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Parkinson disease

Overview
Parkinson disease (PD) is a common, progressive movement disorder, with characteristic features of
rigidity, slowness of movement (bradykinesia), and tremor. It is caused by degeneration of the
dopamine producing neurons within the substantia nigra of the midbrain.
Normally, dopamine producing neurons project to the basal ganglia, where along with acetylcholine,
they have a key role in the subconscious regulation of an individuals movement. In particular, they help
initiate and terminate movements, suppress unwanted movements, and regulate muscle tone. In PD,
the progressive loss of dopamine producing neurons leads to an imbalance of neurotransmitters,
resulting in a characteristic disturbance in the regulation of movement.
The image displayed opposite shows a colored magnetic resonance imaging (MRI) scan of a coronal
section through the brain of a person suffering from Parkinson disease. The spinal column is at lower
center. The cerebrum of the brain (at upper frame) and the ears (at lower left and right) are also seen.
The disease is caused by the loss of nerve cells from the basal ganglia (dark blue areas in box).

Causes
PD is predominantly a disease of the elderly, with an average age of onset of 65 years old. The cause of
the dopamine neuron degeneration remains unknown (idiopathic), although many environmental toxins
and pollutants have been suspected. Genetic factors appear to play a relatively minor role, except in
those who develop PD at a young age. Antipsychotic drugs, as well as some other nervous system
disorders, may cause similar clinical features to PD, known as parkinsonism. It is important to
differentiate them from PD, as they usually require different forms of treatment.

Symptoms
Involuntary contraction and relaxation of muscle groups leads to a tremor which becomes more severe
at rest. Bradykinesia and increased muscle tone cause difficulty in initiating movements or carrying out
complex motor tasks such as fastening and unfastening buttons. The facial muscles may be affected,
leading to a mask-like expression, often with drooling of saliva and disturbances of speech.
Walking is frequently affected, with loss of the normal arm swing, shortened steps, and shuffling of the
feet. Other possible features of PD include depression, dementia, and urinary problems.

Diagnosis
There are currently no routine tests for PD, so the diagnosis is based on the characteristic symptoms and
signs.

Treatment
The aim of treatment in PD is to restore the balance of neurotransmitters within the basal ganglia. Drug
treatments either increase the amount of dopamine, or reduce its breakdown. Initially, they often
improve many of the symptoms. However, as the disease progresses, they become less effective and
troublesome side effects may develop. Surgical treatments may be considered, and involve either
removal or electrical stimulation of different parts of the basal ganglia.
Despite treatment, the progressive nature of the disease means that individuals become increasingly
immobile, with death usually resulting about 10-15 years after diagnosis.