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Neurology and Neuroscience

Parkinson's Disease

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About Parkinson's Disease

Parkinson's disease is a progressive neurological disorder caused by the loss of specific groups of nerve cells in the brain. Parkinson's disease affects people of all ages, but becomes increasingly common as people get older. More than a million people in the United States have the disease, including 1 percent of people over the age of 60. Many symptoms of Parkinson's disease – shaking, slowness, stiffness, anxiety, depression, and difficulty sleeping--remain mild and treatable for many years. No two people with Parkinson's disease have exactly the same symptoms or responses to treatment.

Chemicals in the brain called neurotransmitters produce signals that regulate muscle movement throughout the body. In people with Parkinson's disease, specific brain cells stop working properly, including those that produce the neurotransmitter dopamine. As levels of dopamine fall, patients have increasing difficulty controlling their movements. Medications that replace dopamine and correct other chemical imbalances help to control the symptoms of Parkinson's disease. A number of different genes for Parkinson's disease have been identified, but environmental factors are also believed to influence risk.

In its early stages, Parkinson's disease may be difficult to diagnose: doctors might not consider this diagnosis in younger patients, and in older patients they may incorrectly attribute the symptoms to the aging process.

Treatment for Parkinson's Disease

Neurologists at NewYork-Presbyterian Hospital have the specialized training and expertise needed to help patients and their families manage the many facets of Parkinson's disease symptoms, include non-motor symptoms such as anxiety, depression, sleep disorders, and associated psychosocial issues. Neurologists and neurosurgeons at our two movement disorders centers, Columbia's Center for Parkinson's Disease and Other Movement Disorders and Weill Cornell's Parkinson's Disease and Movement Disorders Institute, conduct a variety of clinical research studies, including multicenter collaborative clinical research trials. We also have a large and highly successful neurosurgical program.

Medical Treatment for Parkinson's Disease

Once a patient has been diagnosed with Parkinson's disease doctors customize the numerous treatment options to meet his or her needs. People with Parkinson's disease often take a variety of medications at different doses and at different times of day to manage symptoms. None of the current therapeutic approaches reverse the progression of Parkinson's disease, but many good treatments are available to alleviate the symptoms.

Current medications to treat Parkinson's include:

  • Levodopa, which is converted into dopamine in the brain, increasing the levels of this important neurotransmitter.
  • Dopamine agonists, which stimulate the dopamine receptors in the brain.
  • Anticholinergics, which decrease the activity of the neurotransmitter acetylcholine, to improve the balance between acetylcholine and dopamine.
  • MAO-B and COMT inhibitors, which help to make levodopa last longer in the brain; MAO-B inhibitors also directly increase dopamine levels.
Surgical Treatment for Parkinson's Disease

In some patients, medications do not adequately control the disabling symptoms of Parkinson's disease. These patients may be eligible for a neurosurgical procedure called deep brain stimulation (DBS). DBS, which was pioneered at NewYork-Presbyterian Hospital, has become an important tool in the treatment of Parkinson's disease. In DBS, neurosurgeons implant a device that acts like a pacemaker for the brain, reducing or eliminating abnormal brain signals in regions that are overly active in Parkinson's disease. DBS is not a cure for Parkinson's disease, and does not slow its progression. But for many, it can dramatically reduce some symptoms of Parkinson's disease and greatly improve quality of life.

Doctors here take special precautions during brain surgery. NewYork-Presbyterian Hospital maintains the most advanced intraoperative neurophysiological monitoring system worldwide. Continuous monitoring of the electrical activity of the brain and spinal cord during surgery diminishes the risk of neurological injury.

Rehabilitation for Parkinson's Disease

Physical, occupational, speech, swallowing, and nutrition therapy can all help patients with Parkinson's disease maintain function over time. Rehabilitation experts at NewYork-Presbyterian will:

  • Evaluate muscle strength and motor skills and develop an individualized program to maintain existing motor function.
  • Improve the volume and clarity of speech, to improve communication.
  • Evaluate swallowing function, and teach safe swallowing techniques.
  • Recommend devices including neck supports, canes, walkers, and wheelchairs and equipment for the home to ensure patient safety and mobility.
  • Discuss ways to modify activities, conserve energy, and simplify work.

Research for Parkinson's Disease

Neurologists, neurosurgeons, and other researchers at NewYork-Presbyterian Hospital are working to learn more about the causes of Parkinson's disease and to find new and more effective methods for early diagnosis and treatments through translational research, clinical trials, and basic science laboratory work. At Columbia's Center for Parkinson's Disease and Other Movement Disorders investigators are:

  • Studying the genes that cause different forms of Parkinson's disease in a variety of populations
  • Studying neuroprotective compounds that may slow the progression of Parkinson's disease.
  • Testing the efficacy of several new drugs for patients in both early and moderate to advanced stages of Parkinson's.
  • Developing better methods for assessing Parkinson's disease progress with positron emission tomography (PET) and functional magnetic resonance imaging (fMRI).
  • Comparing the risk factors for Parkinson's disease in different populations to improve care for each of these groups.
  • Investigating the causes of cell death in Parkinson's disease.

At Weill Cornell's Parkinson's Disease and Movement Disorders Institute, researchers are:

  • Studying neuroprotective compounds that may slow the progression of Parkinson's disease.
  • Testing the efficacy of new drugs for patients with Parkinson's disease.
  • Working to identify the genes and cellular processes that cause Parkinson's disease.
  • Developing methods to diagnose Parkinson's disease with a blood test or brain scan before symptoms begin.
  • Studying the non-motor manifestations of Parkinson's disease, including anxiety, depression, and medication-related impulse control disorders.

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