Parkinson's diseaseFrom Wikipedia, the free
encyclopedia"Parkinson's" redirects here. For other uses, see
Parkinson's (disambiguation).Parkinson's diseaseIllustration of
Parkinson's disease by William RichardGowers, which was frst
published in A Manual ofDiseases of the Nervous
System(1!"Classifcation and external resourcesSpecialty
#eurolo$yICD-10 G%&, '&%()ICD-9-CM ))%OMIM 1!!&&
**!*&&DiseasesDB +!*1MedlinePlus
&&&,**eMedicine neuro-)&. neuro-!)* in youn$pmr-++
rehabMeS /&1&)&&!ene"e#ie$sParkinson /isease
01er1iewParkinson's disease (PD, also known as idiopathic or
primary parkinsonism, hypokinetic rigid syndrome (HRS), or
paralysis agitans) is a degenerative disorder of the central
nervous system mainly affecting the motor system. The motor
symptoms of Parkinson's disease result from the death of
dopaminegenerating cells in the su!stantia nigra, a region of the
mid!rain. The causes of this cell death are poorly understood.
"arly in the course of the disease, the most o!vious symptoms are
movementrelated# these include shaking, rigidity, slowness of
movement and difficulty with walking and gait. $ater, thinking and
!ehavioral pro!lems may arise, with dementia commonly occurring in
the advanced stages of the disease, whereas depression is the most
common psychiatric symptom. %ther symptoms include sensory, sleep
and emotional pro!lems. Parkinson's disease is more common in older
people, with most cases occurring after the age of &'# when it
is seen in young adults, it is called young onset P(()%P().The main
motor symptoms are collectively called parkinsonism, or a
*parkinsonian syndrome*. The disease can !e either primary or
secondary. Primary Parkinson's disease is referred to as idiopathic
(having no known cause), although some atypical cases have a
genetic origin, while secondary parkinsonism is due to known causes
like to+ins. ,any risks and protective factors have !een
investigated- the clearest evidence is for an increased risk of P(
in people e+posed to certain pesticides and a reduced risk in
to!acco smokers. The pathology of the disease is characteri.ed !y
the accumulation of a protein into $ewy !odies in neurons, and from
insufficient formation and activity of dopamine in certain parts of
the mid!rain. Where the $ewy !odies are located is often related to
the e+pression and degree of the symptoms of an individual.
(iagnosis of typical cases is mainly !ased on symptoms, with tests
such as neuroimaging!eing used for confirmation.Treatments are
effective at improving the early motor symptoms of the disease.
This is typically with the medications $(%P/ and dopamine agonists.
/s the disease progresses and dopaminergic neurons continue to !e
lost, these drugs eventually !ecome ineffective at treating the
symptoms and at the same time produce a complication marked !y
involuntary writhing movements. (iet and some forms of
reha!ilitation have shown some effectiveness at improving symptoms.
0urgery and deep !rain stimulation have !een used to reduce motor
symptoms as a last resort in severe cases where drugs are
ineffective. 1esearch directions include investigations into new
animal models of the disease and of the potential usefulness of
gene therapy, stem cell transplants and neuroprotective agents.
,edications to treat nonmovementrelated symptoms of P(, such as
sleep distur!ances and emotional pro!lems, also e+ist.2n 3'45 P(
resulted in 4'5,''' deaths up from 66,''' deaths in 477'.849 The
disease is named after the "nglish doctor:ames Parkinson, who
pu!lished the first detailed description in An Essay on the Shaking
Palsy in 4;4ualityof life of those with the disease and their
families. Pu!lic awareness campaigns include Parkinson's disease
day (on the !irthday of :ames Parkinson, 44 /pril) and the use of a
red tulip as the sym!ol of the disease. People with parkinsonism
who have increased the pu!lic's awareness of the condition include
actor ,ichael :. Fo+, %lympic cyclist (avis Phinney, and
professional !o+er ,uhammad /li. Parkinson's not only affects
humans, !ut other primates as well, which have often !een used in
researching the disease and testing approaches to its
treatment.8698&98?9Contents8hide9 4@lassification 30igns and
symptomso 3.4,otoro 3.3Aeuropsychiatrico 3.5%ther 5@auseso
5.4"nvironmental factorso 5.3Benetics 6Pathologyo 6.4/natomicalo
6.3Pathophysiologyo 6.5Crain cell death &(iagnosis ?Prevention
uately controlled !y medication, or to those who are intolerant to
medication, as long as they do not have severeneuropsychiatric
pro!lems.8&&9 %ther, less common, surgical therapies
involve intentional formation of lesions to suppress overactivity
of specific su!cortical areas. For e+ample, pallidotomy involves
surgical destruction of the glo!us pallidus to control
dyskinesia.8?39Reha&ilitationFurther in"ormation (ehabilitation
in Parkinson's diseaseThere is some evidence that speech or
mo!ility pro!lems can improve with reha!ilitation, although studies
are scarce and of low >uality.8?598?69 1egular physical e+ercise
with or without physiotherapy can !e !eneficial to maintain and
improve mo!ility, fle+i!ility, strength, gait speed, and >uality
of life.8?69 Dowever, when an e+ercise program is performed under
the supervision of a physiotherapist, there are more improvements
in motor symptoms, mental and emotional functions, daily living
activities, and >uality of life compared to a selfsupervised
e+ercise program at home.8?&9 2n terms of improving fle+i!ility
and range of motion for people e+periencing rigidity, generali.ed
rela+ation techni>ues such as gentle rocking have !een found to
decrease e+cessive muscle tension. %ther effective techni>ues to
promote rela+ation include slow rotational movements of the
e+tremities and trunk, rhythmic initiation, diaphragmatic
!reathing, and meditation techni>ues.8??9 /s for gait and
addressing the challenges associated with the disease such as
hypokinesia(slowness of movement), shuffling and decreased arm
swing# physiotherapists have avariety of strategies to improve
functional mo!ility and safety. /reas of interest with respect to
gait during reha!ilitation programs focus on !ut are not limited to
improving gait speed, !ase of support, stride length, trunk and arm
swing movement. 0trategies include utili.ing assistive e>uipment
(pole walking and treadmill walking), ver!al cueing (manual, visual
and auditory), e+ercises (marching andPAF patterns) and altering
environments (surfaces, inputs, open vs. closed).8?