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Case Study 192: Parkinson’s Disease

What is it?
Parkinson’s is a progressive neurodegenerative disorder that primarily affects movement. It results from the loss of dopamine-producing neurons in a region of the brain called the substantia nigra. Dopamine is critical for smooth, coordinated muscle movements.

Key Symptoms (Motor)
• Tremor (often at rest, described as “pill-rolling”)
• Bradykinesia (slowness of movement)
• Rigidity (stiffness of the limbs/trunk)
• Postural instability (impaired balance, frequent falls)

Non-Motor Symptoms (often overlooked but equally important)
• Sleep disturbances
• Depression and anxiety
• Constipation
• Loss of smell (anosmia)
• Cognitive changes (later stages may involve dementia)

Diagnosis
There’s no single test - diagnosis is clinical, based on symptoms and exam findings. Imaging like DaTscan may support diagnosis but isn’t always necessary.

Treatment Options
• Levodopa-carbidopa: the gold standard medication, replenishing dopamine.
• Dopamine agonists, MAO-B inhibitors, COMT inhibitors: additional medication classes.
• Deep Brain Stimulation (DBS): a surgical treatment for advanced cases, targeting brain circuits to reduce motor symptoms.

Living with Parkinson’s
Physical therapy, occupational therapy, speech therapy, and lifestyle modifications are crucial. Exercise and multidisciplinary care can significantly improve quality of life.

Teaching Point
Parkinson’s is more than tremor - it’s a complex disorder with motor and non-motor symptoms. Awareness and comprehensive care are essential to support patients at every stage of the journey.

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