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Parkinson's Disease

What causes this improvement?

04/12/2005

Question:

My friend who has had Parkinson`s Disease for about 8years, and is on levodopa treatment only, feels very unwell for most of the time and has very little enthusiasm for doing anything. He also, physically, has a problem coping with the demands of everyday life. Very recently he has been diagnosed with depression and will begin treatment for this very soon. However, whenever he is in a situation where there is some stress he is markedly improved and has a much better quality of life. He had to attend a funeral and coped very well; he is well when he attends the local Parkinson`s support group; at a consultation with a senior neurologist he was particularly well and could do things he cannot normally do (put his own shoes on, write a sentence, walk well). His wife, who obviously is coping with his incapacity daily, gets totally frustrated because, apart from these isolated times, he is capable of doing very little and no doctor is actually seeing this. Can you tell me if this is a common finding in Parkinson`s Disease and whether a surge of something (adrenalin?) is actually helping with the physical side of the Parkinson`s Disease? Also, is there any way we can employ this to help my friend at other times?

Answer:

PD is an interesting disease indeed, because of its variability, not just day to day, but sometimes from hour to hour.  While it is believed that alteration in dopamine levels in the brain play the main role in causing the symptoms of PD, it is true that there are other neurotransmitters (brain chemicals) affected also.  The combination of changes in neurotransmitters (dopamine, norepinephrine and serotonin for example) can cause alterations not only in mobility in patients, but also in mood, motivation, behavior and sleep patterns.  At least 50% of persons with PD also suffer some degree of depression or mood disturbance.  This in turn can worsen mobility by causing a general sense of malaise, less motivation for activity, and exercise and even poorer sleep.  It all becomes a cycle.  Aggressive treatment of depression is very important, therefore, for these reasons.  However, maintaining a daily exercise program and an active lifestyle are just as important to this treatment as medication.  An example of the effectiveness is seen in patients that do better when they are engaged in activity outside of the home, but at home are sedentary and become more symptomatic. 

In summary, optimal PD medication treatment is important to mobility as well as aggressive treatment for mood disturbances because of multiple neurotransmitters being involved.  Non-medication therapy including daily exercise will further improve mobility and mood in PD patients.

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Response by:

Karen M Thomas, DO Karen M Thomas, DO
Formerly:
College of Medicine
The Ohio State University