PARKINSON'S DISEASE - Full extract 

David is a retired solicitor and a great letter writer. He corresponds regularly with his brother and sister interstate and enjoys writing letters to the editor.

One morning he came into the surgery looking quite troubled. His wife was with him and she looked just as concerned. " David hasn't been himself over the past few months." she said. " He's become a bit tottery on his feet, and over the weekend he had a fall. His writing seems to have gradually become scrawly too."

I hadn't seen David for a year or so but I could see there had been a change. He was less animated and had little to say. There was a slight tremor of his right hand but little else to find. It took him a long time to get down from the couch and walk over to his chair. I asked him to write his name and address on a piece of paper. The letters were small and pushed together.

"Not too good is it," he said rather glumly.

The picture was suggestive of Parkinson's disease and I explained this to David and his wife. However, I was not certain, so I referred him to a neurologist for assessment.

The neurologist was sure that David has Parkinson's disease and she suggested that he start medication. Within a few weeks he had shown considerable improvement. I saw another one of his letters published recently. Apparently he has bought a personal computer and is learning to type.

Parkinson's disease is a degenerative disorder where there is a loss of special nerve cells in a particular part of the brain. A neurotransmitter called dopamine also becomes depleted. This leads to tremors, rigidity of the limbs and a general slowness of movement.

The cause of Parkinson's disease is not known.

Interestingly, certain medications such as anti-nausea drugs and some heavy sedatives can cause side-effects that are similar to the symptoms of Parkinson's disease.

A little more than 1 in 1000 Australian adults ( 25,000 people ) have Parkinson's disease. In people aged over 70 the incidence rises to about one or two in 100. The average age of onset is about 60 but sometimes those affected can be in their 30s or younger. The onset is so gradual that many people cannot remember when their symptoms started. Parkinson's disease is not hereditary or contagious and usually does not shorten a person's life expectancy. Men and women are equally affected.

A fluctuating tremor in the hand may be the first sign of the disease. This is more noticeable when a person is at rest and the tremor tends to disappear with specific activities. Hand and arm movements may be stiff, leading to small, untidy handwriting. Other subtle changes may be evident - like failure to swing an arm when walking.

After many years with the condition, the tremor can become more obvious. Speech may become slurred, there may be a lack of facial expression and a person may move more slowly. Other symptoms are depression and a degree of memory loss. There is a great variation in the features of Parkinson's disease. It should be remembered that most people with the condition lead a full life and manage well for many years.

These days, patients suspected of having Parkinson's disease are usually referred to a neurologist. There is no simple test for the condition; it is a clinical diagnosis based on the overall presentation of the patient. In some cases, investigations are arranged to exclude other medical conditions. The neurologist helps with the diagnosis and advises on medication.

Parkinson's disease is best managed by a team approach - the GP, neurologist, physiotherapist, occupational therapist and speech therapist all have a role to play.

Early drug treatments for the disease were aimed at reducing tremors. Surgery was also tried with some success. A major breakthrough came in the late '60s with the discovery of a drug called levodopa, a precursor to the neurotransmitter dopamine. Early improvement was often spectacular but usually not sustained. Side effects such as nausea, unsteadiness and constipation are common. A variety of new and improved drugs have been released. Sometimes, a combination of several medications is required to obtain good control of symptoms.

Health Tips:
* The Parkinson's Disease Association provides excellent resources and information for those who wish to know more about the condition.

Weblinks: www.parkinsons-vic.org.au
         NEV - www.nevdgp.org.au/info/std_misc/PARKINSON'S_DISEASE_About.htm

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: December 11, 2004