Parkinsons 1

Joshua Barrows

Dr. Patricia Visser

BIO 254

28 April 2015

Parkinsons Disease

Parkinsons Disease (PD) is a slowly progressive, degenerative

movement disorder that has distinct characteristics such as tremors,

bradykinesia, stiffness of the extremities and unstable posture. The

cause of this disease is still very unknown, meaning there are no lab

tests to diagnose a patient with PD, and most of the diagnosis comes

from clinical evaluation. What is understood about Parkinsons disease

is that the death of vital nerve cells in the brain affects the way

dopamine is produced. Dopamine is a chemical that sends signals to

the area of the brain that is involved with movement and coordination.

The more PD progresses in a person, the less dopamine is produced,

resulting in less control of movement. The mean age of onset

Parkinsons is about 57 years old and has been found to be more

common in men than women. All together, we will focus on a few

topics about Parkinsons disease to help better understand it. These

will include the normal anatomy of the affected area of the body, cause

and resulting abnormal anatomy of the affected area of the body,

diagnosis of PD, possible treatments and recovery prognosis, and any

relevant non-scientific related topics to Parkinsons.

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In order to fully understand Parkinsons we must first look at the

normal Anatomy and Physiology of the area being affected by this

disease. The body communicates through electrical signals and

impulses sent by the nervous system. A neuron is the basic part of the

nervous system and is what helps send and receive signals in order to

do activities such as move your hands and legs and speak. The normal

anatomy of a nervous system cell consists of a cell body or soma,

dendrite, axon, and axon termini. The dendrite of the cell is where

sensory input information is received. This information will travel

through the cell body, down the axon and to the effector (what is being

signaled). There is a space between the axon of one cell and the

dendrites of another cell called the synapse. This is the area where

neurotransmitters such as dopamine are released and allow signals to

cross the gap by attaching themselves to special receptors on the

other side of the synapse. The specific parts of the brain that

Parkinsons disease affects are called the basal ganglia and substantia

nigra. These both follow the same concepts above on how signals are

sent through the body. Nerve cells in the substantia nigra produce

dopamine and also relay messages for body movement. The complex

connected nerve cells of the basal ganglia are also responsible for

sending signals that control body movement and work with the

substantia nigra to send signals through the central nervous system.

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When everything is working properly, and dopamine is being produced

at normal levels, body movement is carried out well.

Now that the normal anatomy and physiology of the nerve cells

is understood and how they are related to the way the basal ganglia

and substantia nigra produce dopamine and help control body

movement, the abnormal anatomy that causes Parkinsons can also be

better understood. PD has a direct affect on the basal ganglia and

substantia nigra, but because the process that affects these cells is not

fully understood, scientists arent completely sure as to why this

happens in individuals. For some unknown reason, the dopamine

producing substantia nigra cells will begin to die off. This causes the

dopamine to stop being produced, and PD symptoms begin to kick in

when about 80% of the dopamine is lost. Without the proper amount of

dopamine being produced, a portion of the basal ganglia called the

striatum cannot correctly stimulate its receptors. This means that the

nerve cells cant send signals from the brain down to the spinal cord for

correct body movement and muscle control. The lack of dopamine

being produced has a direct effect on the way the basal ganglia works

and can cause both over stimulation resulting in tremors, or under

stimulation resulting in rigidness and lack of mobility in certain areas of

the body.

The lack of knowledge about Parkinsons makes it difficult to test

for, but there are proper diagnostic techniques that can help indicate
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PD. Most of the diagnosis is clinical evaluation using different exams to

monitor motor symptoms, as well as an extensive medical background

review. Symptoms that are suspected to be from Parkinsons disease

during a physical exam would be resting tremors, decreased mobility,

and rigidness. The decreased mobility has to be ruled out from many

other PD like disorders. Other signs that can help support the diagnosis

of Parkinsons are infrequent blinking and lack of facial expressions.

Once again however, these symptoms will have to be ruled out from

other known causes such as depression. Another technique that is

used, and has a higher rate of distinguishing PD from other conditions

is the use of levodopa. This is a medication that is used to help

manage the disease. A person with Parkinsons would have a much

larger response to the medication than somebody with a different

condition.

Several treatments are used to help control Parkinsons disease

and its progression, however PD is not something that can be reversed

or cured. The most common treatment for Parkinsons disease is the

use of medications, followed by surgery and physical adaptive

measures to minimize symptoms. Levodopa is the most popular

medication used in the treatment of PD. This is a precursor to

dopamine and can cross the blood brain barrier to the basal ganglia,

where it is formed into dopamine. It helps reduce rigidness and body

tremors. Other medications may be used in contrast with levodopa, as

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the correct amount of dopamine produced is extremely crucial. These

drugs include dopamine agonists, Amantadine, and COMT inhibitors. If

medications do not work, surgery is the next most common option for

treatment. Surgery involves deep brain stimulation of the specific area

that is causing the patients symptoms in order to stop the over

activity of the basal ganglia. This could include stimulation of

subthalmic nucleus or globus pallidus interna. The prognosis for people

with untreated Parkinsons is much worse than for those that receive

treatment. Although PD is not a fatal illness, when untreated it can lead

to deterioration of all brain functions and an early death. Each person

responds to treatments differently, so the amount of progress the

disease makes, depends on each individuals body. Some people will

see little change in 20 years while other will see great degeneration

within 10. Studies show that people with early onset Parkinsons do

have shorter life spans than those with a later diagnosis.

Although a lot of the physiology behind how Parkinsons disease

is understood, there are still a lot of misdiagnosed symptoms and

unproven theories as to what causes the disease. A few examples of

the several different Parkinson like disorders that are wrongly

identified, as Parkinsons are post-traumatic Parkinsonism,

arteriosclerotic Parkinsonism, and essential tremors. Post-traumatic

Parkinsonism is associated with frequent head injuries such as a

professional boxer. This causes Parkinson like symptoms, but it is not

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true PD. The more head injuries you have, is not causation of true PD.

We know that PD can be inherited genetically, but the reason as to why

the basal ganglia stop functioning properly is not proven. Essential

tremors are similar, where the body experiences tremor like symptoms

that are similar to Parkinsons, but shaking does not determine

whether a person has PD or not. Someone with essential tremors would

not benefit from medications for true Parkinsons disease. There are

also treatments used for PD, which are not scientifically proven to

work. One example of a treatment that is extremely controversial is

stem cell therapy. A transplant of a healthy dopamine-producing cell is

implanted in a person. There have been no studies showing a benefit in

patients.

Finally, it is extremely difficult to understand all of the different

aspects of Parkinsons disease because of the lack of knowledge that

we have about it. Knowing the physiological reason as to what is

happening in the body is only half of the battle. Not understanding why

this happens and what causes PD makes it hard to tell the difference

between true Parkinsons and Parkinson like symptoms, as well as

reasonable treatments. As of now we know of no cure for Parkinsons

and that it can be passed down genetically as well as developed

throughout life. All together, Parkinsons disease is degenerative and

cant be avoided, but only controlled as much as possible through

proper medical attention. When comparing normal vs. abnormal

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anatomy of the affected area, proper diagnostic exams, and ruling out

other Parkinson like conditions, it can be diagnosed properly, and

treated accordingly. Overall, the information we know now will lead us

to better understandings, more treatments and possible cures for

Parkinsons disease.

Works Cited

"Parkinson Disease: MedlinePlus Medical Encyclopedia." U.S National

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Library of Medicine. U.S. National Library of Medicine. Web. 27

Apr. 2015.

<http://www.nlm.nih.gov/medlineplus/ency/article/000755.htm>.

"Differentiating Parkinson's Disease From Other Movement Disorders."

EverydayHealth.com. Web. 27 Apr. 2015.

<http://www.everydayhealth.com/parkinsons-disease/movement-

disorders.aspx>.

"Parkinson's Disease Prognosis." News-Medical.net. 2 Dec. 2009. Web.

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Apr. 2015. <http://www.news-medical.net/health/Parkinsons-

Disease-Prognosis.aspx>.

"Parkinson Disease." - Movement and Cerebellar Disorders. Web. 27

Apr.

2015. <http://www.merckmanuals.com/professional/neurologic-

disorders/movement-and-cerebellar-disorders/parkinson-

disease>.