Question 1

What is Parkinson's disease?

Accepted Answer

Parkinson's disease is a progressive neurodegenerative disorder caused by the loss of dopamine-producing neurons in the substantia nigra. It causes the four cardinal motor symptoms: resting tremor (rhythmic shaking at rest); bradykinesia (slowness of movement); rigidity (muscle stiffness); and postural instability (balance difficulties). It is the world's fastest-growing neurological disorder, affecting over 10 million people.

Question 2

What causes Parkinson's?

Accepted Answer

Parkinson's is caused by the interaction of genetic susceptibility and environmental exposures. Genetic mutations (LRRK2, SNCA, PRKN, PINK1) account for approximately 10-15% of cases. Environmental risk factors: pesticide exposure (rotenone, paraquat, organophosphates), head trauma, rural living and well water. Protective factors: smoking (nicotinic receptor effects), coffee consumption and regular physical activity. In most cases, the cause involves both genetic predisposition and cumulative environmental triggers.

Question 3

What are the non-motor symptoms of Parkinson's?

Accepted Answer

Non-motor symptoms often cause more disability than motor symptoms and may precede diagnosis by years: anosmia (loss of smell — often the first symptom); REM sleep behaviour disorder; constipation; orthostatic hypotension; depression and anxiety; cognitive impairment (present in up to 50% of patients) and Parkinson's disease dementia (up to 80% eventually); pain; fatigue; urinary symptoms; and excessive daytime sleepiness.

Question 4

How is Parkinson's treated?

Accepted Answer

Levodopa (with carbidopa or benserazide) is the most effective and widely used treatment — a dopamine precursor that crosses the blood-brain barrier. Dopamine agonists (pramipexole, ropinirole, rotigotine) are used, particularly in younger patients to delay levodopa and reduce dyskinesia risk. MAO-B inhibitors (rasagiline, selegiline) provide modest benefit. For advanced disease with motor fluctuations: continuous apomorphine or levodopa-carbidopa intestinal gel infusion; deep brain stimulation (DBS) surgery.

Question 5

What is deep brain stimulation?

Accepted Answer

DBS involves surgically implanting electrodes in specific brain targets — typically the subthalamic nucleus or globus pallidus internus — connected to a programmable pulse generator (like a cardiac pacemaker) implanted in the chest. Electrical stimulation dramatically reduces motor fluctuations and dyskinesia in carefully selected patients with advanced Parkinson's. DBS does not cure or modify the disease but can significantly extend quality of life and independence.

Question 6

Is there a cure for Parkinson's?

Accepted Answer

There is no cure and no approved disease-modifying treatment that slows progression. Multiple therapeutic strategies are in development: alpha-synuclein antibodies (targeting the pathological protein); GLP-1 receptor agonists (showing neuroprotective effects in trials); LRRK2 inhibitors; gene therapy; stem cell transplantation; and focused ultrasound (for tremor). The search for disease modification is the most urgent priority in Parkinson's research.

Question 7

Why is Parkinson's the fastest-growing neurological disorder?

Accepted Answer

The Parkinson's pandemic is driven by: population ageing (risk increases with age); reduced smoking (nicotine is paradoxically protective); increased industrial chemical and pesticide exposure; and improved survival extending disease duration. The number of cases doubled from 1990 to 2016 and is projected to double again by 2040. The societal cost — direct healthcare, informal care and lost productivity — is already over $52 billion/year in the US alone.

Question 8

What is the prodromal phase of Parkinson's?

Accepted Answer

The pathological process in Parkinson's begins 10-20 years before motor symptoms — allowing a window for early intervention if biomarkers can identify at-risk individuals. Prodromal markers include: REM sleep behaviour disorder (most specific — approximately 90% predictive); anosmia; constipation; depression; and neuroimaging changes. Blood and CSF alpha-synuclein seed amplification assays (SAA) can now detect Parkinson's pathology before symptoms — enabling future neuroprotective trial enrolment.

Question 9

How does exercise help Parkinson's?

Accepted Answer

Physical exercise is one of the most evidence-based interventions for Parkinson's — improving motor function, balance, strength, gait, cognition and quality of life. Specific exercise types: aerobic exercise (treadmill, cycling); resistance training; balance training; dance (tango is particularly studied); boxing and martial arts. Animal studies show neuroprotective effects; human studies consistently show functional improvements. Exercise should be a cornerstone of Parkinson's management from diagnosis.

Question 10

What is Lewy body dementia?

Accepted Answer

Lewy body dementia (LBD) and Parkinson's disease dementia (PDD) are on the same spectrum of Lewy body disorders — both caused by alpha-synuclein aggregation in the brain. LBD presents with dementia before or alongside motor features, with cognitive fluctuations, visual hallucinations and parkinsonism. PDD develops in patients who already have established Parkinson's motor symptoms. Antipsychotics (except quetiapine and clozapine) are contraindicated in LBD/PDD — they can cause severe adverse reactions.

Question 11

How does GMJ News cover Parkinson's?

Accepted Answer

GMJ News tracks WHO neurological disorder policy, the Parkinson's pandemic trajectory, alpha-synuclein biomarker research, GLP-1 neuroprotection trials, DBS outcomes and disease-modifying therapy development. Parkinson's is a growing public health challenge in Georgia with the ageing population — relevant to PHIG's neurological health priorities and the Georgian Medical Journal.

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