Parkinson's disease is a neurodegenerative condition in which the brain stops producing a neurotransmitter, or brain communication chemical, called dopamine. Dopamine is essential for movement of the body, and as its level decreases, so do a person’s physical motor abilities.
As many as 1 million Americans live with Parkinson’s disease, the Parkinson’s Foundation reports. This makes it the second-most common neurodegenerative disease in the United States after Alzheimer’s disease. While anyone can develop Parkinson’s disease, research suggests that it affects more men than women, and that most people first develop the disease after age 60, the National Institute on Aging states.
With a label like “neurodegenerative,” meaning it is a brain condition that worsens over time, a Parkinson’s disease diagnosis can feel intimidating. But Dr. Robert Wiggins, a neurologist at Novant Health Neurology & Sleep in Charlotte, emphasized that with the right treatment and guidance, moving your body and maintaining a high quality of life are possible.
In fact, he said the belief that you can’t exercise daily is one of the biggest misconceptions about Parkinson’s disease. Here he discusses this misconception along with three others.
Misconception No. 1 – You can’t exercise with Parkinson’s disease.
We all know we should be exercising every day – and this includes people with Parkinson’s disease. In fact, it’s especially important for people with Parkinson’s.
“We truly believe that exercise, particularly cardiovascular exercise, is really paramount,” Wiggins said. “It'll make people feel better, it'll slow down their progression.”
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Being sedentary, Wiggins explained, has a cumulative effect. Sitting a lot leads to sitting even more. This causes diminishing mobility, and often a resulting feeling of a loss of independence. As the cycle continues, our physical condition deteriorates. Wiggins encourages people with Parkinson’s disease to “safely push it,” meaning attending physical therapy and sticking to a regular exercise plan, to maintain their mobility and independence for much longer.
“I talk about exercise and activity to try to encourage people to do things to slow down their progression,” Wiggins said. “It makes you happier, it makes your mood better. And most people will say that when they exercise, they get tired but actually feel better.”
Moderate-to-strenuous activity for 150 minutes each week is the Parkinson’s Foundation’s recommendation for exercise. This may include activities like brisk walking, jogging, swimming, dance or cycling. The foundation also recommends four fundamental elements for a well-rounded exercise routine: aerobic activity that increases the heart rate; strength training like using light free weights or resistance bands; balance, agility and multitasking that involves multidirectional stepping like yoga or tai chi; and stretching with deep breathing.
Misconception No. 2 – The most popular Parkinson’s disease medication stops working over time.
Many patients with Parkinson’s disease are prescribed carbidopa-levodopa (pronounced kar·buh·dow·puh leh·vuh·dow·puh), which is a combination medication that acts as a replacement for dopamine – the communication chemical – in the brain.
A common misconception is that the drug stops working over time, and this can cause hesitation with patients who are deciding whether to begin taking it. Wiggins explained that while a patient may require higher doses of carbidopa-levodopa over time, it is not because the medication loses effectiveness.
“In the hands of the right physician, this medication can be used very safely and effectively,” Wiggins said. “Though we may have to increase the dose throughout a patient's disease course, it's not because your brain is becoming resistant to that medicine, or it's just not quite as effective. We simply increase the dose because the condition has worsened and therefore we need more medicine.”
Wiggins said to imagine you are filling a hole in your backyard, and every day the hole grows a little bit deeper.
“For a while, you're going to be able to put three tablets into that hole, and it's going to be filled up pretty well,” he said. “But Parkinson's disease, because it's a neurodegenerative condition, unfortunately, does slowly worsen. The deficit of dopamine, the bigger that hole in your backyard so to speak, increases. So we need to put more medicine in it to get the same benefit that we did previously.”
This can either be accomplished by increasing the number of tablets per dose, or increasing the total number of doses throughout the day. While an increased dosage may carry a side effect risk of dyskinesia, involuntary erratic movements, working with a physician to implement an effective lifestyle and medication plan can work to reduce or eliminate this side effect.
Misconception No. 3 – Treating Parkinson’s disease is just about controlling tremors.
A tremor is a common, visible symptom of Parkinson’s disease. But it’s not the only symptom, and treating Parkinson’s disease is about more than controlling tremors.
“A lot of my time and care is put toward addressing the tremor, but also really trying to address a patient’s mobility, their ability to exercise, their mood and their quality of life,” Wiggins said. “Sometimes I find that Parkinson's disease care doesn't revolve around eliminating a patient's tremor. The things we really should be focusing on are people's ability to exercise, move around, spend time with their loved ones, that kind of a thing. Tremor is not the end-all-be-all of Parkinson's disease care.”
In addition, Wiggins mentions that sometimes a tremor can be present without a Parkinson’s disease diagnosis; sometimes one can receive a Parkinson’s disease diagnosis and not have a tremor.
While everyone is different, other symptoms of Parkinson’s disease may include:
- Slowness of movement. Parkinson’s disease can cause slow movements, known as bradykinesia, making it difficult to complete daily functions like chewing or buttoning a shirt. Individuals with Parkinson’s disease may appear to lose or have slowed spontaneous facial expressions, known as facial masking. Volume or projection of voice may also decrease.
- Stiffness. Normally, muscles stretch when they move and then relax. Parkinson’s disease can cause muscles to be stiff all the time, causing pain. For instance, people with the disease may walk without swinging their arms because it hurts.
- Walking and mobility. Walking can require more effort, causing a person’s steps to become shorter. Keeping up with others and maintaining balance when turning can be difficult.
- Urinary issues. Recent studies suggest that as much as 40% of people with Parkinson’s disease experience urinary issues such as urinary urgency and the need to urinate frequently.
- Depression. Depressive disturbances are common with Parkinson’s disease and may affect up to 50% of individuals.
Addressing these symptoms, while they may not be as visible as a tremor, is important to ensure a high quality of life for those with Parkinson’s disease.
Misconception No. 4 – There is no hope after a Parkinson’s disease diagnosis.
Today, a high quality of life is attainable with Parkinson’s disease, and the future holds promise for more technological and medical advances that will continue to improve the outcomes of people with this diagnosis.
“There actually is a lot of hope,” Wiggins said. “I have a lot of optimism and hope that there will be new medications that will not only help treat the symptoms, but hopefully in the near future, will help in what's called a disease-modifying way.”
This means that new medicines to come in the future will not just help the symptoms of Parkinson’s disease, but slow down the progression of the disease. Wiggins said that today, much research is focused on slowing down the progression of the condition.
A well-devised care plan, Wiggins emphasized, means comprehensively treating all signs and symptoms to allow people to keep doing the things they want to do, whether that’s continuing to work, or improving their golf swing. In some cases, a care plan may include a surgical procedure, such as deep brain stimulation, which involves implanting electrodes in the brain that then work to stimulate parts of the brain that control movement.
“The right treatment can oftentimes be life-changing,” Wiggins said.