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ROHAN DEOKAR
 DEFINITION 
 OUTLINE 
 STAGES 
 SYMPTOMS 
 CAUSES 
 EVALUATION 
 PROGRESSION 
 PATHOLOGY 
 PATHOPHYSIOLOGY 
 MANAGEMENT 
 TREATMENT 
OPTIONS 
 PROGNOSIS 
 SIDE EFFECTS 
 HISTORY 
 NOTABLE CASES 
 RESEARCH 
 SUMMARY
 Parkinson’s Disease can be defined as 
a progressive disease of the brain and 
nervous system which is marked by 
tremors, muscular rigidity, and slow, 
imprecise movements. 
 Movement is normally controlled by 
dopamine, a chemical that carries 
signals between the nerves in the 
brain. 
 When up to 90% of the cells producing 
dopamine die, the symptoms of 
Parkinson’s appear. 
 The disease is named after the English 
doctor James Parkinson.
 Parkinson’s is a neurogenerative disorder that 
impairs motor movement due to the loss of 
dopaminergic neurons. It occurs mainly in elders 
over the age of 60. 
 This neurogeneration is due to genetic as well as 
environmental factors, such as toxins and drugs. 
 Main symptoms are MIST-Muscular rigidity, Impaired 
balance, Slow/Stiff and Tremors. 
 There is no cure. Treatment targets the alleviation of 
symptoms only. 
 Non-pharmacological therapy includes speech, 
occupational, physical therapy. 
 Pharmacological treatment includes dopamine
STAGES OF PARKINSON'S DISEASE 
Parkinson's disease is described as early, moderate, or advanced. 
 Early disease describes the stage when a person has a mild tremor 
or stiffness but is able to continue normal daily activities. This refers 
to a person who has been newly diagnosed. 
 Moderate disease describes the stage when a person begins to 
experience limited movement. A person with moderate Parkinson's 
disease may have a mild to moderate tremor with slow movement. 
 Advanced disease describes the stage when a person is 
significantly limited in his or her activity, despite treatment. Daily 
changes in symptoms, medicine side effects that limit treatment, 
and loss of independence in activities of daily living are common. 
Parkinson's disease may also be described by five stages: 
 Stage I: Symptoms affect only one side of the body. 
 Stage II: Both sides of the body are affected, but posture remains 
normal. 
 Stage III: Both sides of the body are affected, and there is mild 
imbalance during standing or walking. But the person remains 
independent. 
 Stage IV: Both sides of the body are affected, and there is disabling 
instability while standing or walking. The person in this stage 
requires substantial help.
 Soft speech 
 Small handwriting 
 Muscle pain 
 Stooped posture 
 Lack of facial 
expression 
 Stooping 
 Slowed activity
 Constipation 
 Fatigue 
 Dizziness 
 Depression 
 Memory problems 
 Bladder urgency and frequency 
 Increased sweating
 Results from the loss of 
dopaminergic neurons of 
the basal ganglia 
 As with most brain tissue, 
the neurons atrophy with 
age. 
 This results in increased 
difficulty in initiating 
movements. 
 Imbalance primarily 
between excitatory 
neurotransmitter 
acetylcholine, and 
inhibitory 
neurotransmitter 
Dopamine in the basal
 The severity of Parkinson’s is 
rated by trained observers on 
a scale of 0(normal) to 17 
(severe) which includes- 
 Movement 
 Attention and Blinking 
 posture 
 Balance and Coordination 
 Reactions 
 Vocalizations
 Currently, there is no cure. 
 progresses at different rates for each person. 
 Medications need to be adjusted as symptoms 
change. 
 May progress more quickly in elder people. 
 May progress slowly when main symptom is 
tremors. 
 Parkinson’s is not a mental disease, although 
30% will eventually develop dementia.
 Anatomical 
 The basal ganglia innervated by the 
dopaminergic system, are the most 
seriously affected brain areas in PD. 
The main pathological characteristic 
of PD is cell death in the substantia 
nigra. 
 Macroscopic alterations can be 
noticed on cut surfaces of the 
brainstem, where neuronal loss can 
be inferred .The histopathology of 
the substantia nigra and several 
other brain regions shows neuron 
loss and Lewy bodies in many of the 
remaining nerve cells. 
 Neuronal loss is accompanied by 
death of astrocytes and activation of 
the microglia. Lewy bodies are a key 
pathological feature of PD.
 Brain cell death 
 There is speculation of several mechanisms by which 
the brain cells could be lost. 
 Lewy bodies first appear in the olfactory lobe and 
medulla with individuals at this stage being 
asymptomatic. As the disease progresses, Lewy bodies 
later develop in the substantia nigra, areas of 
the midbrain and basal forebrain. These brain sites are 
the main places of neuronal degeneration in PD; 
however, Lewy bodies may not cause cell death and 
they may be protective. 
 In patients with dementia, a generalized presence of 
Lewy bodies is common in cortical areas. 
 Other cell-death mechanisms include lysosomal system 
dysfunction and reduced mitochondrial activity. It may 
be related to oxidative stress and neuronal death.
 There is no cure for Parkinson's disease, but 
medications, surgery and multidisciplinary 
management can provide relief from the symptoms. 
 The main families of drugs useful for treating motor 
symptoms are levodopa, dopamine agonists 
and MAO-B inhibitors. 
 The stage of the disease determines which group is 
most useful. Two stages are usually distinguished: an 
initial stage in which the individual with PD has 
already developed some disability for which he 
needs pharmacological treatment, and a second 
stage in which an individual develops motor 
complications related to levodopa usage. 
 Treatment in the initial stage aims for an optimal 
tradeoff between good symptom control and side-effects 
resulting from enhancement of dopaminergic
 Drug therapy is only for symptom 
management, only to slow the 
progression of the disease. 
 Physical therapy helps mobility, 
flexibility and balance. 
 Occupational therapy helps with 
daily routine. 
 Speech therapy helps with voice 
control. 
 Dopamine agonists directly 
stimulate dopamine receptors. 
Used for a relatively young patient. 
 Dopamine replacement therapy. 
 Anticholinergics block increased 
acetylcholine effects. 
 Surgery deep brain stimulation for 
severe disabling dyskinesias.
 Treating PD by surgery was 
a common practice before 
the introduction of 
Levodopa, and is done by 
deep brain stimulation or 
implanting brain 
pacemaker. 
 Dopamine agonists are 
used which reduce the 
symptoms and reduce the 
death of brain cells.
 Regular physical exercise can 
be beneficial to maintain and 
improve mobility, flexibility, 
strength, gait speed, and 
quality of life. 
 Muscles and nerves that 
control the digestive process 
may be affected by PD, 
resulting in constipation. 
 A balanced diet is 
recommended to avoid weight 
loss or gain and minimize 
consequences of GI 
dysfunction.
 PD invariably progresses with time. 
 Motor symptoms, if not treated, advance aggressively in the 
early stages of the disease and more slowly later. 
Untreated, individuals are expected to lose 
independent ambulation after an average of eight years and 
be bedridden after ten years. 
 As the disease advances, disability is more related to motor 
symptoms, such as swallowing/speech difficulties, and 
gait/balance problems; and also to motor complications. 
 The life expectancy of people with PD is reduced. Mortality 
ratios are around twice those of unaffected people. 
 Cognitive decline and dementia, old age at onset, a more 
advanced disease state and presence of swallowing 
problems are all mortality risk factors.
 L-Dopa is effective in elimination of symptoms 
of Parkinson’s, but is less effective in treating 
gait and postural instability. 
 It increases patient sense of well-being. 
 Can lead to cardiovascular problems like 
tachycardia or hypertension. 
 It can also induce psychosis, delusions, etc.
 In 1817 an English doctor, James Parkinson, 
published his essay An Essay on the Shaking 
Palsy describing the characteristic resting tremor, 
abnormal posture and gait, paralysis and diminished 
muscle strength, and the progression over time. 
 Jean-Martin Charcot made the distinction between 
rigidity, weakness and bradykinesia. 
 In 1912,Frederick Lewy described microscopic 
particles in affected brains, later named “Lewy bodies 
“. 
 In 1919, Konstantin Tretiakoff reported the substantia 
nigra as the main cerebral structure affected. 
 Levodopa was first synthesized in 1911 by Casimir 
Funk but it entered clinical practice in 1967. 
 By the late 1980s deep brain stimulation emerged as 
a possible treatment.
 The costs of PD to society are high, 
but precise calculations are difficult 
due to methodological issues in 
research and differences between 
countries. 
 In addition to economic costs, PD 
reduces quality of life of those with the 
disease and their caregivers. 
 April 11, the birthday of James 
Parkinson, has been designated as 
Parkinson's disease day. 
 A red tulip was chosen by international 
organizations as the symbol of the 
disease in 2005. 
 Advocacy organizations include the 
National Parkinson’s Foundation and 
Parkinson’s Disease Foundation.
 Actor Michael Fox has greatly 
increased the public 
awareness of the disease. 
Fox was diagnosed at 30. 
 Cyclist and Olympic 
medalist Davis Phinney, was 
diagnosed with young onset 
Parkinson's at 40. 
 Muhammad Ali has been 
called the "world's most 
famous Parkinson's patient. 
 Other notable cases are 
Yasser Arafat and Pope John 
Paul II.
 There is little prospect of dramatic new 
PD treatments expected in a short time 
frame. 
 Currently active research directions 
include the search for new animal 
models of the disease and studies of the 
potential usefulness of gene 
therapy, stem cells transplants 
and neuroprotective agents. 
 Investigations on neuroprotection are at 
the forefront of PD research. Several 
molecules have been proposed as 
potential treatments . However, none of 
them have been conclusively 
demonstrated to reduce degeneration.
 1-2% of general population are the sufferers. 
 Occur due to imbalance in neurotransmitters 
 Muscular rigidity, Impaired balance, Slow/Stiff 
and Tremors are main symptoms. 
 Levodopa and other dopaminergic drugs are 
used. 
 No treatment possible, only reduction of 
symptoms.
Parkinson’s disease

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Parkinson’s disease

  • 2.  DEFINITION  OUTLINE  STAGES  SYMPTOMS  CAUSES  EVALUATION  PROGRESSION  PATHOLOGY  PATHOPHYSIOLOGY  MANAGEMENT  TREATMENT OPTIONS  PROGNOSIS  SIDE EFFECTS  HISTORY  NOTABLE CASES  RESEARCH  SUMMARY
  • 3.  Parkinson’s Disease can be defined as a progressive disease of the brain and nervous system which is marked by tremors, muscular rigidity, and slow, imprecise movements.  Movement is normally controlled by dopamine, a chemical that carries signals between the nerves in the brain.  When up to 90% of the cells producing dopamine die, the symptoms of Parkinson’s appear.  The disease is named after the English doctor James Parkinson.
  • 4.  Parkinson’s is a neurogenerative disorder that impairs motor movement due to the loss of dopaminergic neurons. It occurs mainly in elders over the age of 60.  This neurogeneration is due to genetic as well as environmental factors, such as toxins and drugs.  Main symptoms are MIST-Muscular rigidity, Impaired balance, Slow/Stiff and Tremors.  There is no cure. Treatment targets the alleviation of symptoms only.  Non-pharmacological therapy includes speech, occupational, physical therapy.  Pharmacological treatment includes dopamine
  • 5. STAGES OF PARKINSON'S DISEASE Parkinson's disease is described as early, moderate, or advanced.  Early disease describes the stage when a person has a mild tremor or stiffness but is able to continue normal daily activities. This refers to a person who has been newly diagnosed.  Moderate disease describes the stage when a person begins to experience limited movement. A person with moderate Parkinson's disease may have a mild to moderate tremor with slow movement.  Advanced disease describes the stage when a person is significantly limited in his or her activity, despite treatment. Daily changes in symptoms, medicine side effects that limit treatment, and loss of independence in activities of daily living are common. Parkinson's disease may also be described by five stages:  Stage I: Symptoms affect only one side of the body.  Stage II: Both sides of the body are affected, but posture remains normal.  Stage III: Both sides of the body are affected, and there is mild imbalance during standing or walking. But the person remains independent.  Stage IV: Both sides of the body are affected, and there is disabling instability while standing or walking. The person in this stage requires substantial help.
  • 6.  Soft speech  Small handwriting  Muscle pain  Stooped posture  Lack of facial expression  Stooping  Slowed activity
  • 7.  Constipation  Fatigue  Dizziness  Depression  Memory problems  Bladder urgency and frequency  Increased sweating
  • 8.  Results from the loss of dopaminergic neurons of the basal ganglia  As with most brain tissue, the neurons atrophy with age.  This results in increased difficulty in initiating movements.  Imbalance primarily between excitatory neurotransmitter acetylcholine, and inhibitory neurotransmitter Dopamine in the basal
  • 9.  The severity of Parkinson’s is rated by trained observers on a scale of 0(normal) to 17 (severe) which includes-  Movement  Attention and Blinking  posture  Balance and Coordination  Reactions  Vocalizations
  • 10.  Currently, there is no cure.  progresses at different rates for each person.  Medications need to be adjusted as symptoms change.  May progress more quickly in elder people.  May progress slowly when main symptom is tremors.  Parkinson’s is not a mental disease, although 30% will eventually develop dementia.
  • 11.  Anatomical  The basal ganglia innervated by the dopaminergic system, are the most seriously affected brain areas in PD. The main pathological characteristic of PD is cell death in the substantia nigra.  Macroscopic alterations can be noticed on cut surfaces of the brainstem, where neuronal loss can be inferred .The histopathology of the substantia nigra and several other brain regions shows neuron loss and Lewy bodies in many of the remaining nerve cells.  Neuronal loss is accompanied by death of astrocytes and activation of the microglia. Lewy bodies are a key pathological feature of PD.
  • 12.  Brain cell death  There is speculation of several mechanisms by which the brain cells could be lost.  Lewy bodies first appear in the olfactory lobe and medulla with individuals at this stage being asymptomatic. As the disease progresses, Lewy bodies later develop in the substantia nigra, areas of the midbrain and basal forebrain. These brain sites are the main places of neuronal degeneration in PD; however, Lewy bodies may not cause cell death and they may be protective.  In patients with dementia, a generalized presence of Lewy bodies is common in cortical areas.  Other cell-death mechanisms include lysosomal system dysfunction and reduced mitochondrial activity. It may be related to oxidative stress and neuronal death.
  • 13.  There is no cure for Parkinson's disease, but medications, surgery and multidisciplinary management can provide relief from the symptoms.  The main families of drugs useful for treating motor symptoms are levodopa, dopamine agonists and MAO-B inhibitors.  The stage of the disease determines which group is most useful. Two stages are usually distinguished: an initial stage in which the individual with PD has already developed some disability for which he needs pharmacological treatment, and a second stage in which an individual develops motor complications related to levodopa usage.  Treatment in the initial stage aims for an optimal tradeoff between good symptom control and side-effects resulting from enhancement of dopaminergic
  • 14.  Drug therapy is only for symptom management, only to slow the progression of the disease.  Physical therapy helps mobility, flexibility and balance.  Occupational therapy helps with daily routine.  Speech therapy helps with voice control.  Dopamine agonists directly stimulate dopamine receptors. Used for a relatively young patient.  Dopamine replacement therapy.  Anticholinergics block increased acetylcholine effects.  Surgery deep brain stimulation for severe disabling dyskinesias.
  • 15.  Treating PD by surgery was a common practice before the introduction of Levodopa, and is done by deep brain stimulation or implanting brain pacemaker.  Dopamine agonists are used which reduce the symptoms and reduce the death of brain cells.
  • 16.  Regular physical exercise can be beneficial to maintain and improve mobility, flexibility, strength, gait speed, and quality of life.  Muscles and nerves that control the digestive process may be affected by PD, resulting in constipation.  A balanced diet is recommended to avoid weight loss or gain and minimize consequences of GI dysfunction.
  • 17.  PD invariably progresses with time.  Motor symptoms, if not treated, advance aggressively in the early stages of the disease and more slowly later. Untreated, individuals are expected to lose independent ambulation after an average of eight years and be bedridden after ten years.  As the disease advances, disability is more related to motor symptoms, such as swallowing/speech difficulties, and gait/balance problems; and also to motor complications.  The life expectancy of people with PD is reduced. Mortality ratios are around twice those of unaffected people.  Cognitive decline and dementia, old age at onset, a more advanced disease state and presence of swallowing problems are all mortality risk factors.
  • 18.  L-Dopa is effective in elimination of symptoms of Parkinson’s, but is less effective in treating gait and postural instability.  It increases patient sense of well-being.  Can lead to cardiovascular problems like tachycardia or hypertension.  It can also induce psychosis, delusions, etc.
  • 19.  In 1817 an English doctor, James Parkinson, published his essay An Essay on the Shaking Palsy describing the characteristic resting tremor, abnormal posture and gait, paralysis and diminished muscle strength, and the progression over time.  Jean-Martin Charcot made the distinction between rigidity, weakness and bradykinesia.  In 1912,Frederick Lewy described microscopic particles in affected brains, later named “Lewy bodies “.  In 1919, Konstantin Tretiakoff reported the substantia nigra as the main cerebral structure affected.  Levodopa was first synthesized in 1911 by Casimir Funk but it entered clinical practice in 1967.  By the late 1980s deep brain stimulation emerged as a possible treatment.
  • 20.  The costs of PD to society are high, but precise calculations are difficult due to methodological issues in research and differences between countries.  In addition to economic costs, PD reduces quality of life of those with the disease and their caregivers.  April 11, the birthday of James Parkinson, has been designated as Parkinson's disease day.  A red tulip was chosen by international organizations as the symbol of the disease in 2005.  Advocacy organizations include the National Parkinson’s Foundation and Parkinson’s Disease Foundation.
  • 21.  Actor Michael Fox has greatly increased the public awareness of the disease. Fox was diagnosed at 30.  Cyclist and Olympic medalist Davis Phinney, was diagnosed with young onset Parkinson's at 40.  Muhammad Ali has been called the "world's most famous Parkinson's patient.  Other notable cases are Yasser Arafat and Pope John Paul II.
  • 22.  There is little prospect of dramatic new PD treatments expected in a short time frame.  Currently active research directions include the search for new animal models of the disease and studies of the potential usefulness of gene therapy, stem cells transplants and neuroprotective agents.  Investigations on neuroprotection are at the forefront of PD research. Several molecules have been proposed as potential treatments . However, none of them have been conclusively demonstrated to reduce degeneration.
  • 23.  1-2% of general population are the sufferers.  Occur due to imbalance in neurotransmitters  Muscular rigidity, Impaired balance, Slow/Stiff and Tremors are main symptoms.  Levodopa and other dopaminergic drugs are used.  No treatment possible, only reduction of symptoms.