“Though the term “autism” first appeared around 1911, very little was known or medically researched about autism spectrum disorder until the late 20th century. New discoveries and advancements continue to be made today to help individuals on the spectrum achieve their full potential.

What disorders are related to ASD?

Certain known genetic disorders are associated with an increased risk for autism, including Fragile X syndrome (which causes intellectual disability) and tuberous sclerosis (which causes benign tumors to grow in the brain and other vital organs) — each of which results from a mutation in a single, but different, gene. Recently, researchers have discovered other genetic mutations in children diagnosed with autism, including some that have not yet been designated as named syndromes. While each of these disorders is rare, in aggregate, they may account for 20 percent or more of all autism cases.

People with ASD also have a higher than average risk of having epilepsy. Children whose language skills regress early in life — before age 3 — appear to have a risk of developing epilepsy or seizure-like brain activity. About 20 to 30 percent of children with ASD develop epilepsy by the time they reach adulthood. Additionally, people with both ASD and intellectual disability have the greatest risk of developing seizure disorder.

How is ASD diagnosed?

ASD symptoms can vary greatly from person to person depending on the severity of the disorder. Symptoms may even go unrecognized for young children who have mild ASD or less debilitating handicaps. Very early indicators that require evaluation by an expert include:

• no babbling or pointing by age 1
• no single words by age 16 months or two-word phrases by age 2.
• no response to name
• loss of language or social skills previously acquired
• poor eye contact
• excessive lining up of toys or objects
• no smiling or social responsiveness

Later indicators include:

• impaired ability to make friends with peers
• impaired ability to initiate or sustain a conversation with others
• absence or impairment of imaginative and social play
• repetitive or unusual use of language
• abnormally intense or focused interest
• preoccupation with certain objects or subjects
• inflexible adherence to specific routines or rituals

Health care providers will often use a questionnaire or other screening instrument to gather information about a child’s development and behavior. Some screening instruments rely solely on parent observations, while others rely on a combination of parent and doctor observations. If screening instruments indicate the possibility of ASD, a more comprehensive evaluation is usually indicated.

A comprehensive evaluation requires a multidisciplinary team, including a psychologist, neurologist, psychiatrist, speech therapist, and other professionals who diagnose and treat children with ASD. The team members will conduct a thorough neurological assessment and in-depth cognitive and language testing. Because hearing problems can cause behaviors that could be mistaken for ASD, children with delayed speech development should also have their hearing tested.

What causes ASD?

Scientists believe that both genetics and environment likely play a role in ASD. There is great concern that rates of autism have been increasing in recent decades without full explanation as to why. Researchers have identified a number of genes associated with the disorder. Imaging studies of people with ASD have found differences in the development of several regions of the brain. Studies suggest that ASD could be a result of disruptions in normal brain growth very early in development. These disruptions may be the result of defects in genes that control brain development and regulate how brain cells communicate with each other. Autism is more common in children born prematurely. Environmental factors may also play a role in gene function and development, but no specific environmental causes have yet been identified. The theory that parental practices are responsible for ASD has long been disproved. Multiple studies have shown that vaccination to prevent childhood infectious diseases does not increase the risk of autism in the population.

What role do genes play?

Twin and family studies strongly suggest that some people have a genetic predisposition to autism. Identical twin studies show that if one twin is affected, then the other will be affected between 36 to 95 percent of the time. There are a number of studies in progress to determine the specific genetic factors associated with the development of ASD. In families with one child with ASD, the risk of having a second child with the disorder also increases. Many of the genes found to be associated with autism are involved in the function of the chemical connections between brain neurons (synapses). Researchers are looking for clues about which genes contribute to increased susceptibility. In some cases, parents and other relatives of a child with ASD show mild impairments in social communication skills or engage in repetitive behaviors. Evidence also suggests that emotional disorders such as bipolar disorder and schizophrenia occur more frequently than average in the families of people with ASD.

In addition to genetic variations that are inherited and are present in nearly all of a person’s cells, recent research has also shown that de novo, or spontaneous, gene mutations can influence the risk of developing autism spectrum disorder.  De novo mutations are changes in sequences of deoxyribonucleic acid or DNA, the hereditary material in humans, which can occur spontaneously in a parent’s sperm or egg cell or during fertilization. The mutation then occurs in each cell as the fertilized egg divides. These mutations may affect single genes or they may be changes called copy number variations, in which stretches of DNA containing multiple genes are deleted or duplicated.  Recent studies have shown that people with ASD tend to have more copy number de novo gene mutations than those without the disorder, suggesting that for some the risk of developing ASD is not the result of mutations in individual genes but rather spontaneous coding mutations across many genes.  De novo mutations may explain genetic disorders in which an affected child has the mutation in each cell but the parents do not and there is no family pattern to the disorder. Autism risk also increases in children born to older parents. There is still much research to be done to determine the potential role of environmental factors on spontaneous mutations and how that influences ASD risk.

Do symptoms of autism change over time?

For many children, symptoms improve with age and behavioral treatment. During adolescence, some children with ASD may become depressed or experience behavioral problems, and their treatment may need some modification as they transition to adulthood. People with ASD usually continue to need services and supports as they get older, but depending on severity of the disorder, people with ASD may be able to work successfully and live independently or within a supportive environment.

How is autism treated?

There is no cure for ASD. Therapies and behavioral interventions are designed to remedy specific symptoms and can substantially improve those symptoms. The ideal treatment plan coordinates therapies and interventions that meet the specific needs of the individual. Most health care professionals agree that the earlier the intervention, the better.

Educational/behavioral interventions: Early behavioral/educational interventions have been very successful in many children with ASD. In these interventions therapists use highly structured and intensive skill-oriented training sessions to help children develop social and language skills, such as applied behavioral analysis, which encourages positive behaviors and discourages negative ones. In addition, family counseling for the parents and siblings of children with ASD often helps families cope with the particular challenges of living with a child with ASD.

Medications: While medication can’t cure ASD or even treat its main symptoms, there are some that can help with related symptoms such as anxiety, depression, and obsessive-compulsive disorder. Antipsychotic medications are used to treat severe behavioral problems. Seizures can be treated with one or more anticonvulsant drugs. Medication used to treat people with attention deficit disorder can be used effectively to help decrease impulsivity and hyperactivity in people with ASD. Parents, caregivers, and people with autism should use caution before adopting any unproven treatments

“The effects of parkinsonism depend on why it happens. Most parkinsonian conditions affect parts of your brain responsible for movement. That means you move more slowly. You also may have muscle tremors, causing you to shake.

Under normal circumstances, your brain uses chemicals known as neurotransmitters to control how your brain cells (neurons) communicate with each other. When you have Parkinson’s disease, you don’t have enough dopamine, one of the most important neurotransmitters.

When your brain sends activation signals that tell your muscles to move, it fine-tunes your movements. The neurons that fine-tune your movements need dopamine. Without it, they can’t do their job correctly. That’s why lack of dopamine causes the slowed movements and tremors symptoms of Parkinson’s disease.

With lack of dopamine, the basal ganglia (a key area of your brain) start to deteriorate. As they do, you lose the abilities they once controlled. As Parkinson’s disease gets worse, the symptoms expand and intensify. Later stages of the disease often affect how your brain functions, causing dementia-like symptoms and depression.”

Cleveland Clinic (Parkinsonism: What It Is, Causes & Types)

Types of Meds Used 

(click box to enlarge writing,if needed)

Parkinson’s disease is the second most common progressive, neurodegenerative disease after Alzheimer disease. Parkinson’s disease is named after James Parkinson, a 19^th century general practitioner in London. Parkinson’s disease is characterised by pathologic intra-neuronal α–synuclein-positive Lewy bodies and neuronal cell loss. Classically this process has been described as involving the dopaminergic cells of the substantia nigra pars compacta, later becoming more widespread in the CNS as the disease progresses. However, recently there has been a growing awareness that the disease process may involve more caudal portion of the CNS and the peripheral nervous system prior to the clinical onset of the disease.¹ Parkinson’s disease affects movement, muscle control, balance, and numerous other functions.

MEDS: The combination of levodopa and carbidopa (Brand names Sinemet, Parcopa, Duopa^® (as a combination product containing Carbidopa, Levodopa=Rytary^® (as a combination product containing Carbidopa, Levodopa).

Levodopa and carbidopa are used to treat the symptoms of Parkinson’s disease and Parkinson’s-like symptoms that may develop after encephalitis (swelling of the brain) or injury to the nervous system caused by carbon monoxide poisoning or manganese poisoning. Parkinson’s symptoms, including tremors (shaking), stiffness, and slowness of movement, are caused by a lack of dopamine, a natural substance usually found in the brain. Levodopa is in a class of medications called central nervous system agents. It works by being converted to dopamine in the brain. Carbidopa is in a class of medications called decarboxylase inhibitors. It works by preventing levodopa from being broken down before it reaches the brain. This allows for a lower dose of levodopa, which causes less nausea and vomiting.

Medications are commonly used to increase the levels of dopamine in the brain of patients with Parkinson’s disease in an attempt to slow down the progression of the disease. Dopaminergic agents remain the principal treatments for patient with Parkinson’s disease, such as Levodopa and Dopaminergic agonist. In many patients, however, a combination of relatively resistant motor symptoms, motor complications such as dyskinesias or non-motor symptoms such as dysautonomia may lead to substantial disability in spite of dopaminergic therapy. In recent days, there has been an increasing interest in agents targeting non-motor symptoms, such as dementia and sleepiness.

As patients with Parkinson’s disease live longer and acquire additional comorbidities, addressing these non-motor symptoms has become increasingly important. Among anti-depressants, Amitriptiline and SSRI are commonly used, while Rivastigmine became the first FDA approved medication for the treatment of dementia associated with PD.

SURGERY:   Surgery for Parkinson’s disease has come a long way since it was first developed more than 50 years ago. The newest version of this surgery, deep brain stimulation (DBS), was developed in the 1990s and is now a standard treatment. Worldwide, about 30,000 people have had deep brain stimulation.

Lifestyle modifications have been shown to be effective for controlling motor symptoms in the early stages of Parkinson’s disease. The surgical treatment options available for Parkinson’s patients with severe motor symptoms are pallidotomy, thalamotomy and Deep Brain Stimulation (DBS).

The novel approaches for treatment of Parkinson’s disease that are currently under investigation include neuroprotective therapy, foetal cell transplantation, and gene therapy.

What is DBS?

For patients whose symptoms are not adequately controlled by medications:

DBS=Deep Brain Stimulation was introduced two decades+ ago and has gained widespread popularity as a surgical treatment for medically refractory Parkinson’s disease. DBS is a reversible procedure that has advantage over surgical lesioning (pallidotomy) and unilateral brain stimulation. DBS is comparable in efficacy to unilateral surgical lesioning while bilateral subthalamic nucleus stimulation is superior to pallidotomy. DBS is FDA approved for the treatment of medically refractory Parkinson’s disease and ET. DBS has proven its efficacy in the treatment of cardinal motor features of Parkinson’s disease such as bradykinesia, tremor and rigidity and it is unresponsive for non-motor symptoms such as cognition, speech, gait disturbance, mood and behavior. Long-term studies have demonstrated that many of these effects last for long as levodopa responsiveness in maintained

During deep brain stimulation surgery, electrodes are inserted into the targeted brain region using MRI and neurophysiological mapping to ensure that they are implanted in the right place. A device called an impulse generator or IPG (similar to a pacemaker) is implanted under the collarbone to provide an electrical impulse to a part of the brain involved in motor function. Those who undergo the surgery are given a controller, which allows them to check the battery and to turn the device on or off. An IPG battery lasts for about three to five years and is relatively easy to replace under local anesthesia.

Is DBS Right for Me?

Although DBS is certainly the most important therapeutic advancement since the development of levodopa, it is not for every person with Parkinson’s. It is most effective – sometimes, dramatically so – for individuals who experience disabling tremors, wearing-off spells and medication-induced dyskinesias.

Deep brain stimulation is not a cure for Parkinson’s, and it does not slow disease progression. Like all brain surgery, deep brain stimulation surgery carries a small risk of infection, stroke, or bleeding. A small number of people with Parkinson’s have experienced cognitive decline after this surgery. That said, for many people, it can dramatically relieve some symptoms and improve quality of life. Studies show benefits lasting at least five years.

Gamma Knife radiosurgery

 Gamma Knife radiosurgery is a painless procedure that uses hundreds of highly focused radiation beams to target deep brain regions to create precise functional lesions within the brain, with no surgical incision. Gamma Knife may be a treatment option for patients with Parkinson’s tremor who are high risk for surgery due to medical conditions or advanced age.

As the nation’s leading provider of Gamma Knife procedures, UPMC has treated more than 12,000 patients with tumors, vascular malformations, pain, and other functional problems.

It is very important that a person with Parkinson’s who is thinking of treatment from meds to surgery to possiby Gamma Knife radiosurgery be well informed about the procedures and realistic in his or her expectations. This means there’s no standard treatment for the disease – the treatment for each person with Parkinson’s is based on his or her symptoms.

Other treatments include:

Lifestyle and home remedies

Some lifestyle changes may help ease your Parkinson’s disease symptoms. But certain medicines can make your symptoms worse. Ask your healthcare team which remedies provide the greatest symptom relief with the fewest side effects.

Healthy eating

No foods are proved to treat Parkinson’s disease, but some may help ease symptoms. For example, eating foods high in fiber and drinking plenty of fluids can help prevent constipation.

A balanced diet also provides nutrients, such as omega-3 fatty acids, that may help people with Parkinson’s disease.

Exercise

Exercising may improve your muscle strength, walking, flexibility and balance. It also may help decrease depression and anxiety.

Ask your healthcare professional to suggest a physical therapist who can help create an exercise program for you. Exercises that may help include walking, swimming, gardening, dancing, water aerobics and stretching.

To improve your balance and gait, try these tips:

• Don’t move too quickly.
• Put down your heel first when walking.
• Look straight ahead, not down, when you walk.

Prevent falls

The following tips may help:

• Don’t rush.
• Don’t do too many things at once.
• Use handrails.
• Use night-lights.
• Don’t use throw rugs or rolling chairs and keep cords out of the way.
• Learn new turning and walking techniques, including landing on your heel first. Also, stand tall and look straight ahead rather than down at your feet when you walk. If you start shuffling, stop. Check your posture and make sure you’re standing up straight.
• Use a walker or cane if your healthcare professional recommends it.

Daily living activities

These healthcare professionals can help with daily tasks:

• Occupational therapist. An occupational therapist can show you ways to help with activities such as dressing, bathing and cooking.
• Speech therapist. A speech therapist may be able to help with swallowing and speech problems.

Your Parkinson’s Disease MD is the best to review what treatment with alternative treatments you should include in your plan.  Always check with your MD!

Last reviewed 4/06/26 by Elizabeth Lynch RN BSN

“Parkinson’s disease statistics

• Parkinson’s disease is the fastest growing neurodegenerative disease in the world, and the second most common after Alzheimer’s disease.
• There are an estimated 1 million people in the U.S. living with PD and more than 10 million people worldwide.
• Every 6 minutes, someone is diagnosed with PD.
• On average, 240 people are diagnosed with PD every day = totaling approximately 90,000 new diagnoses every year.
• The average age of onset is 60, but 10% of diagnoses occur before age 50 (known as Young Onset Parkinson’s)
• Men are 50% more likely to get PD than women.
• The annual economic burden of PD in the U.S. is approximately $52 billion.”

American Parkinson’s Disease Foundation  (What is Parkinson’s Disease | APDA)

What are the signs and symptoms (s/s) of this disease?

The early signs and symptoms of Parkinson’s disease that are often overlooked by both patients and doctors because the symptoms are subtle and the progression of the disease is typically slow. S/S of parkinson’s disease are:

Parkinson’s disease does not affect everyone the same way. In some people the disease progresses quickly, in others it does not. Although some people become severely disabled, others experience only minor motor disruptions. Tremor is the major symptom for some patients, while for others tremor is only a minor complaint and different symptoms are more troublesome.

The Motor function symptoms associated with Parkinson’s Disease:

• The tremors associated with Parkinson’s disease has a characteristic appearance. Typically, the tremor takes the form of a rhythmic back-and-forth motion of the thumb and forefinger at three beats per second. This is sometimes called “pill rolling.” Tremor usually begins in a hand, although sometimes a foot or the jaw is affected first. It is most obvious when the hand is at rest or when a person is under stress. In three out of four patients, the tremor may affect only one part or side of the body, especially during the early stages of the disease. Later it may become more general. Tremor is rarely disabling and it usually disappears during sleep or improves with intentional movement.
• Rigidity, or a resistance to movement, affects most parkinsonian patients. A major principle of body movement is that all muscles have an opposing muscle. Movement is possible not just because one muscle becomes more active, but because the opposing muscle relaxes. In Parkinson’s disease, rigidity comes about when, in response to signals from the brain, the delicate balance of opposing muscles is disturbed. The muscles remain constantly tensed and contracted so that the person aches or feels stiff or weak. The rigidity becomes obvious when another person tries to move the patient’s arm, which will move only in ratchet-like or short, jerky movements known as “cogwheel” rigidity.
• Bradykinesia, or the slowing down and loss of spontaneous and automatic movement, is particularly frustrating because it is unpredictable. One moment the patient can move easily. The next moment he or she may need help. This may well be the most disabling and distressing symptom of the disease because the patient cannot rapidly perform routine movements. Activities once performed quickly and easily — such as washing or dressing — may take several hours.
• Postural instability, or impaired balance and coordination, causes patients to develop a forward or backward lean and to fall easily. When bumped from the front or when starting to walk, patients with a backward lean have a tendency to step backwards, which is known as retropulsion. Postural instability can cause patients to have a stooped posture in which the head is bowed and the shoulders are drooped.

The Non-Motor function symptoms that are often associated with Parkinson’s Disease include:

-Cognitive impairment –Dementia –Psychosis –Depression –Fatigue -Sleep disturbances -Constipation -Sexual dysfunction -Vision disturbances.

As the disease progresses, walking may be affected. Patients may halt in mid-stride and “freeze” in place, possibly even toppling over.  Patients may walk with a series of quick, small steps as if hurrying forward to keep balance. This is known as festination.

A detailed overview of the Unified Parkinson’s Disease Rating Scale that is used by doctors to follow the course of disease progression and evaluate the extent of impairment and disability.

Abstract

The Movement Disorder Society Task Force for Rating Scales for Parkinson’s Disease prepared a critique of the Unified Parkinson’s Disease Rating Scale (UPDRS). Strengths of the UPDRS include its wide utilization, its application across the clinical spectrum of PD, its nearly comprehensive coverage of motor symptoms, and its clinimetric properties, including reliability and validity. Weaknesses include several ambiguities in the written text, inadequate instructions for raters, some metric flaws, and the absence of screening questions on several important non-motor aspects of PD. The Task Force recommends that the MDS sponsor the development of a new version of the UPDRS and encourage efforts to establish its clinimetric properties, especially addressing the need to define a Minimal Clinically Relevant Difference and a Minimal Clinically Relevant Incremental Difference, as well as testing its correlation with the current UPDRS. If developed, the new scale should be culturally unbiased and be tested in different racial, gender, and age-groups. Future goals should include the definition of UPDRS scores with confidence intervals that correlate with clinically pertinent designations, “minimal,” “mild,” “moderate,” and “severe” PD. Whereas the presence of non-motor components of PD can be identified with screening questions, a new version of the UPDRS should include an official appendix that includes other, more detailed, and optionally used scales to determine severity of these impairments.

How Parkinson’s disease is diagnosed:

There isn’t a specific test to diagnose Parkinson’s disease;  it is based on factors such as signs/symptoms, patient history, physical examination, and a thorough neurological evaluation.

A doctor trained in nervous system conditions (neurologist) will diagnose Parkinson’s disease based on your medical history, a review of your signs and symptoms, and a neurological and physical examination.

Your doctor may suggest a specific single-photon emission computerized tomography (SPECT) scan called a dopamine transporter (DAT) scan. Although this can help support the suspicion that you have Parkinson’s disease, it is your symptoms and neurological examination that ultimately determine the correct diagnosis. Most people do not require a DAT scan.

Furthermore, making the diagnosis is even more difficult since there are currently no blood or lab tests available to diagnose the disease. Your health care provider may order lab tests, such as blood tests, to rule out other conditions that may be causing your symptoms.  Some tests, such as a CT Scan (computed tomography) or MRI (magnetic resonance imaging) and PET Scans may be used to rule out other disorders that cause similar symptoms. Imaging tests aren’t particularly helpful for diagnosing Parkinson’s disease.  Given these circumstances, a doctor may need to observe the patient over time to recognize signs of tremor and rigidity, and pair them with other characteristic symptoms.

The doctor will also compile a comprehensive history of the patient’s symptoms, activity, medications, other medical problems, and exposures to toxic chemicals. This will likely be followed up with a rigorous physical exam with concentration on the functions of the brain and nervous system. Tests are conducted on the patient’s reflexes, coordination, muscle strength, and mental function. Making a precise diagnosis is essential for prescribing the correct treatment regimen. The treatment decisions made early in the illness can have profound implications on the long-term success of treatment.

Recommended Related to Parkinson’s

Questions to Ask Your Doctor About Parkinson’s Disease:

Since you’ve recently been diagnosed with Parkinson’s disease, ask your doctor these questions at your next visit.   1.What stage is my illness in now?

2. How quickly do you think my disease will progress?

3. How will Parkinson’s disease affect my work?

4. What physical changes can I expect?

5. Will I be able to keep up the activities, hobbies, and sports I do now?

6. What treatments do you suggest now?

7.Will that change as the disease progresses?

8. What are the side effects of medication?…

Because the diagnosis is based on the doctor’s exam of the patient, it is very important that the doctor be experienced in evaluating and diagnosing patients with Parkinson’s disease. If Parkinson’s disease is suspected, you should see a specialist, preferably a movement disorders trained neurologist.

Revised 4/06/26 by Elizabeth Lynch BSN RN

“This April, we’re striving to reach more people and improve the lives of those affected by Parkinson’s disease (PD) through greater awareness.

Parkinson’s Awareness Month is the perfect time to brush up on your Parkinson’s facts. Here are 5 fast facts about PD:

1. Nearly 90,000 people in the U.S. are diagnosed with Parkinson’s each year.
2. Scientists believe a combination of environmental and genetic factors cause PD.
3. People with Parkinson’s experience both movement and non-movement related symptoms.
4. Symptoms can be managed through treatments like medications, lifestyle changes, exercise and in some cases, surgery.
5. Early-onset Parkinson’s disease occurs in people younger than 50 years of age.”

Parkinson’s Foundation

(Parkinson’s Awareness Month | Parkinson’s Foundation)

Parkinsonism is a term used to describe the collection of signs and movement symptoms associated with several conditions — including Parkinson’s disease (PD). Signs include slowness (bradykinesia), stiffness (rigidity) and resting tremor. Conditions other than Parkinson’s disease may have one or more of these symptoms, mimicking PD. Your neurologist should assess your symptoms when making a diagnosis. 

Below are the more common medical conditions that can present with Parkinsonian disorders (parkinsonism). Parkinsonism can be classified into two major groups: primary and secondary.

Parkinson’s disease is the most common primary cause of parkinsonism. It can be further subdivided into sporadic (most common) and familial (hereditary) PD.

Primary Parkinsonism

Primary parkinsonian disorders include Parkinson’s disease and atypical parkinsonian disorders. Both can be misdiagnosed, however a neurologist with training in movement disorders can help make an accurate diagnosis and coordinate care.

Parkinson Disease (PD) is a chronic and progressive movement disorder, meaning that symptoms continue and worsen over time. Nearly one million people in the US are living with Parkinson’s disease. The cause is unknown, and although there is presently no cure, there are treatment options such as medication and surgery to manage its symptoms.

Parkinson’s involves the malfunction and death of vital nerve cells in the brain, called neurons. Parkinson’s primarily affects neurons in an area of the brain called the substantia nigra. Some of these dying neurons produce dopamine, a chemical that sends messages to the part of the brain that controls movement and coordination. As PD progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally.

Secondary Parkinsonism

This type of parkinsonism includes neurological disorders commonly caused by brain tumors, toxins or medications. Symptoms are similar to those seen in Parkinson’s disease and may sometimes go away with treatment, depending on the disorder. Unlike Parkinson’s disease, the medication Levodopa does not improve symptoms.

There are many secondary or acquired causes of parkinsonism:

-Drug Induced Parkinsonism-Drug-induced parkinsonism can be difficult to distinguish from Parkinson’s, though the tremors and postural instability may be less severe. It is usually the side effect of drugs that affect dopamine levels in the brain, such as antipsychotics, some calcium channel blockers and stimulants like amphetamines and cocaine. If the affected person stops taking the drug(s), symptoms usually go away over time, but may take as long as 18 months.

-Vascular Parkinsonism -Vascular parkinsonism is usually caused by clotting in the brain from multiple small strokes. People with vascular parkinsonism tend to have more problems with gait than tremor and have more problems in the lower body. The disorder progresses very slowly in comparison to other types of parkinsonism. People might report an abrupt onset of symptoms or symptoms that get worse then plateau for a while. Symptoms in vascular parkinsonism may or may not respond to levodopa.

Other secondary causes of Parkinsonism:

• Metabolic diseases, such as Wilson’s disease
• Endocrine diseases, such as hypothyroidism
• Heavy metals, such as manganese
• Infectious diseases, such as Whipple’s disease
• Normal pressure hydrocephalus
• Toxins, such as MPTP
• Repetitive head trauma

Parkinsonism can also be categorized based on the abnormal proteins that accumulate in the brain, such as alpha synuclein.

Atypical Parkinson’s Conditions:

Dementia with Lewy Bodies (DLB):

DLB is second only to Alzheimer’s as the most common cause of dementia in elderly people. It causes progressive intellectual and functional deterioration. In addition to the signs and symptoms of Parkinson’s disease, people with DLB tend to have frequent changes in thinking ability, level of attention or alertness and visual hallucinations.

Progressive Supranuclear Palsy (PSP):

PSP is slightly more common than amyotrophic lateral sclerosis (ALS), also called Lou Gehrig disease. Symptoms usually begin in the early 60’s. Common early symptoms include loss of balance while walking that results in unexplained falls, forgetfulness and personality changes.

The visual problems associated with PSP generally occur three to five years after the walking problems and involve the inability to aim the eyes properly because of weakness or paralysis of the muscles that move the eyeballs.

Multiple System Atrophy (MSA):

MSA (also referred to as Shy-Drager syndrome) is the term for a group of disorders in which one or more systems in the body stop working. In MSA, the autonomic nervous system is often severely affected early in the course of the disease.

Symptoms include bladder problems resulting in urinary urgency, hesitancy or incontinence and orthostatic hypotension (nOH). In nOH the blood pressure drops so low when standing that fainting or near fainting can occur. When lying down, blood pressure can be quite high (called supine hypertension). For men, the earliest sign may be loss of erectile function. Other symptoms that may develop include impaired speech, difficulties with breathing and swallowing, and inability to sweat.

Corticobasal Degeneration (CBD):

CBD is the least common atypical parkinsonism. It usually develops after age 60. Symptoms include a loss of function on one side of the body, involuntary and jerky movements of a limb and speech problems. It may become difficult or impossible to use the affected limb although there is no weakness or sensory loss. People with CBD may feel as if their limb is not under his/her voluntary control. There is no specific treatment for CBD. Treatment is focused on reducing symptoms and improving quality of life.

Parkinsonian disorders and Levodopa

Various parkinsonian disorders can be categorized based on how they respond to the medication called levodopa. PD tends to respond well to levodopa therapies, while most atypical parkinsonian disorders do not.

Sometimes people with parkinsonian symptoms who do not respond well to levodopa may be referred to as having parkinsonism. This can be confusing since parkinsonism technically refers to a set of movement symptoms, rather than a specific diagnosis.

Understanding about your diagnosis:

Despite recent research and diagnostic advances, the diagnosis of PD and types of atypical parkinsonian still relies primarily on a clinical evaluation. There are many overlapping signs and symptoms among PD, atypical parkinsonisms, and secondary parkinsonisms, making it difficult to diagnose. An accurate diagnosis can take months or even years to determine.

You may be diagnosed right away with “typical” or idiopathic Parkinson’s, or your doctor may tell you that you have parkinsonism. A “diagnosis” of parkinsonism may simply mean that you have movement symptoms, like slowness, rigidity and tremor. It might also mean that your doctor does not have enough information to know if your symptoms will respond well to levodopa.

Additionally, some doctors use the term parkinsonism interchangeably with atypical parkinsonism. Talk to your doctor if you have questions about what your diagnosis means.

There are three types of Parkinson’s disease and they are grouped by age of onset:

 1-Adult-Onset Parkinson’s Disease – This is the most common type of Parkinson’s disease. The average age of onset is approximately 60 years old. The incidence of adult onset PD rises noticeably as people advance in age into their 70’s and 80’s.

2-Young-Onset Parkinson’s Disease – The age of onset is between 21-40 years old. Though the incidence of Young-Onset Parkinson’s Disease is very high in Japan (approximately 40% of cases diagnosed with Parkinson’s disease), it is still relatively uncommon in the U.S., with estimates ranging from 5-10% of cases diagnosed.

3-Juvenile Parkinson’s Disease – The age of onset is before the age of 21. The incidence of Juvenile Parkinson’s Disease is very rare.

Parkinson’s disease can significantly impair quality of life not only for the patients but for their families as well, and especially for the primary caregivers. It is therefore important for caregivers and family members to educate themselves and become familiar with the course of Parkinson’s disease and the progression of symptoms so that they can be actively involved in communication with health care providers and in understanding all decisions regarding treatment of the patient.

According to the American Parkinson’s Disease Association, there are approximately 1.5 million people in the U.S. who suffer from Parkinson’s disease – approximately 1-2% of people over the age of 60 and 3-5% of the population over age 85. The incidence of PD ranges from 8.6-19 per 100,000 people. Approximately 50,000 new cases are diagnosed in the U.S. annually. That number is expected to rise as the general population in the U.S. ages. Onset of Parkinson’s disease before the age of 40 is rare. All races and ethnic groups are affected.

Knowledge is Critical when Dealing with a Life-Altering Condition such as Parkinson’s Disease and being able to make the changes to last longer and at your optimal level of functioning! First step is accept you have it!

If you or a loved one has been diagnosed with Parkinson’s disease, it’s critical to learn everything you possibly can about this condition so that you can make informed decisions about your treatment. That’s why the Medifocus Guidebook on Parkinson’s Disease was developed, a comprehensive 170 page patient Guidebook that contains vital information about Parkinson’s disease and is so helpful.

The Medifocus Guidebook on Parkinson’s Disease starts out with a detailed overview of the condition and quickly imparts fundamentally important information about Parkinson’s disease, including:

 The theories regarding the underlying causes of Parkinson’s disease.

What Are the Possible Risk factors that can be a cause of Parkinson’s Disease?

 The Parkinson’s Disease Foundation notes even after decades of intense study, the causes of Parkinson’s disease are not really understood. However, many experts believe that the disease is caused by several genetic and environmental factors, which can vary in each person.

1-Genetic Factors

For some patients, genetic factors could be the primary cause; but in others, there could be something in the environment that led to the disease. Scientists have noted that aging is a key risk factor. There is a 2-4% risk for developing the disease for people over 60. That is compared to 1-2% risk in the general population.

2-Environmental Factors

Some scientists believe that PD can result from overexposure to environmental toxins, or injury. Research by epidemiologists has identified several factors that may be linked to PD. Some of these include living in rural areas, drinking well water, pesticides and manganese.

Some studies have indicated that long term exposure to some chemicals could cause a higher risk of PD. These include the insecticides permethrin and beta-hexachlorocyclohexane (beta-HCH), the herbicides paraquat and 2,4-dichlorophenoxyacetic acid and the fungicide maneb. In 2009, the US Veterans Affairs Department stated that PD could be caused by exposure to Agent Orange.

We should remember that simple exposure to a single toxin in the environment is probably not enough to cause PD. Most people who are exposed to such toxins do not develop PD.

Last Reviewed 04/06/26 by Elizabeth Lynch RN BSN

“In 2024, distracted driving killed 3,208 people. April, which is National Distracted Driving Awareness Month, is a good time to regroup and take responsibility for the choices we make when we’re on the road. Follow these safety tips for a safe ride:

• Need to send a text? Pull over and park your car in a safe location.
• Designate your passenger as your “designated texter” to respond to calls or messages.
• Do not scroll through apps while driving. Struggling not to text and drive? Put the cell phone in the trunk, glove box, or back seat of the vehicle until you arrive at your destination.

The Consequences

During a portion of Distracted Driving Awareness Month, from April 9 through 13, you may see increased law enforcement on the roadways as part of the national paid media campaign Put the Phone Away or Pay. This campaign reminds drivers of the deadly dangers and the legal consequences – including fines – of texting behind the wheel.

Take Action

• Remind your friends and family: If you’re in the driver’s seat, it’s the only thing you should be doing. No distractions.
• If your driver is texting or otherwise distracted, tell them to stop and focus on the road.
• Ask your friends to join you in pledging not to drive distracted.”

National Highway Traffic Safety Administration, part of the U.S. Department of transportation (April Is Distracted Driving Awareness Month | NHTSA)

April is Distracted Driving Awareness Month, entering its fourth year. As with past years, it’s an event without an official sponsor, but law agencies are taking the opportunity to crack down on distracted drivers.

Distracted driving sweeps and educational campaigns were announced in several major states, including California, Wisconsin and Tennessee.

We should always drive with focus and to reach our destination safely.  Distracted Driving Awareness Month puts safety first and text messages, arriving on time, and friends under the influence in the back seat.

According to 2016 statistics, the National Safety Council estimates as many as 40,000 people died on U.S. roadways. That’s a 6% increase over 2015 statistics and 14% over 2014. The NDC says that’s the most dramatic two-year increase in 53 years.

What can you do? Turn off your phone. Designate a sober driver. Reduce your speed. Crying children can wait until you can pull over safely. Wear your seat belt.

HOW TO OBSERVE

Take the pledge to stay focus and end distracted driving. The National Highway Traffic Safety Administration, National Safety Council, state, county and local law enforcement support campaigns increasing awareness to end distracted driving. Throughout the month of April, visit www.nsc.org or www.nhtsa.gov to learn more about what’s causing crashes, how to prevent them and what else you can do.

Use #DistractedDrivingAwarenessMonth to share on social media.

HISTORY

Distracted Driving Awareness Month is promoted by several safety organizations in the United States.

April is national Distracted Driving Awareness Month, and the East Moline Police Department is partnering with the Illinois Department of Transportation to remind motorists that if they drive with a phone in one hand, they can expect a ticket in the other.

With traffic fatalities on the rise in Illinois and across the country, the East Moline Police Department is committed to reducing easily preventable crashes caused by distractions such as texting or talking on a cellphone.