FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

PARKINSON'S DOESN'T SHORTEN LIFE, JUST ITS "QUALITY"

Question: My mother was just diagnosed with Parkinson's disease, and she is only 58 years old. I thought it was a disease of old age. Her doctor wasn't very reassuring. What can be done for her, and what is the long-term prognosis?

Answer: Parkinson's disease is a disorder of the nervous system named after the British physician James Parkinson (1755-1824) who first described this condition. Individuals with Parkinson's typically have at least three of the following four symptoms: 1) tremor of the hands and arms, 2) a marked reduction or complete absence of specific normal movements such as blinking, facial gestures, or arm swinging with walking, 3) muscular rigidity and 4) abnormalities of posture, balance and the manner of walking (gait). Initially these symptoms become apparent in a mild form and then gradually worsen with the passage of time. There are several other symptoms that occur commonly but are not necessary for making the diagnosis. They are depression, a significant drop in blood pressure upon standing up, a facial rash called seborrheic dermatitis and constipation.

When Dr. Parkinson described this condition, he had no clear understanding of the specific region of the brain that was malfunctioning or of the underlying abnormality that caused it. Today our knowledge has advanced only a bit further. We know that Parkinson's disease, a term that is now used to describe a grouping of several related disorders, is caused by death of cells in a specific region of the brain called the substantia nigra. However, it is unclear what actually causes these irreplaceable cells to die. And, part of the difficulty that frustrates efforts to help those with the disorder is that the symptoms don't become apparent until 80 percent of those brain cells have already died. That leaves only a precious few functioning cells in the substantia nigra to work with.

Parkinson's can strike at any age, but it is most common in those over 50, and the frequency with which it strikes keeps increasing with advancing age. So, your mother is not too young to have it. One study done in Boston found that 34 percent of those over 65 had some form of the disease. Generally though, the incidence is considered to me much lower that this -- between 1 and 2 percent of the total population.

For those who are early in the course of this disease, medicine can allow the continuation of a productive life. Actor Michael J. Fox and Attorney General Janet Reno are two public figures who are still productive despite this disease. The drugs that we have to treat the symptoms provide benefit only for a few hours before that dose wears off, and with continued use the drugs lose their effectiveness. Because of this and the natural progressive nature of the disease, new treatments are under investigation.

There has been some limited improvement with surgical treatments. Implanted electrical deep brain stimulators are being studied, as is the transplant of tissue into the damaged substantia nigra. These treatments, as well as new drugs, are of scientific interest, but to date they haven't provided real treatment options for the majority of individuals with Parkinson's. Instead of a bright future, those with this diagnosis face a bleak prognosis of a decline in function over many years, ultimately leading to the need for total care. The disease does not shorten life, but it certainly diminishes the quality of it for the individual and for his or her loved ones.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.