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Parkinsonism is an idiopathic chronic neuromuscular disorder, in which a person develops
tremors, rigidity and dyskinesia, followed by a permanent handicap within a span of few years.
Incidence: Parkinson disease is more commonly found among males. This is commonly seen
in old age generally insixth and seventh decade Though now a days because of probably the
increasing stress, Parkinson is also seen in young age which is called as Young Onset Parkinson
Disease (YOPD). The incidence rapidly increased over the age of 60 years, with only 4% of the
cases being under the age of 50 years. The rate for men (19.0 per 100,000, 95% ) was 91%
higher than that for women (9.9 per 100,000, 95% ). The age-and gender-adjusted rate per
100,000 was highest among Hispanics (16.6 per 100,000, 95%), followed by non-Hispanic
Whites (13.6 per 100,000, 95%), Asians (11.3 per 100,000, 95%), and Blacks (10.2 per 100,000,
95%). These data suggest that the incidence of Parkinson’s disease varies by race/ethnicity
(Eeden et. al., 2002)
Etiology : The exact cause of this disease is not known. But in my opinion, the increase in stress
in day to day life, the introduction of chemical pesticides in almost all eatables may be the
leading cause. The increase in oxidant levels in our body due to a fast and competitive life can
again be one of the main reasons behind the nature of disease. Hereditary factor is also believed
to play a major role in the etiology because Parkinson is seen in families.
Clinical features: Tremors which initially starts unilaterally and gradually progress to all four
limbs. The patient becomes handicapped up to the level that he/she is unable to eat or drink of its
own. The sufferer stops mingling in the society because of social phobia. He drags himself away
from the society and even the family. Ultimately he starts developing psychiatric symptoms.
Statistics: In the United States, at least 500,000 people are believed to suffer from Parkinson's
disease, and about 50,000 new cases are reported annually.
Patho-physiology: There is depletion of dopamine secreting neurons in globus pallidus area of
Substantial nigra of the brain. Because of this deficiency the neuro impulses are not transmitted
across the synapsis. The above said factors results in uncontrolled involuntary movements in the
distal areas of the limbs. These are called as tremors at rest. However during sleep there are
no tremors. Any kind of stress may aggravate the symptoms.
THE GENDER DIFFERENCES HAVE BEEN OBSERVED DURING ANALYTICAL
STUDIES OF THE PARKINSON PATIENTS IN VARIOUS FIELDS:
A mildly significant gender differences in disability and quality of life reporting has been noted
with women citing greater disability and decreased quality of life. Various gender differences
have been observed by analysis of patient in clinical field:-
Rapid eye movement
-reduced verbal fluency
-Decreased facial emotion
Women had a significantly greater prevalence of dyskinesias as compared to men.
These motor differences were significant only in patients with PD of greater than 5 years.
Women experience more levodopa induced dyskinesia and men exhibit more sever parkinsonian
Age at onset of PD in women has been observed 2.1 years later than in men.
Correlated positively with parity, fertile life span and menopause.
Patients presenting with tremors add 3.6 years higher age at onset and 38% slower
deterioration/progression of PD.
A review of literature on PD shows an increased incidence in men. Other data
from a series of laboratory studies in animal model of PD suggest that estrogen in females
appear to act as neuro protective of the striatal dopaminergic system . Estrogen inhibits the
uptake of neuro toxins capable of producing degeneration with dopaminergic neurons
In response to treatment to PD, women have greater levodopa bioavailability
or metabolism based on Parkinson disease female on estrogen therapy (POETRY) study,
estrogen replacement therapy may lead to improvement in PD symptoms and provide an
opportunity to reduce the dosage of APD(Anti Parkinson drugs) in women.
Mean UPDRS – III scores were found equal for both genders as was the
rate of motor deterioration and striatal degeneration.
The effect is not yet understood as insight into how fluctuation of estrogen over the life
time effects the dopinergic neurons and the pathways in brain, is currently limited to
research. The patho-physiology underlying the differences may enhance the accuracy and
effectiveness of clinical assessment and treatment of the PD.
Research and clinical trials for PD patients have uner gone widely to study gender differences.
The molecular difference in the female PD brain was observed. This was done using laser
capture microscopy and post mortem brain tissues. The female brains were found to have
different genetic expression profile then male brains. The nigro stratial pathways neuron cells are
significantly different in male and female. The detailed results are still under study.
Mental health outcomes are widely reported among spouse care giver - with wives generally
fairing worse than husbands. The cognitively intact spouses with PD may experience less sever
The patient suddenly is in a state of mental shock, when he comes to know of his disease. He
becomes unsecured about his future and he is surrounded by a constant fear in his mind.
Being a male he is not able to accept his handicap and the helplessness attitude occupies his
He just cannot swallow the fact that someone is being engaged 24 hours as his caretaker .At the
stage when he is not able to contribute to the earning of his family. He probably starts thinking
that he has become an extra burden to the family. Here he starts cultivating the suicidal
thoughts. If the patient is monetarily sound, he may overcome the above said symptoms, but
there is a perfect saying that “THE IDLE MIND IS A DEVILS WORKSHOP.” The patients are
seen to develop hyper-sexuality, obsessive compulsive disorders, depressive psychosis, etc. Of
course, these are triggered by the medicines. I know personally a patient of Parkinson who went
in to the habit/ addiction of exhibitionism for which he was to suffer a lot including the social
boycott, hatred and insults.
The patients who develop grave psychiatric symptoms are generally referred to the
psychiatrist for further management. The patient is put on antipsychotic drugs for a longer
Such patients are dealt with tactfully. they are always to be accompanied by some caretaker
and never left alone. He is always encouraged to think and act positive. He is never insulted
or reminded of his off scene deeds. If the economy and the bank balance permit he should
be taken for deep brain stimulation surgery (the best option presently) which will give him
the far better lifestyle and a productive life for his remaining age. Here I must tell you the
fact that the life of the patient remains complete and only the life style is affected.
TREATMENT OF PARKINSON DISEASE
There are only few drugs which decrease the symptoms to a little extent either by imitating the
dopamine or inhibiting the antagonist enzymes in the Dopamine pathway. However, these drugs
are not the permanent solution to the problem . The brain get used to the synthetic dopamine and
its effect vanishes within a span of five years. Since this is a progressive disorder the underwater
current takes the shape of whirlpool. These anti Parkinson drugs on the other hand have shown
lot of adverse effects which include Dystonia (increased rigidity in all the four limbs), dyskinesia
(slowness and impaired body movements), insomnia (sleep disorder) and psychiatric symptoms
(obsessive compulsive disorders and hyper sexuality). Because of dystonia the distal muscles of
his arms and legs become rigid and the patient is painful and helpless in accomplishing his day to
day routine tasks like brushing the teeth, ablution in toilet, taking bath, combing his hair,
fastening the buttons of his shirt, and so on. Hypokinesia results in loss of swinging of hands
while walking, imbalance on walking, slowness of speech, and awkward movements of the
limbs. The in coordination of skeletal and smooth muscles may even lead difficulty in speech,
difficulty in swallowing and difficulty in defecation.
It is said to play an important role in keeping the patient mobile. Here I would like to quote the
reference of NOEL N BATTEN who claims that performing blood flow exercises can overcome
Parkinson disease. Batten has mentioned in his book certain interesting points to overcome the
The effects of sunrise on our mind encourages us to do things that stimulate blood flow.
If our mind remains overactive all night, our neck muscles remain stiff the whole night,
to inhibit blood flow and create several problems.
Peace of mind and relaxed neck muscles encourage good blood flow in the Prefrontal
cortex of the brain.
Every PD patient should do shrugs; straddle squats, side bends, and knee ups exercises.
“Hatred” is one attribute that can develop in to Parkinson disease
DIET ADVICE :-
It is better to obtain fiber from fruits, vegetables and grains. Fruits such as figs , prunes ,papaya
and pine apple are valuable natural laxative . It is also important to drink plenty of drinks like
water and juices. The patient should have moderate amount of tea and coffee. Too much of
proteins interfere with the action of drugs, hence to be avoided in day time . The small helpings
of food every two to three hours may be more appealing.
In the previous years thalamectomy was the only possible surgery but with remarkable side
effects. Now in this modern era, deep brain stimulation has come up with the out standing
results. In this surgery, the specific areas in the brain are stimulated by implanting the
electrodes/pacemakers with the remote (turning) in the patients hand. Even this surgery is
supposed to be effective only for few years .Though the life style definitely improves but the
under current progression of the disease still remains as such.
STEM CELL TRANSPLANT:-
It is among the latest researches undergoing clinical trial at present. This includes the
transplantation of stem cells derived from the fetus into selective area of brain of Parkinson.
These stem cells take the shape and function of the neighboring cells of defective/ deficient area
where these are injected. Since this procedure involved the sacrifice of a live fetus so it was
banned in most of the countries. Though now the ban has been lifted up in US and thereby
permitting the clinical trials for the mankind.
GENE THERAPY: -
In patients with Parkinson's disease, their brains get overactive after losing the normal supply of
a chemical called GABA (gamma-aminobutyric acid). A gene that codes for glutamic acid
decarboxylase (GAD) can improve the condition of people with the disease when injected into
their brains.GAD is an enzyme that catalyses production of an inhibitory neurotransmitter called
(GABA). Typically, people with Parkinson's produce too little GABA, and consequently have
overstimulation in an area of the brain called the subthalamic nucleus. This over activity in turn
puts strain on neurons that produce another neurotransmitter – dopamine – which is vital for
movement control. This helps explain some of the symptoms of Parkinson's, which include
tremors, sluggish movements, rigid muscles and impaired posture and balance.
The new treatment, gene therapy, works by inserting billions of copies of a gene into patients'
brains that helps them produce more GABA. The patients receive an infusion of a virus
engineered to deliver a gene called glutamic acid decarboxylase (GAD) into a brain centre that is
overactive in Parkinson's disease — the subthalamic nucleus. GAD encodes a neurotransmitter
called GABA, which quiets neurons in this area.
The cost of care associated with Parkinson diseases includes both direct and indirect costs.
Direct costs are expenditures for medical and non-medical services needed as a result of the
illness. Direct medical costs include expenditures for pharmaceuticals, physician office visits,
emergency room care, and inpatient hospital visits. Direct nonmedical costs are costs incurred
by the patient for special care, including costs of transportation and special equipment or
modifications to the home or car. Indirect costs are related to changes in worker productivity,
including absence from work and decreased earning ability. There are also intangible costs
associated with the pain, suffering, and reduced quality of life associated with the illness.
Although intangible costs are difficult to quantify in monetary terms and are often omitted from
economic analyses, they are important to consider when examining the overall impact of PD.
Though this disease is diagnosed clinically but can be confirmed by CT scan and MRI brain
which are costly and become difficult to be borne to patient.
Medicines are generally very expensive which a poor patient cannot bear. All the above factors
lead to the draining of his bank balance.
Socially the patient finds him not presentable and he starts withdrawing himself from social
Gathering, parties, functions and gets confined within the cemented walls at home .This
limitation of his movement in the social circle gives birth to extreme depression and other grave
At a certain time of his disease the patient becomes completely dependent on his care taker and
his assistance for 24 X 7 hours. Hence the loss/engagement of two earning persons thereby a
monetary loss to the family and the nation. Moreover since the disease is male dominating, the
loss incurred is too much to the family. These further ads up to the deteriorating psychological
condition of the patient in Toto.
Today fast and competitive life pattern has resulted to an increasing incidence of Parkinson
disease among the youth living in urban area. Because of modernization and stressful urban life
with the maximum level of pollution , this disease is making its root among the aspiring section
of the society. This class of people is not able to spare a little time for their own self like
exercise, proper and regular diet, a sound sleep and little of meditation.
Once the person is taken over by Parkinson disease it becomes very late to take the preventive
measures. He has to be totally dependent upon a full time care taker and he avoids himself
socially. Now he starts developing psychiatric symptoms beside the existing ones.
Such patients of Parkinson disease are to be dealt with love and affection. it becomes our duty to
encourage and motivate such people to move in the society. They should never be bullied .The
NGOs should come forward with the idea of establishing the clubs particularly for PD patients
where they can spend their time and intermingle with their brother PDs. If possible government
agencies should encourage these people to earn their livelihood by providing appropriate job so
that they will not feel themselves dependant. This way we can increase their moral and self
esteem. This may further curtail the psychiatric symptoms also. They will not feel worthlessness.
By keeping themselves busy the patients may not get the progression of the disease at an
If the patient and his family can afford, he should be encouraged for one of the various upcoming
options like DBS surgery.