Parkinson's Disease 101: Causes, Symptoms, Stages & Treatment Options in Singapore

Parkinson's disease is a known neurodegenerative disorder gradually progressing over time, which significantly impacts mobility. Its widespread presence in Singapore poses a substantial public health threat. Though there is no known cure yet, medications to alleviate the symptoms are generally accessible.

Based on a community-based survey by the National Neuroscience Institute, 3 out of every 1,000 people aged 50 and up in Singapore have Parkinson's disease. And, with the rapidly ageing Singapore, the burden of Parkinson's disease is due to rise simultaneously.

Early indications of Parkinson's, like many other brain disorders, might be subtle and go undetected. Although the symptoms may vary for each person, awareness should be a prime concern. With Parkinson's, time is of the essence, and to catch the signs, get diagnosed as early as possible.

Parkinson's Disease - What It Is?

Parkinson's disease is known as a degenerative nervous system condition that impairs movement control. Following Alzheimer's Disease, it is the second most common neurodegenerative disorder. Symptoms appear progressively and may begin with a barely detectable tremor in only one hand.

Though tremors are typical, they can also cause stiffness or movement disorders and uncontrollable shaking. However, as the disease progresses, the patient may encounter difficulty speaking, sleeping, mental and memory issues, behavioural changes, and other severe signs.

At the age of 60, Parkinson's commonly develops. Hence, age is one of the significant risk factors. In some cases, up to 10% of patients with Parkinsons disease develop it before 50. This "early-onset" of Parkinson is generally inherited, although not always.

Approximately, there are 6,000–8,000 people are diagnosed with Parkinson's disease. Yet, an uptick in incidence forecasts by 2030 is conceivable due to an ageing population and growing life expectancy.

Parkinson's disease varies from each patient, and associated disabilities or impairments in everyday activities manifest over the years.

Underlying Causes of Parkinson's Disease

When nerve cells, also called neurons, in the substantia nigra of the brain become damaged or die, Parkinson's disease develops. These nerve cells in the brain produce dopamine, a chemical (neurotransmitter) that aids brain cell communication by transmitting impulses between brain regions. When these neurons in the brain die, they generate less dopamine.

Essentially, dopamine is particularly vital for the activity of another part of the brain called, basal ganglia, where commands for body movement are processed. In short, the progressive movement disorders caused by Parkinson disease is due to insufficient dopamine present in the brain.

Additional factors that appear to play a role in Parkinson's disease include:

• Genetic Factors. Specific genetic mutations can cause Parkinson's disease. However, except in rare circumstances at which many relatives are affected by Parkinson's, they are unlikely.
• Environmental Factors. Certain toxins or external factors may raise the likelihood of developing Parkinson's disease later in life, but minimal risk.

How Does Parkinson's Start?

Few abnormal movements are observed in the early stages of Parkinson's disease. It usually begins with abnormal movements like minor tremors and shaking. As the movement disorders worsen, patients may experience other symptoms like difficulty walking and talking. They may also have behavioural and mental changes, sleep problems, depression, memory issues, and fatigue.

How Parkinson's Disease Is Diagnosed

There are no tests yet that can definitively determine whether or not you have Parkinson's disease. A diagnosis will be made based on underlying symptoms, past medical conditions, and a thorough physical examination by your doctor.

An imaging test, called the DaTscan, which allows clinicians to see detailed images of the brain's dopamine system, may be recommended. Although the results cannot prove that you have Parkinson's disease, they can assist your doctor in confirming a diagnosis.

Parkinson's Disease - Signs & Symptoms

Individuals with Parkinson disease have various indicators and rates of progression. Even when movement disorders start to impact both sides, difficulties typically begin on one side of the body worsen over time.

Parkinson's manifests itself in several common signs, including:

Movement Symptoms

• Tremor. Trembling, or shaking, usually begins in hands and arms, often legs, jaw, or head. Typically, only one side of the body or one leg gets afflicted in the early stages of PD, which later spreads slowly. 'Pill-rolling' tremor affects the hands and fingers and makes it look like the patient is rolling pills between their fingers and thumb.
• Slowed movement or bradykinesia. The inability of the brain to deliver necessary instructions to the proper areas of the body causes the action to slow down. It is unpredictably severe and incapacitating. One may be able to move freely one minute, then require help the next.
• Rigid/Stiff Limbs. Rigidity causes uncontrolled muscle tensing, which creates movement disorders. Stiff muscles can be painful and impair the range of motion.
• Unsteady balance and Stooped Posture. When bumped, the patient might develop a forward lean that makes them more prone to fall. A shuffling gait characterised by small steps and a "hunched over" posture might make it difficult for a patient to begin walking.
• Loss of automatic movement. Unconscious actions like blinking, swinging arms while walking, and smiling may become harder to execute.
• Masked face (hypomimia). Attributed to the combination of bradykinesia and rigidity.
• Difficulty Swallowing (Dysphagia). Patients with PD have difficulty swallowing due to losing control of mouth and throat muscles. A decrease in regular involuntary movements can also result in excessive saliva or drooling.

Restricted Motion

• Akinesia. One of the most common Parkinson disease movement disorders. A condition that leads to loss of ability to move the muscles voluntarily. It is frequently seen in conjunction with muscle rigidity or stiffness, resulting in a loss of arm swing.
• Hypokinesia. Another one of the movement disorders refers to a decrease in the size of movements. In Parkinson disease, hypokinesia accompanies tremor at rest and with rigidity.
• Bradykinesia. Generally known as slow movement, one of Parkinson's most common symptoms. The slowness of motion can take several forms, including a reduction in automatic movements, delays in physical actions, and a lack of facial expression.

Non-Movement Symptoms

While Parkinson's disease is generally understood as a condition that solely causes movement disorders, it can also cause various non-motor symptoms. Some of the patients symptoms are so minor that their family members or friends are unaware of, but they progress slowly.

Among the main symptoms include:

• Mood Disorders. Some indicators include irritability, impulsive behaviour, anxiety, and depression. It's natural to feel depressed or anxious after receiving a Parkinson disease diagnosis, which impacts up to half of all patients. Severe sadness, a loss of interest in enjoyable activities, irritability, and sleep problems are all signs of depression to watch out for.
• Cognitive Changes. Cognitive impairment can cause feelings of distraction or disorganisation, experience difficulties in planning and completing tasks. Symptoms in patients are usually mild, but cognitive deficits can worsen and even lead to dementia for some. It generally occurs a few years after the onset of Parkinson disease, and roughly 40% of patients develop it.
• Sleep Disturbances. Insomnia, excessive daytime sleepiness, vivid dreams, and sleep talking are indicators. Degeneration of the sleep-wake cycle regulators may cause sleep problems and some PD oral medications. More than 75% of patients with Parkinson disease tend to experience sleep problems.
• Impaired Speech. While Parkinson disease cause movement disorders in the body, it also impairs the face, mouth and throat muscles required for speaking and swallowing. Such symptoms lead to difficulties in communication. Some patients struggle to find words, talk in a softer voice, and stutter.

The 5 Stages of Parkinson's Disease

Not everyone with Parkinson' disease will experience all of its symptoms, but in some cases, it won't precisely occur in the same order or degree. To help healthcare professionals track the progressive pattern of Parkinson disease, here are the five stages:

Stage 1

Patients may develop symptoms at this point but usually will not significantly impact everyday activities. The symptoms are so mild that they are overlooked. Tremors and movement difficulties on one side of the body are distinctive symptoms. Treatment by prescription drugs can help reduce tremors and associated symptoms in general.

Stage 2

When symptoms become more noticeable, it's now the moderate stage. More severe stiffness and tremors may occur and abnormalities in facial expressions. It's possible to notice changes in walking and posture as well. As the disease progresses, some basic routines are harder to complete.

Stage 3

This stage is a significant turning point in the disease's progression. The symptoms remain the same as in the previous stage. Unfortunately, loss of balance and slower movement may occur. It's also critical to look out for a lot of falling at this point. Symptoms may greatly hinder basic routines but are still tolerable.

Stage 4

Symptoms are severe and limiting at this stage. While it is possible to stand alone without any assistance, moving may necessitate the use of a walker or any support. The patient requires assistance with everyday activities and is thus unable to live alone.

Stage 5

The most advanced and incapacitating stage. Leg stiffness can make it hard to stand or walk. This stage also necessitates using a wheelchair, as many patients cannot stand alone without falling. All activities demand round-the-clock patient care. Hallucinations and delusions affect up to 50% of patients in Stages 4 and 5. Dementia, which impacts about 50% -80% of patients, is also common.

Treatment Options for Parkinson's Disease

While there is no cure available for Parkinson disease altogether, medications, surgical treatment, lifestyle changes, and other therapies can help alleviate the symptoms.

Several options are available to improve symptoms of Parkinson's disease, including:

Healthy, Balanced Diet

While no specific healthy diet has been proven to treat the symptoms of Parkinson's, certain foods may help. Constipation can be remedied by eating meals high in fibre. A well-balanced diet also contains a beneficial nutrient that may help patients with Parkinson's disease, such as omega-3 fatty acids.

Stay Active

Exercising can help strengthen muscles, improve flexibility, and boost balance. Also,  it can enhance the mood and help deal with depression or anxiety. Since Parkinson's disease can make it very hard to walk with a regular gait, as it affects the sense of balance, exercise can aid with that.

Rely on Tools

For those with Parkinson's disease, daily activities such as clothing, eating, bathing, and writing might be challenging. Use deliberate, concentrated movements and, if necessary, a grasping bar or walking aid to reduce the chance of falling. For assistive device options, it's also essential to speak to occupational therapists.

Fall-Proof Your Home

With the help of occupational therapists, households can be amended to allow patients with Parkinson's disease to act independently. To prevent falls from everyday hazards, install non-skid mats, metal handles for doorknobs and stairs, or minimise clutter altogether. 

Prioritise Self-Care and Support

Living with severe disease can be challenging, and it's okay to feel irritated or depressed now and then. Parkinson's disease, in particular, can be aggravating because of movement disorders. Aside from looking after yourself, seek assistance from family and friends, or look for community support groups. It may be a valuable resource for information on Parkinson's disease and an outlet for support to those experiencing the same difficulties.

Take Medication

Low brain dopamine concentrations are found in patients with Parkinson's disease. On the other hand, dopamine cannot be administered directly to the brain. However, medication may boost or substitute dopamine production.

Several medications prescribed for Parkinson's include:

• Carbidopa-levodopa. Parkinson's disease symptoms such as slowness of movement, tremor, and stiffness are treated with levodopa. It is utilised by nerve cells to generate dopamine, which replenishes the low levels observed in the brain of patients with PD.
• Dopamine agonists. Dopamine agonists don't necessarily replace dopamine but rather mimic its function compared to levodopa. However, they aren't as effective to treat patients as levodopa. However, they persist longer and can be taken with levodopa to smooth out its effect.
• MAO B inhibitors. These certain medications inhibit the enzyme monoamine oxidase B (MAO B), which breaks down dopamine in the brain. MAO B inhibitors, however, are not prescribed to take in conjunction with antidepressants or narcotic medications.
• Amantadine. First developed as an antiviral agent. This drug helps to reduce involuntary movements brought by taking levodopa.
• Anticholinergics. One of the oldest classes of Parkinson's disease medications helps lessen tremor and muscle stiffness.

Undergo Surgical Treatment

Medications can help most Parkinson's disease patients retain a good quality of life. However, some patients may find that drugs are no longer helpful when the disease progresses and surgery becomes viable.

Deep Brain Stimulation

For patients who fail to have an excellent response to medications, deep brain stimulation (DBS) may be suitable. In this surgical procedure, surgeons implant electrodes in the brain. The electrodes send electrical impulses to the brain to inhibit or alter the abnormal activity that causes symptoms of Parkinson's disease.

Deep brain stimulation (DBS) can deal with most Parkinson's main symptoms. It can also help moderate medication fluctuations, minimise or stop involuntary movements, reduce tremors, stiffness, and improve slowed movement. However, it bears the same risks as other brain surgery, such as stroke or brain haemorrhage.

DBS may provide long-term relief from Parkinson's symptoms, but it does not stop the disease from advancing.

Is It Possible to Prevent Parkinson's?

At present, there is no known treatment available that can effectively delay the progression of movement disorder symptoms of Parkinson's disease, as per the National Institute of Neurological Disorders and Stroke (NINDS).

Since the underlying cause of Parkinson's remains unknown, preventive therapies are also lacking. In relieving PD symptoms and minimising the influence on patients, it is recommended to incorporate physical exercise into a daily routine and keep a healthy and balanced diet.

Parkinson's Disease: Professional Resource & Support in Singapore

Various healthcare professionals may engage in managing your Parkinson's disease. Singapore has a wide variety of medical professionals who treat the different manifestations and underlying cause of the disease. Depending on the symptoms, some experts will play a significant role in your treatment journey than others. Essentially, it is best to recognise and accept support from others in managing your condition.

The multidisciplinary team in charge of your care is as follows:

• General Practitioner. If you have symptoms, the first person you should see is your general practitioner. Before your diagnosis, they are most likely the ones responsible for referring you to a range of other healthcare professionals.
• Parkinson's Specialist. A neurologist or geriatrician who specialises in Parkinsons disease. If your condition is difficult to handle or progresses quickly, this specialist may be heavily involved in your care.
• Nurse Practitioner. Nurse clinicians are crucial in assessing the course of Parkinson's disease and identifying and managing the most difficult symptoms. As part of the team, nurse clinicians should be aware of the value of ongoing medication instruction.
• Occupational Therapists. They assess your abilities to perform daily duties and provide recommendations for making your home safer and easier to manage.
• Speech Therapists. Speech therapists assist people in adjusting to changes in their speech or swallowing ability. They can suggest tools or exercises that help with quiet speech and foods ideal for swallowing difficulties.

Life with Parkinson's Disease

While living with Parkinsons disease might be challenging, it's crucial to consider the patient's individual needs and the steps to regain control in life. Developing and sustaining ties with professionals in the field of Parkinson's disease can make life easier, on top of relying on family and friends for support.

For one, the Parkinson community in Singapore relies on a well-integrated network of community healthcare facilities to offer patients the best care available. Several healthcare institutions, such as the National Neuroscience Institute (NNI) at Tan Tock Seng Hospital (TTSH) and Singapore General Hospital (SGH), offer community care partners programme. It has a great emphasis on providing excellent movement disorders clinics and robust research activities for PD patients.

Aside from Parkinson's specialists, patients with increasing needs may benefit from various care services and resources like memory care homes in supporting their journey to maintain a normal lifestyle. As Parkinson's disease advances, your loved one will require more assistance with daily activities, which care facilities for elderly home singapore can provide.

Various treatment options are explored in dealing with Singapore's prominent Parkinson's disease. Be proactive and take early steps to understand the condition and its symptoms. Doing so can benefit you and your loved one, face any complications and restore a sense of control in life.