Parkinson in older adults

Understanding Parkinson’s Disease in Older Adults

Parkinson’s Disease is a neurodegenerative disorder that affects how the nerve cells in the brain produce dopamine. It is commonly referred to as a movement disorder, as those with the disease suffer from tremors and balance. Although rare, Parkinson’s Disease has been diagnosed in younger people, but it typically affects older adults.

This article covers:

The History of Parkinson’s Disease

In 1817, a British doctor named James Parkinson (Heyn & Stoppler) made the first detailed description of Parkinson’s Disease. In his work, ‘An Essay on the Shaking Palsy’, he observed and described the symptoms associated with Parkinson’s disease, such as the tremors, poor posture, and rigidity. Mr. Parkinson even explained in the essay that the condition was a result of a problem in the brains medulla area (Findatopdoc).
Parkinson’s disease was discovered well before 1817, however. The disorder was also described in India’s medical doctrine, where it was called Kampavata. During this time, and even today, they treated the symptoms of Parkinson’s disease with Mucuna Pruriens or tropical legumes.

Parkinson’s Disease: Overview of Major Events

A lot of what we know today is based on advances in technology and previous medical breakthroughs. Some major events regarding Parkinson’s Disease were (Findatopdoc):

  • Jean-Martin Charcot, a French neurologist, was the first to use the term ‘Parkinson’s Disease’ in 1827.
  • Brain surgery on patients with Parkinson’s disease was banned as a result of several people becoming partially paralyzed in the early 1900s.
  • Dr. Brissaud suggested in 1925 that damage to the substantia nigra was likely the cause of Parkinson’s disease.
  • Brain surgeries resurfaced in the 1940s and showed improvements to symptoms presented in Parkinson’s disease patients.
  • Anticholinergics were prescribed in the 1950s to reduce the contraction of muscles.
  • The National Parkinson Foundation and the Parkinson’s Disease Foundation were founded in 1957.
  • Parkinson’s disease symptoms were treated via Levodopa injection.
  • The five stages of Parkinson’s disease were introduced by Hoehn and Yahr in 1967.
  • The FDA permitted the use of deep brain stimulation surgery in 1997.
  • In 2004, researchers identified LRRK2, a gene linked to the cause of Parkinson’s disease.
  • The Parkinson’s outcomes project was created in 2009 and has more than 9000 participants.
  • In 2016, The National Parkinson Foundation and the Parkinson’s Disease Foundation merged to create the Parkinson’s Foundation.

Parkinson in Seniors

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Parkinson’s Disease In The Elderly

Parkinson’s Disease is labeled ‘an older person’s disease’, as approximately 95% of the people diagnosed are over the age of 60. In addition, older men tend to be far more commonly affected than women (A Place For Mom, 2015). Research has yet to determine the reasons behind this.

Causes of Parkinson’s Disease In Seniors

Parkinson’s Disease affects the section of the brain called the substantia nigra pars compacta, and it controls muscle movement and produces dopamine. Without dopamine, muscle movements become jerky or difficult to control.
Scientists believe the disease is more common in seniors based on a combination of genetic and environmental factors. As people age, the processes imperative to the function of substantia nigra neurons begin to decline. Based on an article by Reeve, Simcox, & Turnbull (2014), the following causes cell death of the substantia nigra neurons:

  • Accumulation of mitochondrial DNA defects
  • Oxidative damage
  • Accumulation of neuromelanin

These stressors can weaken the neurons significantly. Although it is unknown why, mitochondrial dysfunction and changes to the protein degradation pathways are more detrimental to the neurons in the substantia nigra than anywhere else in the brain.

Parkinson’s Disease Old Age Onset

Although Parkinson’s Disease in older adults is more common, there is still a lack of clarity behind why those diagnosed in their late 70s have greater impairments. A research study was done to review patients with middle-age Parkinson’s Disease onset and those with old-age Parkinson’s Disease onset over a five year period.

The study performed by Diedrich et al. (2003) showed very interesting results. Those with old-age onset scored significantly higher on the Parkinson’s Disease Rating scale for motor skills. The rating scale showed higher scores for the following:

  • Rigidity
  • Bradykinesia
  • Axial impairment

Patients with old-age onset Parkinson’s Disease have greater motor impairments because of:

  • Significant destruction of nerve pathways from the substantia nigra to the basal ganglia
  • Reduced compensatory mechanisms leading to rapid disease progression and,
  • Comorbidities

Parkinson’s Disease Symptoms

The symptoms associated with Parkinson’s disease in older adults are not too much different than those who are younger with the disease. Those with Parkinson’s Disease may experience the following motor and non-motor symptoms:

  • Impaired memory
  • Constipation
  • Poor balance
  • Depression
  • Anxiety
  • Bradykinesia
  • Tremors (hands, arms, legs, and/or face)
  • Slowed movement
  • Reduced sense of smell
  • Lack of coordination
  • Increased sweating
  • Increased salivation
  • Challenges with urination
  • Trouble sleeping
  • Orthostatic hypotension
  • Rigidity of trunk and limbs

Conditions Similar To Parkinson’s Disease

While Parkinson’s disease may be someone’s first thought if they present with the symptoms above, it could probably be something else. In fact, Parkinson’s disease can be difficult to diagnose because of other conditions that have similar symptoms.

For example, certain high blood pressure medications can cause symptoms similar to those in Parkinson’s disease. These other conditions may cause almost identical symptoms as well (Healthwise Staff, 2010):

  • Encephalitis
  • Carbon monoxide poisoning
  • Thyroid disorders
  • Liver disease
  • Alzheimer’s Disease

Genes Linked to Parkinson’s Disease

Seniors diagnosed with Parkinson’s disease that have no family history of the disorder, are a mystery to researchers. Patients that do have a family history usually have one or more of these five genes (Heyn & Stoppler):
Mutations in the LRRK2 gene are prevalent in patients with Parkinson’s disease and are probably the cause of it. Based on the Michael J. Fox Foundation, this gene is the greatest known contributor to Parkinson’s disease (Michael J. Fox Foundation).

  • The PARK2 gene creates Parkin. It is a protein that aids in breaking down and recycling proteins.
  • Mutations in the PARK2 gene are present in young onset Parkinson’s disease.
  • Individuals with early-onset Parkinson’s disease have mutations in the protein, DJ-1. PARK7 creates this protein, which protects cells from oxidative stress.
  • Researchers assume that PINK1 protects structures within mitochondria from stress. Patients with early-onset Parkinson’s disease have mutations in PINK1.
  • SNCA makes the alpha-synuclein protein, which accumulates into clumps known as Lewy bodies in those with Parkinson’s disease. In early-onset Parkinson’s disease, a mutation to SNCA can be found.

Parkinson’s Disease Progression Timeline

Parkinson’s disease symptoms do not come all at once. As the disease progresses, additional symptoms will emerge and other symptoms will worsen. There are five stages that help physicians determine how far the disease has advanced (Health Line, 2017). The five stages of Parkinson’s Disease are:

Stage 1

At Stage 1 of Parkinson’s Disease, some symptoms may be present but they are not severe enough to interfere with one’s lifestyle. The most noticeable symptoms are tremors and movement that is more difficult on one side. Physicians may prescribe medication to help reduce symptoms at this stage.

Stage 2

At Stage 2 of Parkinson’s Disease, symptoms are moderate. While symptoms are barely noticeable in Stage 1, they do become presentable in Stage 2. Patients will begin feeling symptoms on both sides of their body. They will also notice increased tremors, stiffness, and trembling. An individual at this stage can still live alone but will have to adjust to tasks taking longer due to muscle stiffness.

Stage 3

At Stage 3 of Parkinson’s Disease, also known as the middle stage, there is a greater loss of balance. At this stage, individuals are at an increased risk of falls due to slower reflexes. Physicians consider this stage a major turning point for the disease as the increased symptoms lead to greater difficulty with daily tasks. Occupational therapy and medication may aid in decreasing symptoms.

Stage 4

Those at Stage 4 of Parkinson’s Disease require additional assistance with activities of daily living (ADLs). While it’s possible to stand without assistance, ambulation may require the use of an assistive device, such as a walker. People at Stage 4 of Parkinson’s Disease should not live alone.

Stage 5

The most advanced stage of Parkinson’s Disease is Stage 5. The following symptoms occur:

  • Advanced stiffness
  • Hallucinations
  • Delusions
  • Dementia

Most noteworthy, Parkinson’s disease in older adults at this stage may find that the side effects of medications outweigh the benefits.

The stages are numbered in sequential order, but people will not progress through symptoms or severity in the same way. This is due to Parkinson’s disease being highly personal and individualized.

Treatment Options for Parkinson’s Disease

The suggested treatments will hinge on a variety of factors — including what stage of Parkinson’s disease an individual patient is in, as well as the patient’s overall health. Healthier patients may be able to tolerate far more aggressive treatment options compared with patients who already have numerous other health problems.

Pharmacological interventions are the gold standard during early stages of the disease. The goal is to increase the patient’s dopamine levels. Therefore dopamine-enhancing medications are prescribed. There are numerous medications that fall into this dopamine-enhancing category that are prescribed. A few of them are (WebMD):

  • Levodopa
  • Mirapex
  • Neupro
  • Requip

There are other medications that help with symptom relief, such as COMT-Inhibitors. Some commonly prescribed COMT-Inhibitors are:

  • Asmar
  • Comtan

Many individuals diagnosed with Parkinson’s disease will struggle with strong side effects that are associated with these drugs. It then becomes a question of if the side effects are worth the potential benefits. Therefore, this is a personal question for individual patients and their medical providers to consider.

Non-pharmaceutical Treatment Options for Parkinson’s Disease

During early stages of Parkinson’s Disease, doctors may also recommend that their patients try the following:

  • Increase their physical activity level
  • Try physical therapy

Patients in the early stages of Parkinson’s Disease have shown to benefit from aerobic exercise. For patients struggling with sluggishness or a shuffling gait, Physical Therapy is an option.

Aggressive Treatment Options For Parkinson’s Disease

If these earlier and less aggressive treatment options do not work, or if a person has an advanced case of Parkinson’s Disease, then medical providers may recommend more aggressive interventions. The most aggressive intervention is deep brain stimulation. The patient’s brain id implanted with electrodes with deep brain stimulation (DBS). These electrodes register electric impulses/pulses.

Researchers note that this intervention helps control tremors and may help the body more effectively regulate its response to medication. However, it does not change the long-term trajectory of the disease.

Is Parkinson’s Disease fatal?

Many people’s first questions when they hear the diagnosis of Parkinson’s Disease from their doctors is:

  • How long do I have left to live?
  • Will Parkinson’s Disease kill me?

Most research and statistics indicate that Parkinson’s disease does not significantly affect the length of a person’s life. Therefore, it is a question of the quality of life, not the quantity of life! However, even though it does not, in general, shorten life expectancy, in later stages of the disease, Parkinson’s Disease may lead to a wide range of associated health problems that in turn can lead to death.

For example, a person with advanced Parkinson’s disease may be more likely to develop pneumonia if they are having respiratory and/or swallowing difficulties. Also, they may be at-risk for falling and breaking a hip. With the elderly population, a broken hip can have deadly consequences.

In Conclusion

Parkinson’s Disease is a potentially scary diagnosis to receive. However, it is important to remember that it is not a death sentence. There are numerous treatments and interventions that can dramatically improve a person’s quality of life. As a result, information is critical.