Parkinson’s Disease: 10 Clinical Fast Facts
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on March 3, 2022.
It’s Not Always All-in-the-Family
Do you have a relative with Parkinson's disease (PD) and are you worried about your chances of getting it?
PD is a disease of the central nervous system where brain cells die, and not enough dopamine (a neurotransmitter) is made. PD causes problems getting around, and symptoms may include:
- shuffled walking
- rigidity and muscle stiffness
- slowed body movements
- unstable posture.
While the cause of PD is not fully known, it seems plausible it might run in families. However, only about 15 percent (15 out of 100) of those with PD also have a first-degree relative, such as parent, brother, or sister, with PD.
Diagnosis of Parkinson's Disease Isn't Always Clear Cut
Many researchers believe that Parkinson's disease (PD) is due to a combination of factors including genetics and environmental toxins.
Patients who develop young-onset Parkinson’s disease by age 40 may have a genetic component and close relatives may have an increased risk of developing Parkinson’s. However, PD usually starts in most people after age 60, and the chances of having an inherited gene is much lower if an older family member develops PD.
There is no specific lab test to diagnose PD. Instead, doctors look for symptoms during an exam. Also, if a patient's symptoms improve after taking a Parkinson's medication such as levodopa, the diagnosis is more likely to be correct.
Research is Making Strides for Parkinson's Disease
There is no cure for Parkinson’s disease yet, although research is active and making daily strides.
Much of the boost to disease awareness can be attributed to celebrities who suffer from the disease themselves, yet selflessly promote active research. From actor Michael J. Fox, to the late world renowned boxer Muhammad Ali to former NBA player Brian Grant, celebrities have given Parkinson's disease a recognizable face.
In 2000, the Michael J. Fox Foundation (MJFF) was launched, the largest nonprofit organization funding Parkinson’s disease research and drug development in the world.
- But much work remains to be done: over 10 million Parkinson’s patients exist worldwide; with over 1 million in the U.S.
- Roughly 60,000 Americans are diagnosed with PD each year.
- Men are 1.5 times more likely to have Parkinson's disease than women.
- Nearly 1.2 million people will be living with Parkinson's disease (PD) in the U.S. by 2030, according to the Parkinson's Foundation.
What’s Involved With OFF Episodes and Freezing in PD?
OFF Episodes occur when the levodopa treatment wears off before it's time for your next dose.
- When that happens, your PD symptoms can re-emerge and be at their worse. Tremor, slowness, stiffness, difficulty moving or walking can occur.
- This can interrupt your daily activities and make moving or gettign around difficult. OFF epidoses can last from a few minutes to a few hours.
- OFF episodes are common and occur frequently in people being treated for PD. It can even happen several times per day.
Freezing, or the temporary, involuntary inability to move, is a problematic safety issue for patients with Parkinson's disease (PD). The person may not be able to cross a door threshold, get into an elevator, or even get out of a chair. The risk of falling is increased, and poses a great danger. In fact, about 38% of people living with PD fall each year.
- Freezing can occur when a patient is close to the end of their dopaminergic medication dose, which is called an OFF episode. But freezing is different from an off-epidose. Dose adjustments can help to alleviate these freezing episodes. In addition, tricks such as shifting weight or imagining a line to cross can help.
- When a freeze occurs, take a break, a deep breath, and then go forward; don't feel rushed by others.
- Working with a physical therapist can help you to learn techniques that can work for you.
Latest Drugs for Parkinson's Disease
Although a Parkinson's disease cure does not yet exist, research is expanding treatment options. Some of the more exciting approvals include:
- Duopa, approved in 2015, is a levodopa/carbidopa enteral suspension given via the small intestine using a surgically placed pump. Duopa may help to lessen the OFF times in PD due to more stable plasma concentrations.
- In April 2016, pimavanserin (Nuplazid), a non-dopaminergic, selective serotonin inverse agonist (SSIA), was approved for the treatment of psychosis associated with PD.
- An agent known as safinamide (Xadago), classified as an alpha-aminoamide, was approved in March 2017 as an add-on therapy to levodopa/carbidopa (Sinemet) in patients with Parkinson’s disease (PD) experiencing OFF episodes.
- In August 2017, the FDA approved Gocovri (amantadine) extended-release capsules for treatment of dyskinesia in patients with Parkinson's disease receiving levodopa-based therapy, with or without dopaminergic medications. In Feb. 2021 Gocovri was also approved to be used with levodopa/carbidopa to treat OFF-episodes.
- In December 2018, Inbrija (levodopa) was FDA-approved. Inbrija is an oral, dry powder inhalation for the treatment of OFF episodes in those already taking a carbidopa/levodopa regimen. Onset of action was seen as early as 10 minutes in studies.
- In August 2019, Nourianz (istradefylline) from Kyowa Kirin, Inc. was approved for use as an oral adjunctive treatment to levodopa and carbidopa in adult patients with Parkinson’s disease (PD) experiencing OFF episodes. Nourianz is classified as is an adenosine A2A receptor antagonist.
- In April 2020, Ongentys (opicapone) capsules were approved to be used in addition to levodopa/carbidopa in patients with Parkinson’s disease (PD) experiencing “OFF” episodes. Ongentys, from Neurocrine Biosciences, is classified as a catechol-O-methyltransferase (COMT) inhibitor.
- In May 2020, Kynmobi (apomorphine) was approved for the on-demand management of OFF episodes associated with Parkinson’s disease. Kynmobi, from Sunovion, is a novel dopamine agonist formulation available as a sublingual (under the tongue) film. An injection form of apomorphine known as Apokyn is also available for "OFF" episodes.
To learn more about Parkinson's disease drug therapy, see: Parkinson's Disease: A Healthcare Professional's Guide
Vegas Road Trip? Suspect a Drug Reaction
If a patient with Parkinson's disease exhibits new and out of the ordinary behaviors, like compulsive shopping, gambling, or hypersexuality, it may be due to a drug reaction.
In fact, impulse control disorders are found in roughly 10 percent of patients taking the drug class known as dopamine agonists. These drugs work by mimicking the activity of the brain chemical dopamine.
A study published in JAMA Internal Medicine looked at a decade's worth of FDA safety data for these drugs and found that pramipexole (Mirapex) and ropinirole (Requip) were most frequently associated with this disorder. This can also occur with other dopaminergic agents like rotigotine (Neupro) or carbidopa / levodopa (Sinemet).
The compulsive behaviors usually improve or disappear when the dose is reduced or the drug is discontinued. If you suspect these side effects, speak to your healthcare provider immediately who may be able to change to a medicine without this effect. Sometimes drug-induced behaviors like these can be mistaken for disease worsening and may result in skilled nursing care or additional medications.
Can't You Smell That Smell?
Most people with a reduced sense of smell (hyposmia) do not develop Parkinson’s disease. However, this is a common symptom in people with PD, and it can be an early sign of the disease. Why does this happen?
Researchers believe that the protein alpha-synuclein, found in the brain of all PD patients, may originate in the olfactory bulb region first before moving into other parts of the brain. Active alpha-synuclein research is ongoing at the Michael J Fox Foundation (MJFF). According to MJFF, there are currently 13 clinical trials of potential Parkinson’s therapies targeting alpha-synuclein.
Some medications and the virus that causes COVID-19 can cause hyposmia, too, so be sure to have your doctor or pharmacist review your current medications or take a COVID test, if you've lost your sense of smell. If you test positive for COVID, contact your doctor for further instructions.
Depression and Parkinson’s Often Travel Together
Depression can occur frequently in patients with Parkinson’s disease, but there has been concern that many depression drugs could worsen PD symptoms like tremor or rigidity.
- Research published in the American Journal of Psychiatry has found certain antidepressants that inhibit reuptake of serotonin or norepinephrine -- drugs like paroxetine (Paxil) and venlafaxine (Effexor XR) -- are possible options for depression treatment in PD. Other options include fluoxetine, citalopram, sertraline and duloxetine.
- Studies have shown these drugs can improve depressive symptoms without worsening PD symptoms.
- In one study, participants had a 20 to 27 percent improvement over placebo in depressive symptoms. It's important to be careful when combined with other serotonergic agents or concurrent MAOBI due to risk of serotonin syndrome.
Sleep problems, weight gain and an elevation in blood pressure were seen as side effects from the antidepressants in some patients.
Exercise is Key: Keep Moving
Ironically, movement is one way to help battle the movement disorders linked with Parkinson's disease (PD).
Medications are the cornerstone for PD, but physical exercise also plays a very important role.
A research report reveals regular exercise is important to help keep the patient strong physically, maintain balance, and improve mood.
First, patients should talk to their doctor before they start any regular exercise program.
- Resistance training
are all useful exercises that many PD patients can enjoy. Water aerobics or swimming are good ways to exercise without the risk of falling.
Experts also suggest treadmills or walking around the house if walking outdoors is too challenging. A recumbent bicycle is a great all-around exercise equipment to invest in, too, and may offer a bit more safety than walking.
Some patients may also benefit from working directly with a personal trainer or physical therapist at first, especially if they are new to regular exercise.
Studies: Clinical Trials in Parkinson's Disease
While many drugs currently available for Parkinson's disease (PD) affect symptoms such as rigidity and tremors, a treatment that can slow the course of PD -- a disease modifying agent -- is not yet approved. Today, research is progressing in this area. However, around the world, between 40% and 70% of trials face delays because of a lack of volunteers.
In response, the Fox Trial Finder was created by the Michael J. Fox Foundation to help increase the number of participants — both patients and control groups who do not have Parkinson’s — into research trials that need them to help boost the pace of drug development process.
According to the Fox Foundation, clinical trials are a final and crucial step on the path to developing better treatments for Parkinson’s patients today.
- Fox Trial Finder lists ongoing PD clinical trials and research studies.
- Matches registrants to the trials that are best suited to their needs.
- Register for Fox Trial Finder to connect with recruiting clinical trials in your area and help speed research.
Finished: Parkinson’s Disease - 10 Clinical Fast Facts
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- Frenklach A. Management of Depression in Parkinson’s Disease.The American Journal of Psychiatry. 2017:11 (4): May 2017. Accessed March 3, 2022 at https://psychiatryonline.org/doi/10.1176/appi.ajp-rj.2016.110405
- Kalia LV, et al. Parkinson's disease. Lancet. 2015 Aug 29;386(9996):896-912. doi: 10.1016/S0140-6736(14)61393-3. Epub 2015 Apr 19. Accessed Feb. 23, 2021 at DOI: 10.1016/S0140-6736(14)61393-3
- The Michael J Fox Foundation for Parkinson's Research. Smell Loss and Parkinson's Disease. Accessed March 3, 2022 at https://www.michaeljfox.org/understanding-parkinsons/living-with-pd/topic.php?smell-loss
- Connolly B, Lang A. Pharmacologic Treatment of Parkinson's Disease: A Review. JAMA. 2014;311(16):1670-1683. Accessed March 3, 2022 at DOI: 10.1001/jama.2014.3654
- The National Parkinson Foundation. Freezing. Accessed March 3, 2022 at http://www.parkinson.org/Living-with-Parkinsons/Managing-Parkinsons/Activities-of-Daily-Living/Freezing
- Reynolds G, et al. The Therapeutic Potential of Exercise to Improve Mood, Cognition, and Sleep in Parkinson’s Disease. Mov Disord. 2016 Jan; 31(1): 23–38. Accessed March 3, 2022 at doi: 10.1002/mds.26484
- Weiss HD, Pontone GM. Dopamine receptor agonist drugs and impulse control disorders. JAMA Intern Med. 2014 Dec;174(12):1935-7. doi: 10.1001/jamainternmed.2014.4097 Accessed March 3, 2022.
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