While most people tend to think of Parkinson’s disorder as a neurological movement disorder, and it most certainly is, many people do not realize that other systems in the body can also be severely affected by Parkinson’s. Often, the same chemical exposure (for example Agent Orange,) can also cause other disorders, such as ischemic heart disease. However, often it is the Parkinson’s itself, or the medication used to treat it that is the causal factor in the development of a new disorder. Whether a veteran’s Parkinson’s was caused by exposure to the TCDD in agent orange, pesticides, trichloroethylene, or its origins are unknown, Parkinson’s cause many secondary disabilities.
Parkinson’s is known as a neurodegenerative disorder; that is, it causes neurons to degenerate or decay. The most famous area for PD degeneration is in an area of the brain called the substantia nigra, where Parkinson’s causes the death of neurons that generate dopamine, a neurotransmitter which is involved with movement. However, more recent studies have also shown that Parkinson’s also attacks nerves in the heart which produce another neurotransmitter, noradrenaline. This typically takes place in the left ventricle and can have many complications.
Noradrenaline is the primary messenger used by the sympathetic nervous system, the system of the body used to control things we don’t consciously think about: the beating of the heart, breathing, blood pressure, even how dilated our pupils are at any given time.
The most common cardiovascular problem related to Parkinson’s is orthostatic hypotension, a sudden drop in blood pressure when standing or sitting upright. Many Parkinson’s patients may need to get out of bed or out of a chair extremely slowly to avoid passing out. This can cause FURTHER secondary disabilities, including orthopedic or muscular trauma due to falls.
Medications such as Levodopa can be a lifesaver to Parkinson’s sufferers, however up to 10% of those medicated by PD medications such as Levodopa, Carbidopa, and Entacapone experience cardiovascular symptoms such as irregular heartbeat, hypertension, ischemic heart disease, and stroke. One study found that 2.4% of patients who were taking carbidopa/levodopa had cardiovascular ischemic events, compared to only 1.1% in patients taking a placebo.
A 2013 study found a nearly three-fold increase in the risk of stroke in patients with Parkinson’s. There is also a two-fold increase in the risk of heart failure and a 50% increase in the risk of dying from heart failure in Parkinson’s patients.
While Parkinson’s is a neurological disorder, it can quite frequently cause orthopedic problems. Falls from Parkinson’s are frequent, both from the movement symptoms as well as the orthostatic hypotension noted above. As Parkinson’s frequently attacks the elderly, their bones may be brittle and easily break during a fall. To make matters worse, Parkinson’s sufferers have an increased risk of developing osteoarthritis and osteoporosis. This is believed to be due to a loss of bone mass resulting from the fact that PD sufferers tend to move around a lot less than non-sufferers.
In those sufferers who have had severe falls or needed spinal or other surgery, the tremors associated with Parkinson’s often severely affect recovery, or make total recovery nearly impossible. A cast is designed to reduce movement of a recovering limb; involuntary tremors are not helpful in this regard.
Both Parkinson’s itself, as well as the medications used to treat it, can have severe psychiatric effects that can often be extremely debilitating. Dementia is common, and PD sufferers often experience cognitive problems, attention problems, as well as depression, anxiety, and even psychosis.
As I mentioned above, the primary problem in Parkinson’s disease involves the creation of dopamine, and while dopamine is involved in movement, it also is involved in addictive behavior. Often, bizarre behavioral changes happen in patients who are being treated with Parkinson’s medication, such as sexual addiction, compulsive gambling, binge eating, and overuse of medications.
As I mentioned above, Parkinson’s affects the parts of our neurological system that works automatically, without effort. We do not will food along our digestive tract, or decide to start sweating more; it just happens. As such, many seemingly smaller problems can arise. Many Parkinson’s sufferers experience constipation, loss of bowel and/or bladder control, excessive sweating, vision problems, and even the loss of the sense of smell (anosmia.)
Sleep problems are extremely common in Parkinson’s patients. REM disorders, where patients actually act out their dreams, can be extremely dangerous and occur frequently in Parkinson’s. Other patients experience insomnia, others cannot stay awake. In fact, 13% of Parkinson’s patients who are on medication experience sudden sleep attacks.
50% to 80% of patients with Parkinson’s disease have abnormal glucose tolerance which may Parkinson’s medication may worsen. However, the link between diabetes and Parkinson’s is not yet fully understood. Diabetes may be secondary to Parkinson’s, particularly if the patient is obese, is experiencing binge eating due to medications, and is not moving as much as they used to. However, some research actually points to diabetes as being a possible culprit in the development of Parkinson’s, so this association may go either way.
Parkinson’s is an insidious and difficult disorder to experience, and we can see that it is much more than just some tremors. If you have service-connected Parkinson’s, you need to be fully aware of these secondary conditions in order to receive the medical care and compensation you deserve.