Parkinson's diseaseFrom Wikipedia, the free encyclopedia"Parkinson's" redirects here. For other uses, see Parkinson's (disambiguation).Parkinson's diseaseIllustration of Parkinson's disease by William RichardGowers, which was frst published in A Manual ofDiseases of the Nervous System(1!"Classifcation and external resourcesSpecialty #eurolo$yICD-10 G%&, '&%()ICD-9-CM ))%OMIM 1!!&& **!*&&DiseasesDB +!*1MedlinePlus &&&,**eMedicine neuro-)&. neuro-!)* in youn$pmr-++ rehabMeS /&1&)&&!ene"e#ie$sParkinson /isease 01er1iewParkinson's disease (PD, also known as idiopathic or primary parkinsonism, hypokinetic rigid syndrome (HRS), or paralysis agitans) is a degenerative disorder of the central nervous system mainly affecting the motor system. The motor symptoms of Parkinson's disease result from the death of dopaminegenerating cells in the su!stantia nigra, a region of the mid!rain. The causes of this cell death are poorly understood. "arly in the course of the disease, the most o!vious symptoms are movementrelated# these include shaking, rigidity, slowness of movement and difficulty with walking and gait. $ater, thinking and !ehavioral pro!lems may arise, with dementia commonly occurring in the advanced stages of the disease, whereas depression is the most common psychiatric symptom. %ther symptoms include sensory, sleep and emotional pro!lems. Parkinson's disease is more common in older people, with most cases occurring after the age of &'# when it is seen in young adults, it is called young onset P(()%P().The main motor symptoms are collectively called parkinsonism, or a *parkinsonian syndrome*. The disease can !e either primary or secondary. Primary Parkinson's disease is referred to as idiopathic (having no known cause), although some atypical cases have a genetic origin, while secondary parkinsonism is due to known causes like to+ins. ,any risks and protective factors have !een investigated- the clearest evidence is for an increased risk of P( in people e+posed to certain pesticides and a reduced risk in to!acco smokers. The pathology of the disease is characteri.ed !y the accumulation of a protein into $ewy !odies in neurons, and from insufficient formation and activity of dopamine in certain parts of the mid!rain. Where the $ewy !odies are located is often related to the e+pression and degree of the symptoms of an individual. (iagnosis of typical cases is mainly !ased on symptoms, with tests such as neuroimaging!eing used for confirmation.Treatments are effective at improving the early motor symptoms of the disease. This is typically with the medications $(%P/ and dopamine agonists. /s the disease progresses and dopaminergic neurons continue to !e lost, these drugs eventually !ecome ineffective at treating the symptoms and at the same time produce a complication marked !y involuntary writhing movements. (iet and some forms of reha!ilitation have shown some effectiveness at improving symptoms. 0urgery and deep !rain stimulation have !een used to reduce motor symptoms as a last resort in severe cases where drugs are ineffective. 1esearch directions include investigations into new animal models of the disease and of the potential usefulness of gene therapy, stem cell transplants and neuroprotective agents. ,edications to treat nonmovementrelated symptoms of P(, such as sleep distur!ances and emotional pro!lems, also e+ist.2n 3'45 P( resulted in 4'5,''' deaths up from 66,''' deaths in 477'.849 The disease is named after the "nglish doctor:ames Parkinson, who pu!lished the first detailed description in An Essay on the Shaking Palsy in 4;4ualityof life of those with the disease and their families. Pu!lic awareness campaigns include Parkinson's disease day (on the !irthday of :ames Parkinson, 44 /pril) and the use of a red tulip as the sym!ol of the disease. People with parkinsonism who have increased the pu!lic's awareness of the condition include actor ,ichael :. Fo+, %lympic cyclist (avis Phinney, and professional !o+er ,uhammad /li. Parkinson's not only affects humans, !ut other primates as well, which have often !een used in researching the disease and testing approaches to its treatment.8698&98?9Contents8hide9 4@lassification 30igns and symptomso 3.4,otoro 3.3Aeuropsychiatrico 3.5%ther 5@auseso 5.4"nvironmental factorso 5.3Benetics 6Pathologyo 6.4/natomicalo 6.3Pathophysiologyo 6.5Crain cell death &(iagnosis ?Prevention uately controlled !y medication, or to those who are intolerant to medication, as long as they do not have severeneuropsychiatric pro!lems.8&&9 %ther, less common, surgical therapies involve intentional formation of lesions to suppress overactivity of specific su!cortical areas. For e+ample, pallidotomy involves surgical destruction of the glo!us pallidus to control dyskinesia.8?39Reha&ilitationFurther in"ormation (ehabilitation in Parkinson's diseaseThere is some evidence that speech or mo!ility pro!lems can improve with reha!ilitation, although studies are scarce and of low >uality.8?598?69 1egular physical e+ercise with or without physiotherapy can !e !eneficial to maintain and improve mo!ility, fle+i!ility, strength, gait speed, and >uality of life.8?69 Dowever, when an e+ercise program is performed under the supervision of a physiotherapist, there are more improvements in motor symptoms, mental and emotional functions, daily living activities, and >uality of life compared to a selfsupervised e+ercise program at home.8?&9 2n terms of improving fle+i!ility and range of motion for people e+periencing rigidity, generali.ed rela+ation techni>ues such as gentle rocking have !een found to decrease e+cessive muscle tension. %ther effective techni>ues to promote rela+ation include slow rotational movements of the e+tremities and trunk, rhythmic initiation, diaphragmatic !reathing, and meditation techni>ues.8??9 /s for gait and addressing the challenges associated with the disease such as hypokinesia(slowness of movement), shuffling and decreased arm swing# physiotherapists have avariety of strategies to improve functional mo!ility and safety. /reas of interest with respect to gait during reha!ilitation programs focus on !ut are not limited to improving gait speed, !ase of support, stride length, trunk and arm swing movement. 0trategies include utili.ing assistive e>uipment (pole walking and treadmill walking), ver!al cueing (manual, visual and auditory), e+ercises (marching andPAF patterns) and altering environments (surfaces, inputs, open vs. closed).8?