM)The Diagnostic and Statistical Manual of Mental Disorders (DSM)
The Diagnostic and Statistical Manual of Mental Disorders (DSM)
 
Classificatory systems - Advantages & Disadvantages
Classificatory systems - Advantages & DisadvantagesClassificatory systems - Advantages & Disadvantages
Classificatory systems - Advantages & Disadvantages
 

Recently uploaded

PULMONARY EDEMA AND ITS MANAGEMENT.pdf
PULMONARY EDEMA AND  ITS  MANAGEMENT.pdfPULMONARY EDEMA AND  ITS  MANAGEMENT.pdf
PULMONARY EDEMA AND ITS MANAGEMENT.pdfDolisha Warbi
 
call girls in paharganj DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in paharganj DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in paharganj DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in paharganj DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️saminamagar
 
Lippincott Microcards_ Microbiology Flash Cards-LWW (2015).pdf
Lippincott Microcards_ Microbiology Flash Cards-LWW (2015).pdfLippincott Microcards_ Microbiology Flash Cards-LWW (2015).pdf
Lippincott Microcards_ Microbiology Flash Cards-LWW (2015).pdfSreeja Cherukuru
 
call girls in aerocity DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in aerocity DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in aerocity DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in aerocity DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️saminamagar
 
Big Data Analysis Suggests COVID Vaccination Increases Excess Mortality Of ...
Big Data Analysis Suggests COVID  Vaccination Increases Excess Mortality Of  ...Big Data Analysis Suggests COVID  Vaccination Increases Excess Mortality Of  ...
Big Data Analysis Suggests COVID Vaccination Increases Excess Mortality Of ...sdateam0
 
POST NATAL EXERCISES AND ITS IMPACT.pptx
POST NATAL EXERCISES AND ITS IMPACT.pptxPOST NATAL EXERCISES AND ITS IMPACT.pptx
POST NATAL EXERCISES AND ITS IMPACT.pptxvirengeeta
 
See the 2,456 pharmacies on the National E-Pharmacy Platform
See the 2,456 pharmacies on the National E-Pharmacy PlatformSee the 2,456 pharmacies on the National E-Pharmacy Platform
See the 2,456 pharmacies on the National E-Pharmacy PlatformKweku Zurek
 
Let's Talk About It: To Disclose or Not to Disclose?
Let's Talk About It: To Disclose or Not to Disclose?Let's Talk About It: To Disclose or Not to Disclose?
Let's Talk About It: To Disclose or Not to Disclose?bkling
 
Pharmaceutical Marketting: Unit-5, Pricing
Pharmaceutical Marketting: Unit-5, PricingPharmaceutical Marketting: Unit-5, Pricing
Pharmaceutical Marketting: Unit-5, PricingArunagarwal328757
 
April 2024 ONCOLOGY CARTOON by DR KANHU CHARAN PATRO
April 2024 ONCOLOGY CARTOON by  DR KANHU CHARAN PATROApril 2024 ONCOLOGY CARTOON by  DR KANHU CHARAN PATRO
April 2024 ONCOLOGY CARTOON by DR KANHU CHARAN PATROKanhu Charan
 
Case Report Peripartum Cardiomyopathy.pptx
Case Report Peripartum Cardiomyopathy.pptxCase Report Peripartum Cardiomyopathy.pptx
Case Report Peripartum Cardiomyopathy.pptxNiranjan Chavan
 
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaurMETHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaurNavdeep Kaur
 
LUNG TUMORS AND ITS CLASSIFICATIONS.pdf
LUNG TUMORS AND ITS  CLASSIFICATIONS.pdfLUNG TUMORS AND ITS  CLASSIFICATIONS.pdf
LUNG TUMORS AND ITS CLASSIFICATIONS.pdfDolisha Warbi
 
Presentation on General Anesthetics pdf.
Presentation on General Anesthetics pdf.Presentation on General Anesthetics pdf.
Presentation on General Anesthetics pdf.Prerana Jadhav
 
97111 47426 Call Girls In Delhi MUNIRKAA
97111 47426 Call Girls In Delhi MUNIRKAA97111 47426 Call Girls In Delhi MUNIRKAA
97111 47426 Call Girls In Delhi MUNIRKAAjennyeacort
 
PERFECT BUT PAINFUL TKR -ROLE OF SYNOVECTOMY.pptx
PERFECT BUT PAINFUL TKR -ROLE OF SYNOVECTOMY.pptxPERFECT BUT PAINFUL TKR -ROLE OF SYNOVECTOMY.pptx
PERFECT BUT PAINFUL TKR -ROLE OF SYNOVECTOMY.pptxdrashraf369
 
call girls in munirka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in munirka  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in munirka  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in munirka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️saminamagar
 
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...Wessex Health Partners
 
epilepsy and status epilepticus for undergraduate.pptx
epilepsy and status epilepticus  for undergraduate.pptxepilepsy and status epilepticus  for undergraduate.pptx
epilepsy and status epilepticus for undergraduate.pptxMohamed Rizk Khodair
 
call girls in green park DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in green park  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in green park  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in green park DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️saminamagar
 

Recently uploaded (20)

PULMONARY EDEMA AND ITS MANAGEMENT.pdf
PULMONARY EDEMA AND  ITS  MANAGEMENT.pdfPULMONARY EDEMA AND  ITS  MANAGEMENT.pdf
PULMONARY EDEMA AND ITS MANAGEMENT.pdf
 
call girls in paharganj DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in paharganj DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in paharganj DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in paharganj DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
 
Lippincott Microcards_ Microbiology Flash Cards-LWW (2015).pdf
Lippincott Microcards_ Microbiology Flash Cards-LWW (2015).pdfLippincott Microcards_ Microbiology Flash Cards-LWW (2015).pdf
Lippincott Microcards_ Microbiology Flash Cards-LWW (2015).pdf
 
call girls in aerocity DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in aerocity DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in aerocity DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in aerocity DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
 
Big Data Analysis Suggests COVID Vaccination Increases Excess Mortality Of ...
Big Data Analysis Suggests COVID  Vaccination Increases Excess Mortality Of  ...Big Data Analysis Suggests COVID  Vaccination Increases Excess Mortality Of  ...
Big Data Analysis Suggests COVID Vaccination Increases Excess Mortality Of ...
 
POST NATAL EXERCISES AND ITS IMPACT.pptx
POST NATAL EXERCISES AND ITS IMPACT.pptxPOST NATAL EXERCISES AND ITS IMPACT.pptx
POST NATAL EXERCISES AND ITS IMPACT.pptx
 
See the 2,456 pharmacies on the National E-Pharmacy Platform
See the 2,456 pharmacies on the National E-Pharmacy PlatformSee the 2,456 pharmacies on the National E-Pharmacy Platform
See the 2,456 pharmacies on the National E-Pharmacy Platform
 
Let's Talk About It: To Disclose or Not to Disclose?
Let's Talk About It: To Disclose or Not to Disclose?Let's Talk About It: To Disclose or Not to Disclose?
Let's Talk About It: To Disclose or Not to Disclose?
 
Pharmaceutical Marketting: Unit-5, Pricing
Pharmaceutical Marketting: Unit-5, PricingPharmaceutical Marketting: Unit-5, Pricing
Pharmaceutical Marketting: Unit-5, Pricing
 
April 2024 ONCOLOGY CARTOON by DR KANHU CHARAN PATRO
April 2024 ONCOLOGY CARTOON by  DR KANHU CHARAN PATROApril 2024 ONCOLOGY CARTOON by  DR KANHU CHARAN PATRO
April 2024 ONCOLOGY CARTOON by DR KANHU CHARAN PATRO
 
Case Report Peripartum Cardiomyopathy.pptx
Case Report Peripartum Cardiomyopathy.pptxCase Report Peripartum Cardiomyopathy.pptx
Case Report Peripartum Cardiomyopathy.pptx
 
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaurMETHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
 
LUNG TUMORS AND ITS CLASSIFICATIONS.pdf
LUNG TUMORS AND ITS  CLASSIFICATIONS.pdfLUNG TUMORS AND ITS  CLASSIFICATIONS.pdf
LUNG TUMORS AND ITS CLASSIFICATIONS.pdf
 
Presentation on General Anesthetics pdf.
Presentation on General Anesthetics pdf.Presentation on General Anesthetics pdf.
Presentation on General Anesthetics pdf.
 
97111 47426 Call Girls In Delhi MUNIRKAA
97111 47426 Call Girls In Delhi MUNIRKAA97111 47426 Call Girls In Delhi MUNIRKAA
97111 47426 Call Girls In Delhi MUNIRKAA
 
PERFECT BUT PAINFUL TKR -ROLE OF SYNOVECTOMY.pptx
PERFECT BUT PAINFUL TKR -ROLE OF SYNOVECTOMY.pptxPERFECT BUT PAINFUL TKR -ROLE OF SYNOVECTOMY.pptx
PERFECT BUT PAINFUL TKR -ROLE OF SYNOVECTOMY.pptx
 
call girls in munirka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in munirka  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in munirka  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in munirka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
 
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...
 
epilepsy and status epilepticus for undergraduate.pptx
epilepsy and status epilepticus  for undergraduate.pptxepilepsy and status epilepticus  for undergraduate.pptx
epilepsy and status epilepticus for undergraduate.pptx
 
call girls in green park DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in green park  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in green park  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in green park DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
 

Parkinson disease

  • 1. Parkinson's Disease Ms. Hemangi Narvekar Clinical Psychologist National Institute for Empowerment of Persons with Multiple Disabilities (NIEPMD), Chennai
  • 2. CONTENTS  Introduction  Symptoms  Stages  Causes & Risk Factors  Treatment  Summary  References
  • 3. INTRODUCTION  Parkinson's disease (PD) is a chronic and progressive movement disorder, meaning that symptoms continue and worsen over time.  Parkinson's disease was first characterized extensively by an English doctor, James Parkinson, in 1817.  Described as early as 5000 B.C. in the Indian Ayurvedic medicinal tradition and in the Nei Jing, the first Chinese medical text 2500 years ago, Parkinson's disease is the second most common neurodegenerative disorder after Alzheimer disease.  Parkinson's disease itself is not fatal. However, complications from the disease are serious.
  • 4. SYMPTOMS Parkinson's disease symptoms and signs may vary from person to person. Early signs may be mild and may go unnoticed. The Primary Symptoms include:  Tremors - Trembling in fingers, hands, arms, feet, legs, jaw, or head. Tremors most often occur while the individual is resting, but not while involved in a task.  Rigidity - Stiffness of the limbs and trunk, which may increase during movement. Rigidity may produce muscle aches and pain.
  • 5. SYMPTOMS  Bradykinesia - Slowness of voluntary movement. Over time, it may become difficult to initiate movement and to complete movement.  Postural instability - Impaired or lost reflexes can make it difficult to adjust posture to maintain balance. Postural instability may lead to falls.  Parkinsonian gait - Individuals with more progressive Parkinson's disease develop a distinctive shuffling walk with a stooped position and a diminished or absent arm swing.
  • 6. SYMPTOMS Some of the secondary symptoms include:  Anxiety, insecurity, and stress  Confusion, memory loss, and dementia  Constipation  Change in handwriting  Depression  Difficulty swallowing and excessive salivation  Diminished sense of smell  Increased sweating  Male erectile dysfunction  Skin problems  Slowed, quieter speech, and monotone voice  Urinary frequency/urgency
  • 7. STAGES OF PARKINSON’S DISEASE  Stage 1: During this initial stage, the person has mild symptoms that generally do not interfere with daily activities. Tremor and other movement symptoms occur on one side of the body only. Friends and family may notice changes in posture, walking and facial expressions.  Stage 2: In stage two of Parkinson’s, the symptoms start getting worse. Tremor, rigidity and other movement symptoms affect both sides of the body. Walking problems and poor posture may become apparent. In this stage, the person is still able to live alone, but completing day-to-day tasks becomes more difficult and may take longer.
  • 8. STAGES OF PARKINSON’S DISEASE  Stage 3: Stage three is considered mid-stage in the progression of the disease. Loss of balance and slowness of movements are hallmarks of this phase. Falls are more common. Though the person is still fully independent, symptoms significantly impair activities of daily living such as dressing and eating.  Stage 4: During this stage of Parkinson’s, symptoms are severe and very limiting. It’s possible to stand without assistance, but movement may require a walker. The person needs help with activities of daily living and is unable to live alone.  Stage 5: This is the most advanced and debilitating stage of Parkinson’s disease. Stiffness in the legs may make it impossible to stand or walk. The person requires a wheelchair or is bedridden. Around-the-clock nursing care is required for all activities. The person may experience hallucinations and delusions.
  • 10. CAUSES  Parkinson's disease results from the loss of cells in various parts of the brain, including a region called the substantia nigra.  The substantia nigra cells produce dopamine, a chemical messenger responsible for transmitting signals within the brain that allow for coordination of movement.  The substantia nigra contains neuronomelanin, pigment cells, which synapse to cells of the striatum.  The striatum is responsible for balance, control of movements, and walking.  Dopamine, produced in the substantia nigra, passes messages between the striatum and the substantia nigra.  When the cells of the substantia nigra deteriorate there is a corresponding decrease in the amount of dopamine produced between these cells.  Loss of dopamine causes neurons to fire without normal control, leaving patients less able to direct or control their movement.
  • 11. CAUSES  When approximately 60 to 80% of the dopamine-producing cells are damaged, and do not produce enough dopamine, the motor symptoms of Parkinson's disease appear.  The intestines also have dopamine cells that degenerate in Parkinson’s, and this may be important in the gastrointestinal symptoms that are part of the disease.  When the level of dopamine decreases, another neurotransmitter, acetylcholine, is also adversely affected.  The motor function of the striatum is also dependent on the equilibrium reached between dopamine and acetylcholine. This disrupted balance of neurotransmitters contributes to disease progression.  It's not known why the loss of nerve cells associated with Parkinson's disease occurs, although research is ongoing to identify potential causes.  Currently, it's believed a combination of genetic changes and environmental factors may be responsible for the condition.
  • 12.
  • 13.
  • 14.
  • 15. CAUSES  Approximately 15 percent of people with Parkinson disease have a family history of this disorder.  Some gene mutations appear to disturb the cell machinery that breaks down (degrades) unwanted proteins in dopamine-producing neurons.  As a result, undegraded proteins accumulate, leading to the impairment or death of these cells.  Other mutations may affect the function of mitochondria, the energy-producing structures within cells.  As a byproduct of energy production, mitochondria make unstable molecules called free radicals that can damage cells.  Cells normally counteract the effects of free radicals before they cause damage, but mutations can disrupt this process.  As a result, free radicals may accumulate and impair or kill dopamine-producing neurons.
  • 16. CAUSES  So far, five genes have been identified that are definitively associated with Parkinson's disease. 1. SNCA (Alpha-synuclein): SNCA makes the protein alpha-synuclein. In brain cells of individuals with Parkinson's disease, this protein aggregates in clumps called Lewy bodies. Mutations in the SNCA gene are found in early-onset Parkinson's disease. 2. PARK2 (Parkin / E3 ubiquitin protein ligase parkin): The PARK2 gene makes the protein parkin. Parkin normally helps cells break down and recycle proteins. 3. PARK7 (Protein DJ1): PARK7 mutations are found in early-onset Parkinson's disease. The PARK7 gene makes the DJ-1 protein, which may protect cells from oxidative stress.
  • 17. CAUSES 4. PINK1 (PTEN-induced putative kinase 1): Mutations of this gene are found in early-onset Parkinson's disease. It protect structures within the cell called mitochondria from stress. 5. LRRK2 (Leucine-rich repeat kinase 2): LRRK2 makes the protein dardarin. It transmits various signals to control cell activities. Mutations in the LRRK2 gene have been linked to late- onset Parkinson's disease. 6. EIF4G1 (Eukaryotic translation initiation factor 4 gamma 1): It organizes a group of proteins involved in translating pre-prepared genes into proteins. 7. VPS35 (Vacuolar protein sorting-associated protein 35): It’s one of a group of proteins that selects proteins for recycling.
  • 18.
  • 19. CAUSES  Among familial cases of Parkinson disease, the inheritance pattern differs depending on the gene that is altered. If the LRRK2 or SNCA gene is involved, the disorder is inherited in an autosomal dominant pattern, which means one copy of an altered gene in each cell is sufficient to cause the disorder. In most cases, an affected person has one parent with the condition.  If the PARK2, PARK7, or PINK1 gene is involved, Parkinson disease is inherited in an autosomal recessive pattern. This type of inheritance means that two copies of the gene in each cell are altered. Most often, the parents of an individual with autosomal recessive Parkinson disease each carry one copy of the altered gene but do not show signs and symptoms of the disorder.
  • 20. RISK FACTORS  Risk factors for Parkinson's disease include: 1. Age - Young adults rarely experience Parkinson's disease. It ordinarily begins in middle or late life, and the risk increases with age. People usually develop the disease around age 60 or older. 2. Sex - Men are more likely to develop Parkinson's disease than are women. 3. Exposure to toxins - Ongoing exposure to herbicides and pesticides may put one at a slightly increased risk of Parkinson's disease. Some studies have demonstrated that prolonged occupational exposure to certain chemicals is associated with an elevated risk of PD. These include the insecticides permethrin and beta-hexachlorocyclohexane (beta-HCH), the herbicides paraquat and 2,4-dichlorophenoxyacetic acid and the fungicide maneb. 4. Stress
  • 21. DIAGNOSIS  There are currently no blood or laboratory tests that have been proven to help in diagnosing PD.  A neurologist who specializes in movement disorders will be able to make the most accurate diagnosis. An initial assessment is made based on medical history, a neurological exam, and the symptoms present.  For the medical history, it is important to know whether other family members have Parkinson's disease, what types of medication have been or are being taken, and whether there was exposure to toxins or repeated head trauma in the past.  A neurological exam may include an evaluation of coordination, walking, and fine motor tasks involving the hands.  Tests such as the Hoehn and Yahr scale and the Unified Parkinson's Disease Rating Scale are used to measure mental capacity, behavior, mood, daily living activities, and motor function. They can be very helpful in the initial diagnosis, to rule out other disorders, as well as in monitoring the progression of the disease to make therapeutic adjustments.  Brain scans and other laboratory tests are also sometimes carried out, mostly to detect other disorders resembling Parkinson's disease.
  • 22. TREATMENT There's currently no cure for Parkinson's disease, but treatments are available to help relieve the symptoms and maintain your quality of life.  Medication Usually, affected individuals are given levodopa combined with carbidopa. Carbidopa delays the conversion of levodopa into dopamine until it reaches the brain. Nerve cells can use levodopa to make dopamine and replenish the brain's dwindling supply. Other drugs, such as bromocriptine, pramipexole, and ropinirole, mimic the role of dopamine in the brain, causing the neurons to react as they would to dopamine. An antiviral drug, amantadine, also appears to reduce symptoms.  Surgery In some cases, surgery may be appropriate if the disease doesn't respond to drugs. Procedures such as cryothalamotomy eliminate the area of the brain that produces tremors.
  • 23. TREATMENT  Physiotherapy A physiotherapist can work with patient to relieve muscle stiffness and joint pain through movement (manipulation) and exercise. The physiotherapist aims to make moving easier, and improve walking and flexibility. They also try to improve fitness levels and ability to manage things for oneself.  Occupational therapy An occupational therapist can identify areas of difficulty in everyday life – for example, dressing or getting to the local shops. They can help one work out practical solutions, and ensure home is safe and properly set up. This will help maintain independence for as long as possible.
  • 24. TREATMENT  Speech and language therapy Many people with Parkinson's disease have swallowing difficulties (dysphagia) and problems with their speech. A speech and language therapist can often help improve these problems by teaching speaking and swallowing exercises, or by providing assistive technology.  Deep brain stimulation (DBS) In DBS, electrodes are implanted into the brain and connected to a small electrical device called a pulse generator that can be externally programmed. DBS can reduce the need for levodopa and related drugs, which in turn decreases the involuntary movements called dyskinesias that are a common side effect of levodopa. It also helps to alleviate fluctuations of symptoms and to reduce tremors, slowness of movements, and gait problems.
  • 25.
  • 26. REFERENCES  http://www.pdf.org/about_pd  http://www.ninds.nih.gov/disorders/parkinsons_disease/parkinsons_disease.htm  http://www.movementdisorders.org/MDS/About/Movement-Disorder-Overviews/Parkinsons- Disease--Parkinsonism.htm  http://www.parkinson.org/understanding-parkinsons/10-early-warning-signs  https://www.michaeljfox.org/understanding-parkinsons/living-with-pd/topic.php?causes  http://www.pdf.org/en/genetics__parkinsons_gwinn  https://www.genome.gov/10001217/learning-about-parkinsons-disease/  https://www.michaeljfox.org/understanding-parkinsons/living-with-pd/topic.php?genetics  http://www.nature.com/nrneurol/journal/v2/n3/full/ncpneuro0126.html