By Boaz Mizrahi
Most of us associate Parkinson's disease with hand tremors in the elderly - seemingly, not a fatal problem. But the truth is that the tremor is only the symptom of a brain injury that is getting worse and worse and impairs our ability to function. This important information will help you get to know and understand the disease more deeply. 

Some data on Parkinson's
Parkinson's or in Hebrew, tremor, is a disease defined as chronic and progressive. This means that it is a disease that only gets worse over time. It mainly affects people over the age of 60 and men are 1.5 times more likely to get sick than women. Famous people with Parkinson's are Muhammad Ali, Salvador Dali, actor Michael J. Fox and Mao Zedong. About 25,000 people with Parkinson's live in Israel. The disease cannot be cured, but the symptoms can be treated.

What is Parkinson's disease and how does it occur?
Parkinson's is a brain disease that affects the nervous system. The disease is the result of degeneration of brain cells and lack of dopamine. Dopamine is a neurotransmitter, which means it has a role in the transmission of brain signals in the nervous system, which is essential, among other things, for muscle control. In Parkinson's disease, the brain cells responsible for releasing dopamine are damaged, or its receptors are damaged. Either way, the result is a loss of muscle control and movement.

The early symptoms of the disease
The first key symptom of Parkinson's in the early stages is a tremor in one limb, usually on one side of the body and while resting. The tremor will start in an external organ and will have a fast rhythm. The shaking will stop when the organ is used.

The second prominent symptom is stiffness and resistance during movement of the joint as well as difficulty in transitioning from sitting to standing. It can also manifest itself in the lack of movement of the hands when walking.

The third symptom is slowness of movement, known as bradykinesia and can be identified by abnormally small writing and a dull, fixed facial expression. There will also be involuntary slowing or stopping when walking.

The fourth symptom is impaired balance. As the disease progresses, additional symptoms related to muscles and movement. The patient may develop a stooped posture accompanied by drooping shoulders, shuffling of the legs and a tilt of the head forward. The change in body posture causes loss of balance and multiple falls.

Additional late symptoms
In more advanced stages of Parkinson's, additional symptoms can develop, but they are not present in all patients.

– Bilateral tremor
- Difficulty falling asleep and chronic fatigue
- Oily skin and scales
- Change in speech: soft voice and "swallowing words"
– Constipation
– Swallowing problems
- Decreased cognitive function: memory loss, confusion and dementia

What are the causes of Parkinson's disease?
The substantia nigra in the brain is the area that influences behaviors such as addiction, conditioning and movement. The cells in the substantia nigra are responsible for dopamine production and when they degenerate and die, dopamine production decreases and eventually stops.

As mentioned, dopamine is a neurotransmitter, which means that it helps transmit commands in the nervous system. When it is gone, the transmission of movement signals goes wrong, which manifests itself in Parkinson's symptoms. Today, it is still not known for sure what causes the death of the cells that produce dopamine, but there are theories that link the disease to free radicals, genetics and a number of other additional factors.

What are my chances of getting sick?
As mentioned, men have a 1.5 times higher risk than women of having milk. The average age at which the disease is diagnosed in Israel is 58, but it can also appear in younger people. Although most patients are over the age of 60, the chance of developing the disease is only between 2 and 4 percent.

Parkinson's diagnosis
There is one test that can determine with certainty whether a person has Parkinson's and that is a biopsy of a certain tissue in the brain, a test that is usually only performed at a post-mortem. In most cases, a neurologist will determine that a person has Parkinson's based on the confirmation of the 4 symptoms and a simple physical examination that examines tremors, stiffness and balance. A CT scan will help distinguish between Parkinson's and other brain injuries such as a stroke, or a brain tumor.

How to differentiate between essential tremor and Parkinson's?
There is another medical condition that manifests itself in tremors, which is called essential tremor. In the early stages of the disease, the symptoms of both diseases can be similar and confusing. But there are several ways to distinguish with a high degree of certainty between the two. In essential tremor, the tremor will increase when the patient tries to use the affected limb, while in Parkinson's, as mentioned, the tremor is present mainly at rest and stops when the limb is activated. In addition, essential tremor will appear in other family members, while Parkinson's is a more personal disease. Also, the diseases differ in the type of drugs to which they respond.

stages of the disease
With more widespread degeneration of the brain cells and reduced production of dopamine, the symptoms increase. The process of deterioration takes years, but it occurs regularly. The stages are determined according to the severity of the first four symptoms as well as the addition of new symptoms, such as a decrease in brain function, changes in behavior and mood, changes in motor function and impairment of daily functioning. According to the severity of these symptoms, the method of treatment is determined.

Medications for Parkinson's disease
As a rule, the drugs cannot cure the disease, but they can significantly alleviate the symptoms and restore some of the functions to a reasonable state. The drugs are actually a substitute for dopamine, i.e. substances that serve as alternative neurotransmitters. The drugs Dupikar (Levo-dopa / Carbidopa), Requip (Ropinirole), Comtan (Entacapone) and many more, are the most common for treatment and are in the medicine basket. Of course they are under prescription and it is mandatory to consult a doctor before taking any medicine.

In addition to medications, there is also a surgical procedure called deep brain stimulation. As its name suggests, it is designed to stimulate the brain cells and is performed by implanting electrodes that send electrical pulses that help overcome the symptoms. The surgery is only performed when the effectiveness of the drugs wears off and it is not suitable for every Parkinson's patient. In addition, it is important to know that this is not a magic solution that improves or stops the deterioration.

What else can you do?
Nutrition - As with most medical conditions, a balanced menu can make it easier. A diet rich in fiber, for example, will ease the problem of constipation and proteins will help alleviate the side effects of some medications.

Toxins - researchers believe that 90% of Parkinson's cases are caused by a combination of heredity and external conditions. For example, exposure to toxins present in pesticides can increase the risk in those with a genetic predisposition. If you have no way of knowing your genetic predisposition, just stay away from toxins and chemicals.

Exercise - several studies have hypothesized that exercise helps reduce and delay the symptoms of the disease. Different types of exercise will affect different symptoms: yoga will improve balance, while walking or weights will strengthen the muscles. Exercising for 3 hours a week will be enough, but it is important to be careful about it before the disease.

Life with Parkinson's
Parkinson's, especially in its advanced stages, is a life-changing disease. As a result, she requires some adjustments, as the average home is not a friendly place for a Parkinson's patient. The lack of balance, the risk of falls and the decrease in brain function must be taken into account when preparing the house for the patient. Obstacles must be removed from the road, handrails, handles and support points must be added where necessary and even consider padding tripping areas.

A final word for the caregivers. Parkinson's disease takes a toll not only on the patient himself, but also on his family members and caregivers (whether nursing or private). The special needs that are only increasing can be a significant challenge for the relatives, both physically and mentally. It is important to remember that the physical disability, as well as the patient's mood and depression, are not his fault, but the result of brain damage beyond his control. It is important to show tolerance and patience, because in the end, these are the people dear to us behind the trembling hands. On the Internet you can find a lot of information about support groups that will help you deal with the disease.