Tremor & Parkinsonism
What is it? How does it happen?
Tremors are defined as inadvertent movement of the body, and may be seen in isolation, or may be part of a bigger disease pathway, such as Parkinsonism. Tremors are caused by malfunction in the movement centers of the brain, which produces movement of the body (or lack of movement, in some cases) involuntarily. This appears as a tremor.
Parkinsonism is more than an isolated tremor- in fact, not all Parkinson’s patients have a tremor. The overwhelmingly most common symptom of Parkinson’s is slowness. Think of trying to wade through a rapidly flowing river- you must wade slowly and carefully to avoid a fall. It feels as if there is an external force moving your body, throwing off your balance, and making your steps awkward. This is much like Parkinson’s- except, rather than an external force (such as the rapidly flowing river in the above example), it is an internal force creating this feeling (the malfunction of the movement centers in the brain).
Parkinson’s Disease is a progressive neurodegenerative disease. Over time, the condition continues to worsen. The cause is not fully elucidated.
What Does Parkinson's Disease look like?
Signs and symptoms
Progressive onset of (usually) a combination of:
- Falling and tripping
- Tremor (involuntary movements or shaking)
- Balance problems
- Slowness of movement
- Unsteady Gait
- Changes in facial expression
- Handwriting changes
- Late finding: memory loss, dementia
Who typically gets it?
Risk Factors
There are a number of risk factors for Parkinsonism; some are related to your lifestyle, but some are out of your control, such as genetics. Here, we will talk about the most common risk factors.
Age
Usually Parkinsonism is seen in the elderly, but not always. Regardless of your age, if you are concerned about Parkinson's disease or abnormal movements, see your doctor.
Genetics
There is a genetic component to Parkinson's, which likely "sets the stage." In other words, it does not seem completely causative of Parkinson's Disease, but more likely creates an "at risk" situation for Parkinson's Disease. Likely a combination of environmental and genetic factors contribute to Parkinson's Disease.
Drugs
Certain medications and illicit drugs can create a Parkinsonian Syndrome in some, though it may be different than a true Parkinson's Disease. Bring a full medication list to your appointment.
Environmental Factors
Multiple environmental triggers are being investigated, which likely work in concert to lead to Parkinson's Disease. Research centers around pesticides, heavy metals, and dietary environmental contributors, among others.
Head Injury
Head injury seems to increase the risk of developing Parkinson's Disease, and other causes of movement disorders should be ruled out, such as an organic brain disorder.
What can be done if I am have Parkinson's Disease?
Treatment Options
Medication Management
Medications focus on symptomatic relief, and are aimed at maintaining quality of life and functionality. Symptoms including tremors, freezing up, "off" phenomenon are things your doctor may discuss with you, which can help to "hone" in your dose. Because the disease is progressive, it may feel at times like you are trying to keep up with your disease- this is the natural course with Parkinson's, and should be discussed with your doctor.
Allied Therapies
Physical, Occupational, and Speech therapy are all used in concert. Finding a therapist who is well versed in Parkinson's will help you to acheive your goals. Psychology and Psychiatry can be incredibly helpful when there may be some psychological overlay, as well. This is a unique condition which can require smooth neuropsychiatric care.
DBS & Surgical treatment
Used for refractory cases, particularly in younger patients, Deep Brain Stimulation (DBS) and surgical interventions are performed typically at academic or tertiary care centers with Movement Disorder specialists.
Caring for the Caregiver
The most important aspect of treatment and care for the dementia patient is the caretaker. This is an important conversation to begin early, even if it may seem too soon, in order to fully understand the patient and family's wishes. In the early stages, this may be checking in with the family member daily, but it will eventually progress to one of many situations: moving in with them, arranging for round-the-clock home nursing staff, assisted living facilities, nursing facility with a dementia unit. The best choice for your family member is likely going to be unique for each family, and it is important to have your specific need in mind, as well.
Caregiver fatigue is a very real concern. No matter how you choose to care for your family member, be certain it is sustainable and healthy for all involved.
How can MIND help?
Our Services
Not only do we consult on your case to perform a Root Cause Analysis, and we will look for additional ways to maintain good quality of life and mental acuity as long as possible. .
Nutrition
We specialize in lifestyle changes tailored to patients with Parkinson's Disease. Small changes can make a big difference- and we don't believe in sacrificing flavor.
Exercise
30 minutes per day, 5 days per week. Let us help figure out a plan that appeals to you! (Hint: it shouldn't hurt!)
Medication
We do believe certain medications get the job done and are necessary, but we believe in low and slow dosing when appropriate, and will always take your preferences into account.
Complementary Therapies
This may include supplements, acupuncture, yoga, massage, or others, and is tailored to your comfort level.
The Bottom Line
Parkinson’s Disease is a progressive neurodegenerative disease. The cause is still not completely known.
There is no cure, but there are treatments and therapies. The goal of care is to preserve quality of life, safety, and functionality.
Additional Resources
Take a deeper dive: