Congratulations to Dr. Michael Okun, who is quoted in Time Magazine’s article “How Is Parkinson’s Disease Diagnosed?”
The varied signs and symptoms of Parkinson’s disease
Dr. Michael Okun, director of the Fixel Institute for Neurological Diseases at the University of Florida and medical adviser to the Parkinson’s Foundation, says that Parkinson’s disease might be better called Parkinson’s diseases—plural—because the condition has many different causes and expressions.
“There are multiple causes for Parkinson’s and a lot of them have similar symptoms, but we tend to clump them together, because humans like to clump things—it’s easier to deal with,” he says.
For one thing, Okun explains, about 15% to 20% of Parkinson’s cases are associated with a genetic abnormality, and in those cases, patients are likelier to develop symptoms earlier—at age 50, or even 45 or 40. In cases that aren’t genetic, neurologists look at possible environmental causes. “We’ve been interested in pesticides, chemicals, and other things in the environment that might be triggering symptoms,” he says.
Whatever the causes, the brains of Parkinson’s patients generally start to show a deficit in three neurotransmitters: serotonin, dopamine, and acetylcholine. Those neurological changes don’t, at first, lead to the motor symptoms that are commonly associated with the disease. Rather, people may experience a loss of the sense of smell, constipation, and sleep disturbances known as REM sleep behavior disorder. In these cases, dreams may become so vivid that people act them out. “Let’s say you’re fighting off the bad guys,” Okun says. “You might be punching in your sleep, and that’s not a good thing for your bed partner.”
Later symptoms start to involve emotional functions. Parkinson’s patients are at higher risk than other people of experiencing depression, anxiety, and apathy, and when anxiety in particular occurs for the first time later in life, a Parkinson’s screening might be warranted. “People who have new-onset anxiety over the age of 50 are at twice the risk of having Parkinson’s disease,” says Okun.