Parkinson’s Disease Signs and Symptoms: Before the Diagnosis

Intro: This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Hello and welcome to the show. You are listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell and today's guest is Dr. Mindy Bixby. Dr. Bixby is a neurologist with the Parkinson's and Movement Disorder Institute at Orange Coast Memorial Medical Center. She received her medical degree in osteopathic medicine at Touro University in California, she completed her neurology residency and fellowship training in movement disorders and neurorehabilitation from the Georgetown University National Rehabilitation Hospital. Dr. Bixby is a three-time recipient of the string of pearls award from Georgetown University Medical School for exhibiting humanism and excellence in teaching. She is involved in research developing new therapies for Parkinson's disease and other movement disorders, and has a special interest in exploring neurorehabilitative modalities to help patients improve functional independence. Welcome to you, Dr. Bixby.

Mindy Bixby, DO: Oh, thank you so much for having me.

Deborah Howell (Host): Today we're going to be talking about Parkinson's disease signs and symptoms before the diagnosis. So from the get-go let's start at the beginning, what is Parkinson's disease?

Mindy Bixby, DO: Well, Parkinson's disease is a progressive disease of the nervous system. Chiefly affecting middle-aged and elderly people. However, there are a percentage of people that have an earlier onset of the disease. It is associated with the degeneration of neurons in a deep structure of the brain called the basal ganglia. An area of the basal ganglia makes a neurotransmitter called dopamine. Parkinson's disease occurs when you are dopamine deficient.

Deborah Howell (Host): I see. We all know dopamine is a very good thing. What benefits does it give us?

Mindy Bixby, DO: Oh, it allows us to control our movements. If it's lacking quite a bit you can actually notice that you may have some emotional changes within you or cognitive changes. Your thinking processes may be a little bit less.

Deborah Howell (Host): Okay, that leads me to my next question about the initial signs and symptoms someone might experience when they have early onset of Parkinson's.

Mindy Bixby, DO: Yes, yes. The disease often manifests itself with either tremor, which are movements of the hands or feet at rest, slowness of movements, balance problems, changes in walking such as falls, decreased arm swing on one side of the body, a feeling of instability, or walking slower with smaller steps. Or they may even experience stiffness, which can be sensed as tightness in the arms or legs, or heaviness, or a feeling of weakness.

Deborah Howell (Host): Does it affect your personality in any way?

Mindy Bixby, DO: It can over time. That's actually known as something called the non-motor symptoms of the disease. And individuals can usually seek medical attention when they start seeing the motor fluctuations of the disease. However, many non-motor symptoms can be present for many, many years prior to the motor manifestations of the disease.

Deborah Howell (Host): Okay, and did you describe most of the non-motor or are there more non-motor symptoms?

Mindy Bixby, DO: Oh there's many more. And they can be very subtle and they can be confused with other disease processes, not related to Parkinson's disease. Such as constipation, lack of smell, or a low ability to smell. You can't smell things that you used to. Sleep disturbances such as acting out in your dreams or more vivid dreams or difficulty falling asleep or maintaining sleep. Also an excessive need to go to the bathroom, such as urgency, frequency, or changes in mood or thought processes like we talked about before.

Deborah Howell (Host): Amazing that those little ganglions in the brain control all of that.

Mindy Bixby, DO: Absolutely.

Deborah Howell (Host): Well, I'm sure it's not the most pleasant disease to encounter, both in yourself and those you love. What are the other symptoms that Parkinson's can be confused with?

Mindy Bixby, DO: Well, constipation you could think that you just have constipation. A lot of people have constipation out there. They don't drink enough water or not enough fiber or not taking care of their diet. And that could be one of the manifestations ten, fifteen years before you ever have the motor symptoms. People may think that they have a nasal infection because they're not able to smell the garlic that they're used to smelling before. Mood changes, just feeling like they have anxiety just simply because their life has been hard or things are changing in their body and they're not really thinking about that. And they maybe think that maybe it's just they're getting slower or they're getting older. Those are some of the things we think about.

Deborah Howell (Host): I’m so glad we’re getting better at diagnosing this, because that must be so incredibly frustrating.

Mindy Bixby, DO: Oh absolutely, absolutely.

Deborah Howell (Host): So at what point would you recommend someone see a physician for a referral to a neurologist specializing in movement disorders?

Mindy Bixby, DO: Well, at the onset of the movement disorder symptoms would be one, or if a patient or a loved one feels that the treatments they are receiving are not adequately controlling their symptoms, or if the patient simply feels that they need a second opinion on their diagnosis.

Deborah Howell (Host): So this is pretty much after they've been diagnosed with Parkinson's that they would go to a neurologist?

Mindy Bixby, DO: Not necessarily, it just depends. We have a lot of general neurologists that do diagnose Parkinson's and some of the primary care doctors are able to diagnose it. But sometimes they actually send a referral to us to actually really hone in on the diagnosis before they give the patient this information. So it really just depends on how comfortable the primary care doctor or the neurologist is with diagnosing the patient.

Deborah Howell (Host): Once we have a diagnosis confirmed, what are some of the treatments to help manage the symptoms in the early stages, and even in the more advanced stages?

Mindy Bixby, DO: Okay, well the nice thing about it, and hopefully everyone is out there doing this, is having a multi-disciplinary approach to this patient where we have these include neurologists, neurosurgeons, neuropsychologists, as well as other healthcare professionals such as physical, occupational, and speech therapists. We all work together to find the right combination of therapies and treatments that help tailor the individual needs of the patient. So first of all, seeing me as a neurologist, we usually start with a dopamine, again like we talked about before, Parkinson's disease is a dopamine deficiency. So the idea is we use medications that help supplement the dopamine in the brain. Whether that be a synthetic form, an enzyme inhibitor that stops the breakdown of the dopamine, or maybe a look-alike drug. If the motor fluctuations are not being controlled or the medication is no longer optimally controlling their symptoms, we may discuss a surgical option known as deep brain stimulation for our patients. Deep brain stimulation uses a surgically implanted device called a neurostimulator, kind of like a heart pacemaker, that delivers electrical stimulation to the targeted area to control movement, of which we call electrical dopamine, which has been amazing for a lot of our patients.

Deborah Howell (Host): It just sounds like a revelation.

Mindy Bixby, DO: Oh it's fantastic. It's amazing. I've been very lucky to be a part of this revelation. We've been around for about 15 years in the United States, and it's amazing how much it helps patients.

Deborah Howell (Host): It used to be used for depression, right?

Mindy Bixby, DO: No, it has... It's been used for essential tremor. They're looking at depression as being one of the targets for deep brain stimulation, but that is not FDA approved at this point. It is approved for dystonia, essential tremor, and Parkinson's disease.

Deborah Howell (Host): Wow. Well, it's a whole new frontier and we can see, you know, the big elephant in the room is always Michael J. Fox when we're talking about Parkinson's disease. And you can see that there can be life and humor and work and family and love.

Mindy Bixby, DO: Absolutely. Absolutely.

Deborah Howell (Host): And I know that MemorialCare has various support groups and exercise programs for Parkinson's patients and their caregivers. Maybe you could explain the importance of group support and exercise, not only for the patients but also for their caregivers and spouses.

Mindy Bixby, DO: Oh, absolutely. It's an amazing thing that MemorialCare has, and the groups are open to patients, their families, and their caregivers. And the goal is to inform them, educate them, and support individuals with Parkinson's and their families. The beauty of these groups allows for a sense of community with each other, and the importance of stressing that the patient is not alone in his or her disease. It absolutely takes a village for the success of these patients, and we want to be there for them. And the support groups are amazing. I believe knowledge is definitely power. We also have exercise classes which I think are a huge benefit for our patients. It does give them a chance to move their bodies and create friendships and engage in the community. It also provides a social environment, from the patient feedback that I have received, an overall feeling of wellbeing in a controlled environment. I'm a huge advocate of exercise, especially in patients with Parkinson's, and research has shown that exercise may slow the progression of the disease and overall improve stamina, cardiovascular health, and improvement in quality of life. There is an old saying, if you don't use it, you lose it, and this is especially true for this population of people.

Deborah Howell (Host): Well, it sounds like a really wonderful time to be involved in the work that you're doing with your patients and their families. And I want to thank you so much Dr. Bixby for taking the time to talk to us today about Parkinson's disease and what's on the horizon.

Mindy Bixby, DO: Thank you. I really appreciate your call.

Deborah Howell (Host): It's been wonderful to have you on the show. I am Deborah Howell, please join us again next time. We're going to be exploring a wide variety of topics this fall, and next week it's another Weekly Dose of Wellness brought to you by MemorialCare Health System. In the meantime, have yourself a fantastic day, get some exercise, be with those you love, and thank you so, so much for tuning in. Bye bye.