How Parkinson’s Disease is Diagnosed (& lots of other Parkinson’s Information)

What is Parkinson’s Disease (PD)?

Parkinson’s is a disease of the central nervous system. The main feature is progressive loss of voluntary motor control. Ultimately, PD interferes with daily life activities.

The symptoms of Parkinson’s are due to nerve cell damage in the brain, which causes dopamine levels to drop. Low levels of dopamine cause problems with movement (Lotankar S, 2017). Nerve cells fire and there isn’t enough dopamine to transmit messages so the brain cannot transmit the signals to coordinate movement. This is when the PD symptoms of tremor and stiffness start to happen.

• PD frequently starts with a tremor in one hand. Other symptoms include diminished motor activity, slow movement, stiffness and loss of balance.
• Progression of the disease leads to stooped posture, difficulty walking and difficulty talking. Patients may also have mental and behavioral changes, sleep problems, depression, memory difficulties and fatigue.
• People usually start to show Parkinson’s symptoms around age 60.
• Patients typically live between 10 and 20 years after diagnosis.
• The actor Michael J. Fox is a well-known sufferer of Parkinson’s.

Parkinson’s Disease Facts (Cerri S, 2019)

• PD affects 3% of the population by the age of 65, up to 5% of people over 85 years old are affected.
• There are gender differences in Parkinson’s: PD affects men twice more often than it affects women.
• Parkinson’s Disease (PD) is the second most common age-related neurodegenerative disorder.

What Causes Parkinson’s Disease?

The precise cause of PD is unknown. It is a combination of genetic and epigenetic risk factors:

• Aging: Cells are more susceptible to damage as they age. The aging nervous system is more vulnerable to infection.
• Genetics account for approximately 30% of the risk (Michael J Fox Org, 2021).
• Gender: Men have a higher risk.
• Environment, specifically toxin/chemical/pesticide exposure: Farmers, wood workers, painters, metallurgy and medical workers exposed to pesticides, solvents and metals have a higher risk (Cerri S, 2019). Agricultural chemicals, pesticides and herbicides, Agent Orange, heavy metals, detergents and solvents have all been implicated in PD (Cerri S, 2019).
• Head injury
• Immune status
• Bacterial or viral infection has been proposed as a potential risk factor (Smeyne RJ, 2021).

How is Parkinson’s Disease Diagnosed?

Parkinson’s disease is characterized by four symptoms (Daniel, 2010):

• Tremor: a rhythmic involuntary shaking movement in one or more parts of the body
• Bradykinesia: a slowness of movement
• Rigor: an episode of shaking or exaggerated shivering which can occur with a high fever
• Postural instability or imbalance

No specific test exists to diagnose Parkinson’s disease. A neurologist diagnoses Parkinson’s based on symptoms, a full medical history and a neurological exam. Lab tests or blood tests may be ordered to rule out other conditions. Imaging tests (MRI, ultrasound of the brain, PET scan) may also be used to rule out other disorders.

One imaging scan called the DaTscan may be used. It looks at the brain’s dopamine system. It can show where in the brain dopaminergic neurons, the source of dopamine, are. The DaTscan doesn’t conclusively diagnose Parkinson’s, but it can help to confirm a diagnosis or rule out another condition mimicking Parkinson’s (Johns Hopkins Medicine, 2021).

If PD is suspected, Parkinson’s disease medication may be given. Significant improvement with the medication can confirm a Parkinson’s disease diagnosis.

It is difficult to make an early diagnosis of PD (Lotankar S, 2017). Patients with very early Parkinson’s disease may not meet the criteria for a diagnosis. But there may be early indications, called prodromal symptoms, of Parkinson’s that appear before the motor symptoms (Johns Hopkins Medicine, 2021). These include the loss of sense of smell, a sleep disturbance called REM behavior disorder, ongoing constipation and mood disorders (anxiety and depression) (Johns Hopkins Medicine, 2021).

The lack of conclusive testing means that a false diagnosis of Parkinson’s disease is possible, especially with conditions that mimic Parkinson’s. When detected at later stages, neurons have already degenerated completely, so PD is often fatal (Lotankar S, 2017).

Could Infection be a Root Cause?

People with various bacterial, viral and fungal infections might be at increased risk of Parkinson’s Disease. Infection can trigger chronic inflammation in the brain (Wang H, 2020).

The different symptoms seen in different patients might be due to the variety of microbes affecting the CNS. These microbes cause infections. The risk of PD is thought to vary with each specific infection type (Wang H, 2020).

Signs of systemic inflammation can appear even years before motor symptoms.

Specific viruses have known neuro effects and the brain can be particularly vulnerable (Smeyne RJ, 2021). Viruses produce high levels of cytokines and chemokines that can cross the blood-brain barrier and cause inflammation and possibly neuronal cell death (Smeyne RJ, 2021). The huge volume of cytokine and chemokine production overwhelms the body’s ability to regulate them and can lead to a “cytokine storm”. This can damage the brain and lead to neuronal dysfunction and cell death (Smeyne RJ, 2021).

Pathologically, inflammation is an early feature in PD, which is consistent with infection being a contributing factor (Smeyne RJ, 2021). The infection-based inflammation can make the CNS more susceptible to later damage that otherwise might not have been so harmful (Smeyne RJ, 2021).

Do Viral Infections Increase Parkinson’s Disease Risk?

Viruses can be the cause of PD (Smeyne RJ, 2021). Viruses can induce changes in parts of the brain that are prominent in PD, and these changes seem to be specific to the viral infection (Smeyne RJ, 2021). These include down-regulation of dopamine production and dopaminergic neuron death (Smeyne RJ, 2021).

Does Lyme Disease Increase Parkinson’s Disease Risk?

Borrelia burgdorferi is a Gram-negative spirochete bacterium that causes Lyme disease. Borrelia burgdorferi may directly damage neurons and the neurological function of the brain (Wirsching I, 2019).  Lyme can affect dopamine by lowering production and by increasing pro-inflammatory cytokines (Blum K, 2017). Long term Lyme disease may result from impaired dopaminergic function and can reduce dopamine levels (Blum K, 2017).

There is evidence that does not support a link between Lyme disease and Parkinson’s: when geographic regions with Lyme disease and death from Parkinson’s were compared, no correlation was found (Smeyne RJ, 2021). However, a Borrelia infection can affect the entire central nervous system and cause a syndrome that may resemble PD (Smeyne RJ, 2021). Studies show that acute or moderately acute Parkinsonism can be a complication of Lyme disease (Pisché G, 2017). Parkinsonism is any condition that causes the movement abnormalities seen in Parkinson’s Disease.

It is not uncommon for Lyme’s disease to imitate neurological diseases like MS, Parkinson’s, ALS, Fibromyalgia and Alzheimer’s disease (Beridze M, 2017). Lyme disease can present as Parkinson’s. There are many case studies in which patients presented with PD symptoms, but actually had Lyme disease. Testing in these patients later confirmed a Borrelia infection (Beridze M, 2017) and (Cassarino DS, 2003).

Given this association with Lyme disease, there should be a thorough exam to ensure that a case of chronic Lyme disease is not misdiagnosed as Parkinson’s (Beridze M, 2017).

Does Mold Illness Increase Parkinson’s Risk?

Mold is a type of fungus. Fungal toxins, or mold, produce mycotoxins (mold toxins). Some types of pathogenic fungi can destroy CNS cells (Purzycki CB, 2010). Mycotoxins often cause both neurotoxicity and immune suppression. Fungal infections can be similar to neurodegenerative disease in that they often are chronic and progressive if untreated (Alonso R, 2015).

Fungal pathogens in the CNS can provoke chronic inflammation and a constant production of toxic microbial products (Purzycki CB, 2010). Both inflammation and microbial products can lead to neuronal degeneration and death (Alonso R, 2015).

Brain tissue from PD patients contains fungal components (Pisa D, 2020). Fungi can be found inside neurons. Fungi can progressively colonize the entire CNS. Tissue damage from fungi or mold can form during months or even years, trapping these microbes in the brain. The mold species Fusarium, Xylaria and Trichoderma have been found to be prominent in PD (Pisa D, 2020).

The different possible infections in the CNS may affect different brain regions. This can account for the differences in motor symptoms found in Parkinson’s.

What are the Possible Solutions or Treatment for Infection-Induced Parkinson’s Disease?

There is no effective prevention strategy for PD. But treatment against pathogenic microorganisms may help to prevent PD. For example, antiviral therapy against Hepatitis C can reduce the risk of Parkinson’s in patients with a Hepatitis C infection (Wang H, 2020). Research has not yet been done on whether treatment against other pathogenic microorganisms (other than Hepatitis C) reduces the risk of PD (Wang H, 2020).

Parkinson’s, and other neurological diseases, could be prevented and even treated by using known antifungal, antiviral and antibacterial therapies years before the brain becomes damaged. It is this damage to the brain that makes it more difficult to reverse symptoms once a condition has been diagnosed. With current medical knowledge, it should be possible to predict these diseases and treat them with anti-microbial therapies that are already in use to fight infections (Pisa D, 2020).

Patients with PD may not necessarily have to wait for new treatments or medications to be discovered. They can simply start treatment for mold illness, Lyme disease or other antimicrobial protocols. In many cases, this would improve symptoms, and may even reverse PD.

We have expertise in treating a range of infections, that could be causing Parkinson’s, or other neurodegenerative diseases. We regularly treat and resolve Lyme, mold and chronic microbial infections in patients of our Functional Medicine clinic.

** Please stay tuned for our next Blog!  **