What is the progression of Parkinson's disease symptoms and when does treatment typically start?

May 16, 2011

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Q. “What is the progression of Parkinson’s disease symptoms and when does treatment typically start?’’

A. Parkinson’s disease is a progressive movement disorder caused by the loss of a group of brain cells that produce dopamine. For people newly diagnosed with Parkinson’s disease, the important thing to know is that the disease progresses very slowly. “We’re talking about years to decades,’’ says Samuel Frank, a neurologist at Boston Medical Center. Because it usually strikes later in life, Frank says that in general, “people die with Parkinson’s disease, not because of it.’’

The disease is typically diagnosed based on a personal account of your symptoms and a physical exam. Your doctor will look for signs like a particular kind of tremor, stiffness, loss of coordination, and slowness of movement, particularly on one side of the body. A recently approved imaging technology called a DaTscan can be used to confirm a diagnosis.

Frank says that disease progression is highly individual, but physicians can classify it in five stages, called the Hoehn and Yahr Scale. At the earliest stage, patients have difficulties performing routine motor tasks and start to lose coordination and balance. At late stages, movements slow and become rigid, and eventually patients lose much of their ability to move and need constant care.

Medications can greatly alleviate the symptoms of the disease, although they do not seem to slow its progression. Different physicians have different approaches to treating patients. Frank says most physicians agree that medical treatment should start when symptoms begin to interfere with daily activities and quality of life. Some people are afraid to start medications because they think that the drugs will fail to work over time, but Frank says that a growing amount of research suggests this idea is a myth. Because symptoms worsen over time, most patients will need to change or add drugs to their regimens, but it does not necessarily mean their old treatments were failing. He also says there is no evidence to support the common belief that the widely used Parkinson drug levodopa is toxic to the brain over time.

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