Parkinson’s disease (PD) is often thought of as an “old person’s disease,” but up to 10% of all cases are diagnosed in patients who are age 50 or younger. When actor Michael J. Fox revealed he had been diagnosed at age 29, he had been battling Parkinson’s for seven years, and he became the face of what is referred to as young-onset Parkinson’s disease or (YOPD).
Because most people think of Parkinson’s as a disease that primarily strikes older people, in younger patients the correct diagnosis may be missed or delayed as symptoms are attributed to other conditions. It’s not uncommon for symptoms such as arm or shoulder stiffness to be attributed to arthritis, sports injuries or other medical conditions and a person may see multiple providers and undergo several tests before finally getting the correct diagnosis.
As with Parkinson’s diagnosed later in life, YOPD is diagnosed based on a person’s medical history and physical examination. No biomarker – objective measurement (protein levels seen in a lab test or imaging scan, for example) that can diagnose Parkinson’s – has been validated. Well-Being spoke to Dr. Juebin Huang a movement disorder specialist at the University of Mississippi Medical Center Department of Neurology about some of the challenges of diagnosing and treating young-onset Parkinson’s disease.
“The symptoms of PD can be elusive,” explains Dr. Huang. “ Some people experience a slowness or stiffness in their arms. I saw one young woman, just 38 years old, and she described a weakness on her left side for about 3 years. She said it was hard to use her left hand and foot. The first reaction might be to test for stroke, or nerve or muscle disorders. As a matter of fact, she had been seeking care from multiple neurologists and she had multiple ER visits for her left side weakness. Lots of tests including MRIs and a nerve conduction study were done without a conclusion regarding what was going on with her left side weakness. When she was referred to me, I was able to recognize that her “weakness’ is actually stiffness and slowness of movement which led to the diagnosis of Parkinson’s for her. She responded to Parkinson’s medications very well and was able to resume most of her activities including, painting her house!”
People are usually more familiar with the motor symptoms of PD such as tremors and involuntary movement, as these are the signs of the disease that are noticeable from the outside. But, Parkinson’s patients can have non-motor symptoms that can also have a major impact on their daily lives. These symptoms include cognitive impairment, mood disorders, problems sleeping, low blood pressure, constipation, speech and swallowing problems.
Medications for Parkinson’s Disease
Currently, a number of medications are available for the management of both motor and non-motor symptoms of PD. All of them are designed to ease symptoms and improve quality of life. At this time, there is no cure that stops or slows disease progression, but significant work is ongoing in this area.
Currently available drugs for motor symptoms primarily target tremor, stiffness and slowness, while those for non-motor symptoms focus on the associated symptoms (such as depression, sleep disturbances and low blood pressure) that may arise throughout the course of the disease. Improved medications are under development for motor and non-motor symptoms.
The medications that are prescribed should be tailored to each patient’s unique symptoms. There is no “one-size-fits-all” approach. Most often, drug therapy is started when symptoms begin to interfere with a person’s ability to do what they want or need to do. Deciding if, when and which medication to take is a personal decision best made in conjunction with a movement disorder specialist. Each patient has to take into account their own symptoms and how they interfere daily life, and weigh the potential benefits, side effects and costs of the currently available medications.
“The factor of side effects from medications for younger patients is particularly challenging,” notes Dr. Huang. “Should they delay taking medications to prevent the long-term damage of the side effects, knowing their symptoms may interfere with their daily life? Or should they begin medications earlier to enjoy more quality of life for as long as they can while they are younger and have the responsibilities of a career, marriage and children? Often, if a patient is young and still working we will be aggressive in treatment so they can function at work at a higher level.”
“Besides taking medications, one of the most important things we can recommend for PD patients, especially those who are younger, is regular exercise,” adds Dr. Huang. “It’s crucial that they exercise consistently to have the most impact. Exercise like yoga and tai chi are excellent, but walking, marching to music with big arm swings, golfing, ping pong, or tennis all help. The key is consistency. Research using mice shows that staying active can slow the deterioration of cells in the brain that are affected by Parkinson’s disease.”
There is a lot a person can do to proactively affect the course of Parkinson’s disease and live a full, happy and healthy life. For information and resources visit www.michaeljfox.org.
Juebin Huang, M.D., Neurology, received his Doctor of Medicine degree from West China University of Medical Sciences and his PhD at Peking Union Medical College Hospital. He served his internship and residency at University of Mississippi Medical Center and completed research fellowships in Neuroimaing at Baylor College of Medicine and Case Western Reserve University. He is board certified in Neurology. His practice focuses on neurodegenerative disorders such as Parkinson’s disease, Alzheimer’s disease, Huntington’s disease, etc.