The lifetime risk of developing PD is around 1%, 3% if a first degree relative is affected with PD. The risk at age 65 years and older is 4-5%

There are genetic risk factors common to certain ethnic populations such as Ashkenazi Jews (GBA and LRRK2), but more so environmental risk factors such as exposure to pesticides and herbicides, and prior head injury.

We cannot predict who will develop PD. We do not have any medication that can prevent PD, however a healthy lifestyle, quality sleep, use of caffeine, a Mediterranean diet and EXERCISE can help to decrease the risk of developing the disease.

This phenomena can is termed autonomic dysfunction, and orthostatic hypotension. Syncope (fainting) is the second most common cause of hospitalization in PD.  This is often associated with supine hypertension, or very high BP when lying down. This occurs in 60-90% of individuals with PD (20-30% with significant symptoms). This may actually precede the PD motor symptoms. Some treatments may include increased Na intake, keeping hydrated, compression stockings, use of medications and monitoring use of anti-hypertensive medication use to avoid sudden drop in BP.

Apathy and depression can exist in PD. Apathy refers to reduced interest or motivation in activities, but individuals do not feel sad or helpless. This can be confused with depression and cognitive decline. If not addressed, apathy can become a risk factor for cognitive decline. Although no proven treatment, medications may be helpful.

Depression affects up to 60% of individuals with PD. The diagnosis may be difficult, as symptoms such as sleep difficulties fatigue, apathy, psychomotor slowing are common to both disorders.  PD depression is often poorly responsive to pharmacological treatment, and may worsen motor symptoms of PD. Depression may lead to cognitive decline and dementia.

Waking difficulties may start a number of years after the onset of PD. Some features of gait impairments include decreased step height, decreased step length/cadence/speed, decreased trunk sway, postural changes, and en bloc turning.

Freezing of gait (FOG) is a sensation as if the feet are glued to the ground. There is difficulty taking the first step, and when turning. There may be difficulties going through doorways, elevators and narrow passages.  FOG may respond to cueing strategies and sensory stimulation such as laser lights, music.

Persons with PD are often not aware of their speech difficulties. Some characteristics of parkinson’s related speech include the following. Hypophonia refers to a reduced amplitude of neural drive and speech motor that may result in reduced vocal loudness. Hypoprosody refers to pitch inflection. Hypokinetic articulation refers to reduced range of articulatory movements. Dysarthria refers to a slurring of speech and difficulty articulating words. Tachyphemia refers to fast speech producing a rapid stammering.

There are certain proven therapy related treatments that can address some of these concerns and include LSVT, SPEAK OUT and LOUD CROWD.

Cognitive changes can occur in PD. These may include “tip of the tongue” phenomenon and trouble finding the right words. Problems can also occur in executive functioning, including trouble with multi-tasking, organization and planning, difficulty switching focus and tasks, as well as decreased initiation of activities

Visuospatial functioning can also be affected, manifest by worsening sense of direction, getting lost in familiar places, difficulty navigating unfamiliar places and misjudging distances and locations. Cognitive training and cognitive rehabilitation therapies may be helpful.

After prolonged L-Dopa treatment, months to years, duration of each individual dose becomes shorter and shorter (weaning OFF or ON/OFF phenomena). Excessive and involuntary movements can occur when the medication is effective (dyskinesia). Treatment of dyskinesia includes fine toning and adjusting the dose of dopamine as well as introducing other agents that may reduce dyskinesia.

The most compelling research shows that exercise improves PD symptoms, delays Parkinson’s progression, decreases rate of complications, and improves mood and cognitive functioning. Parkinson’s rehabilitation and physical medicine modalities can include PT, OT, ST, cognitive therapy, vestibular therapy as well as music, dance and other structural/postural treatments and movement based exercises. Various interactive and virtual technologies are also being used.

DBS has been approved by the FDA for patients who have severe motor fluctuations and/or dyskinesias that can no longer be controlled with medication adjustments. Indications generally are age < 75, normal cognition, and no other major medical problems. Complications (2-3%) include bleeding in the brain or infection, paralysis, loss of vision, decreased cognition, and worsening of gait and balance.  Other technologies such as focused ultrasound should also be considered when being evaluated for this type of intervention.