Parkinsonism: 7 Lifestyle Changes to Help Cope

Parkinson’s disease, which is a disorder of the nervous system that affects movement, is a common neuromuscular disease. But did you know it is possible to display the signs and symptoms of Parkinson’s disease without actually having the disorder? This phenomenon is known as parkinsonism and is associated with both disease and non-disease causes. Read further to learn how parkinsonism impacts movement throughout the body.

Parkinsonism
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What is Parkinsonism?

Parkinson’s disease is a progressive neuromuscular disease that impacts movement. The symptoms are caused by a lack of dopamine in the body, as dopamine-containing neurons (nerve cells) in the brain die. As dopamine levels decline, the effects of the disease increase.

Parkinsonism, however, is a clinical syndrome in which someone has a range of Parkinson’s symptoms related to another condition, but not extensive enough to meet all of the criteria for a Parkinson’s disease diagnosis.

Parkinsonism: Risk Factors

Aside from the associated conditions, certain risk factors predispose one to parkinsonism.

  • Age—Those younger than age 60 are less likely to have parkinsonism.
  • Family history—Having a family member with parkinsonism or a related condition that causes parkinsonism increases risk.
  • Gender—Men are more prone to developing parkinsonism than females.
  • Ethnicity—Hispanics and non-Hispanic Caucasians have the highest incidence of parkinsonism.  
  • Exposure to toxins—Exposure to pesticides has been correlated with neurological diseases.
  • Head trauma—Head trauma can induce symptoms of parkinsonism.

Parkinsonism and Neurodegenerative Disorders

It is caused by a disease other than Parkinson’s occurs in 15% of patients. Although a wide range of conditions can lead to symptoms of Parkinsonism, neurodegenerative disorders are the most common.

  • Supranuclear Palsy (PCP)—Supranuclear palsy is a brain disorder that damages parts of the brain above clusters of nerve cells known as nuclei. Nuclei are responsible for controlling movements like balance, gait, speech, vision, swallowing, and behavior. Patients with PCP progress more rapidly than those with Parkinson’s, rarely experience tremors, and have profound difficulties with speech and swallowing.
  • Lewy Body Disease—Lewy body disease is the second most prevalent form of dementia next to Alzheimer’s disease. Deposits of a protein called alpha-synuclein develop on the brain’s nerve cells, which interferes with dopamine production. The lack of this vital neurotransmitter throughout the entire brain creates a decline in thinking, hallucinations, sleep disorders, and Parkinsonism.
  • Multiple System Atrophy (MSA)—Multiple system atrophy comprises multiple disorders that affect motor skills and the autonomic nervous system—the division of the nervous system controlling all of the functions that occur “automatically” (i.e. sweating, bladder function, blood pressure, heart rate, etc.). MSA tends to progress at a faster rate than Parkinson’s.
  • Corticobasal Degeneration—Corticobasal degeneration is the deterioration of the cerebral cortex and the basal ganglia, which are two areas of the brain that control movement. Contrary to Parkinson’s the symptoms of Parkinsonism caused by corticobasal degeneration begin on one side of the body and gradually progress to both sides.

Vascular Parkinsonism

It is a cerebrovascular disease impacting the vessels that carry blood to the brain. Blood flow is disrupted by multiple small strokes that cause blood clots in the brain. It is not progressive like Parkinson’s disease, but the main characteristic of this type is lower body parkinsonism with movement affecting the lower body displayed in a shuffling gait, unsteadiness, and no tremors.

Parkinsonism and Structural Brain Disorders

Structural brain disorders are conditions impacting the structure of the brain. This can include strokes, trauma to the head, and both benign and malignant (cancerous) tumors. These structural abnormalities cause it directly through brain damage. The specific symptoms that arise as the result of structural brain disorders are determined by the exact location the injury occurs.

Disorders Associated with Parkinsonism: Wilson’s Disease

Wilson’s disease is a rare genetic disorder in which the liver cannot eliminate excess copper through the release of bile. Copper builds up in organs such as the liver and brain to cause extensive organ damage over time. Accumulation of copper impairs the brain and leads to these symptoms. The initial signs include speech difficulties, tremors, poor coordination, drooling, trouble swallowing, and jerky movements. The condition also results in personality changes.

Disorders Associated with Parkinsonism: Liver Failure

It is associated with liver failure is known as “parkinsonism in cirrhosis.” Research published in The Metabolic Brain Disease Journal shows that up to 21% of liver failure patients experience dystonia, which are involuntary muscle contractions, as well as decreased movement. These symptoms of parkinsonism are often progressive and are rarely attributed to cognitive decline.

Disorders Associated with Parkinsonism: Infection

  • HIV/AIDS—HIV is a life-threatening condition of the immune system. The body is unable to fight off infections. It is now recognized as a neurological complication of HIV/AIDS. Symptoms are symmetric with slow, rigid movements.
  • Viral encephalitis—Viral infections occasionally enter the brain by invading the central nervous system. The presence of a virus in the brain causes encephalitis, which is extreme brain inflammation. Neural degeneration is triggered and patients present with a loss of motor control, problems walking, stiffness, and other symptoms of parkinsonism.
  • Meningitis—Meningitis is similar to encephalitis with its inflammation around the brain and spinal cord. The process is typically initiated by viral or bacterial infections.

Drug-Induced Parkinsonism

Aside from the disease causes of this, many develop the condition from medications. This is known as drug-induced parkinsonism. Statistics claim approximately 7% of those with this syndrome developed symptoms after taking dopamine antagonists—medications that block the action of dopamine. The most common drug to cause this syndrome are neuroleptics used for psychotic disorders, schizophrenia, and dementia. However, neuroleptics target hallucinations, nausea, and vomiting. Cardiac medications like calcium channel blockers and medications to reduce blood pressure are prone to causing this syndrome too.

The Role of Dopamine in Parkinsonism

The central nervous system, including the brain and spinal cord, communicates between nerve cells and the body through chemical messengers known as neurotransmitters. It involves the neurotransmitter dopamine, which is delivered to four various pathways in the body. Each neurotransmitter has specific functions and dopamine is responsible for movement, motivation, and emotional regulation.

Parkinson’s disease and parkinsonism affect the dopamine-producing neurons in the substantia nigrathe section of the brain which houses the majority of dopamine neurons. Those neurons become damaged to produce parkinsonism symptoms.

Symptoms of Parkinsonism

It does not impact the body as extensively as full-blown Parkinson’s disease. While the latter has cognitive symptoms, it includes only the motor symptoms of the disease. The combination of symptoms a patient experiences varies due to the underlying cause of their parkinsonism.

  • Tremor—A tremor is the involuntary shaking of a body part (i.e. hands, feet, fingers, arms, etc.).
  • Dystonia—Dystonia is the repetitive twisting contractions of a muscle. In parkinsonism, it most often occurs in the feet and is evident by a cramping sensation accompanied by a curled foot.
  • Rigidity—Rigidity is one of the beginning symptoms of parkinsonism. The muscles become stiff and tight and range of motion is limited. As the condition progresses, rigidity spreads from the limbs to the trunk and facial muscles.
  • Bradykinesia—Bradykinesia is the slowness of movement.
  • Difficulty swallowing—Also termed dysphagia, parkinsonism can affect the process of eating by preventing normal swallowing and chewing. Dietary adjustments (i.e. liquid diets) are sometimes necessary to avoid choking.
  • Gait challenges—Walking patterns are altered. Patients walk more slowly, drag their feet when they walk, and suddenly freeze: a phenomenon defined by the inability to move.
  • Postural instability—The reflexes for standing in an upright position decline, creating a balancing issue.
  • Stooped posture—To compensate for poor balance, many patients developed a stooped or hunched posture.
  • Loss of automatic movements—Automatic movements include smiling, frowning, blinking.
  • Speech difficulties—Trouble projecting while speaking, speaking in a monotone, and slurring words are characteristic speech changes in parkinsonism.
  • Writing changes—Writing may become difficult with script turning small and unorganized.

Diagnosing Parkinsonism

There are no definitive tests for Parkinson’s disease or parkinsonism. Misdiagnosis is possible because the symptoms are nearly identical. However, an accurate diagnosis of parkinsonism and locating its underlying cause is imperative to receive proper treatment. For example, Wilson’s disease presents with symptoms of parkinsonism, yet it is not a neurodegenerative disorder like Parkinson’s disease and requires an entirely different therapy.

The first step in diagnosing Parkinsonism is to be evaluated by a physician. A doctor takes a thorough medical history of previous disease. Through a neurological exam, they access the patient’s movements, facial expressions, balance, gait, and they observe tasks like rising from a chair or rotating the neck for stiffness.

Next, other conditions must be ruled out. Brain imaging provides photos of the brain to identify any structural abnormalities that are contributing to parkinsonism symptoms. Lastly, if Parkinson’s is still suspected, a trial of Levodopa is helpful in establishing a diagnosis. Levodopa is a drug commonly used in Parkinson’s disease treatment because it acts as the precursor to dopamine. A favorable response to Levodopa is indicative of a Parkinson’s disease diagnosis, as those with parkinsonism do not find the drug significantly helpful.

Treating Parkinsonism

Treatment for parkinsonism is determined by the cause. Discontinuing dopamine antagonist medications cures the disorder in patients with drug-induced parkinsonism. In other cases, treating the underlying disease improves parkinsonism symptoms. If complete healing is impossible due to the underlying condition, symptom management through medication therapy, deep brain stimulation, and lifestyle adjustments are vital to preserving quality of life.

Medications for Parkinsonism

While many patients with parkinsonism do not have profound benefits on Levodopa, it can still be a helpful therapy for some forms of parkinsonism. Some do notice modest symptom relief. There are other drugs that increase the amount of dopamine in the brain, which are potentially therapeutic for parkinsonism caused by neurodegenerative disease. Additionally, to treat cognitive symptoms or mood disorders, it is wise to choose a pharmaceutical option that does not exacerbate symptoms.

Surgery: Deep Brain Stimulation (DBS)

Deep brain stimulation (DBS) is a surgical procedure to target parkinsonism motor and movement symptoms. During the operation, a device is inserted into the brain. Imaging allows the surgeon the surgeon to locate the targeted brain area in which to place a set of electrodes. The electrodes are then connected to a device implanted into the chest or abdomen to stimulate brain activity. The device is easily turned off and on via a remote.

Due to risk of infection, stroke, bleeding, and seizures, patients are only a candidate for surgery when symptoms lasting 4 or more years cannot be controlled with medications and lifestyle changes.

Parkinsonism: 7 Lifestyle Changes to Help Cope
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7 Lifestyle Changes to Help This Dyndrome

Lifestyle adjustments are an important facet to parkinsonism treatment. They are a way patients and their families remain active in their care.

Exercise

The biggest lifestyle change for parkinsonism is exercise. This is accomplished under the guidance of a physical therapist. A physical therapist creates an exercise plan based on the patient’s needs.

Physical activity for parkinsonism should include balance and coordination exercises, muscle strengthening tasks, and ambulatory exercises like walking (either independently or with assistance). Physicians typically recommend an hour of exercise 4 to 5 times per week, but the goal is to remain as active as possible.

Studies reveal that engaging in physical activity slows the progression of parkinsonism. It also decreases the rigidity of movement and expands the range of motion.

Rest

Parkinsonism can cause sleep disorders (insomnia, restless leg syndrome, and REM-sleep disorder) that interfere with sleep quality. Abiding by a sleep schedule gives the brain time to heal. If not receiving adequate rest at night, naps during the day are helpful.

Diet

Consume a balanced diet of fruits, vegetables, whole grains, and healthy protein sources like lean meats and beans. Limit processed foods with preservatives and excess sugar. A healthy diet contains foods with antioxidants, which is important for brain health.

Speech therapy

Speech difficulties are common in parkinsonism. Speech therapy assists patients in communicating.

Home modifications

With movement difficulties, home modifications such as rails, stairlifts, walk-in showers, and ramps may be beneficial.

Reduce stress

Stress exacerbates symptoms. Keep stress levels low by exploring new hobbies, meditating, or spending time with family and friends.

Support groups

Support from others is essential in overcoming the burdens of parkinsonism. Talk with fellow patients who understand the challenges through support groups. Family and caregivers can also attend support groups to learn their role in disease management.

References

Butterworth, R.F. (2013). Parkinsonism in cirrhosis: pathogenesis and current therapeutic options. Metab Brain Dis 28, 261–267. https://doi.org/10.1007/s11011-012-9341-7

Watcher, K. (2006). Parkinsonism Recognized as Common HIV Complication. Retrieved from https://www.mdedge.com/internalmedicine/article/12033/infectious-diseases/parkinsonism-recognized-common-hiv-complication