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Five known facts about Parkinson's disease

GENERAL

07-06-2016

Muhammad Ali died at the age of 74. Even if the cause of death was respiratory complications, the boxing legend and humanitarian had battled Parkinson's since 1984. This was only three years after his last fight. He became one of the world's most well-known people to battle the disease. (Article from Vox, published on June 6, 2016)

 

Parkinson's is a chronic, progressive disorder of the nervous system, and it's typically discovered with the onset of symptoms that include hand tremors and body firmness. When Muhammad Ali was detected, the disease was very poorly understood. At that time, researchers didn't know that genes play a role, particularly in people who start to experience symptoms before the age of 50 — like Ali, who was 42.

Nowadays, scientists believe Parkinson's is caused by some mixture of genetic predisposition and triggers from the environment. But it remains a mainly mysterious and annoying condition affecting an estimated 7 to 10 million people worldwide.

As a celebrity, Muhammad Ali helped draw a lot of attention to Parkinson's. He lent his name to a Parkinson's centre at Barrow Neurological Institute in Phoenix, Arizona, and appeared in TV spots to raise consciousness about the disease (sometimes along with fellow patient Michael J. Fox). More researchers are involved these days to try to demystify the disease than ever before.

Many point towards a possible link with head injuries for Muhammad Ali’s illness but disease can be brought on after contact to pesticides. Contrarily, smoking seems to protect people from Parkinson's. Vox Science & Health presents five known facts about the disease.

1) Living in rural areas and doing farm work are clearly associated with Parkinson's

Researchers have secluded several genetic mutations linked to Parkinson's, and testing is available for some of them. But interpretation of the tests is complicated because not everyone who carries the genetic mutations will develop Parkinson's.

Meanwhile, a less acceptable but even more certain risk factor is exposure to pesticides. "It's been acknowledged for 50 years that rates of Parkinson's disease are elevated in rural populations and in farmers," Samuel Goldman, a Parkinson's researcher at the University of California San Francisco, said. Researchers think pesticides are the key cause here, and even consider farming an occupational risk.

The best-understood offenders are the pesticides rotenone and paraquat (which are now highly restricted and used only in very specific situations). There may be other chemicals related to Parkinson's, but human and animal studies have only up to now proved a clear link between exposure to rotenone and paraquat and amplified risk of the disease.

Why these pesticides are associated with Parkinson's is less clear. One supposition is that they appear to attack the brain cells that make dopamine, and it's the deterioration of those cells that causes the disease.

2) Link between head injuries and Parkinson's is less well-understood

The connection between Parkinson's and head injury is a little less clear, as the confirmation has been somewhat contradictory, said Joseph Quinn, director of the Parkinson’s Center at Oregon Health and Science University. This may be, to a certain extent, because the question is really problematic to study.

The disease typically appears late in life, decades after any head injuries, so cause and effect are difficult to pull out especially that not many people can easily recall old head injuries. There is also no diagnostic tool available for Parkinson's, which introduces more risk for misdiagnosis.

Still, Quinn thinks the balance of evidence favours an association here too. The reason head injuries may have a role is that they damage the blood-brain barrier, which keeps toxins out of the brain. "When you get a head injury, the blood-brain barrier becomes leaky — and more nasty stuff from the environment or within your body is able to leak into the brain," Goldman said.

3) The disease is very rare among people under 40, and men are at a much greater risk

The two main risk factors are advanced age and being a man. It is exceptionally unusual for someone under 40 to be diagnosed, and the incidence rapidly increases over the age of 60. According to the National Parkinson Foundation, the average age of diagnosis is around 62.

The disease also seems to be much more common among men than women, though the reason is still uncertain.

4) No diagnostic tool or cure for Parkinson's

Parkinson's is brought on by the deterioration and death of the neurons in the part of the brain that produces dopamine. The main symptoms of the disease are tremor, bradykinesia (or slowness of movement), and stiffness. At start Parkinson's is always asymmetric in the body, where one side is affected first.

Goldman said clinicians have no diagnostic test to rely on, so they classically look for that asymmetry and then administer a dopamine treatment to see if some of the symptoms disperse. If a patient responds to dopamine therapy, that means she more likely has no Parkinson's.

Parkinson's disease has no cure, nor is there a model treatment. Doctors regularly recommend medicines (most commonly dopamine therapies) and lifestyle changes (rest and exercise) or surgery (deep-brain stimulation). But these therapies simply control symptoms and can't slow down the disease evolution or cure the disease.

5) Cigarette smoking seems to be protective

This is certainly not a reason to start smoking cigarette, but one incredibly steady finding in the literature is that smokers seem to have much lower rates of the disease.

"There are probably 100 researches about this," Goldman said, but researchers still don't relatively understand why. One premise is that nicotine may protect the nervous system from the disorder. According to a research, "people who are prone to Parkinson's … might just be less prone to smoke cigarettes as part of their genetic makeup,” Quinn told.

 

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