askthedoctor Parkinson’s J

Service Connection The VA has made Par- kinson’s disease a “pre- sumptive condition” for certain Vietnam veterans due to Agent Orange and other herbicide expo- sure. This simplifies the disability claims process for them.

50 MILITARY OFFICER SEPTEMBER 2015

About 1 million people in the U.S. have Parkinson’s disease, with 60,000 new cases diagnosed each year. Learn the symptoms of this progressive syndrome. By Rear Adm. Joyce Johnson, D.O.

James Parkinson wrote the first comprehensive description of his namesake disease in 1817 with An Essay on the Shaking Palsy. Neurolo- gist Jean-Martin Charcot named the syn- drome “Parkinson’s disease” 60 years later. Parkinson’s disease is more common in men than women and usually (but not always) begins in the 60s or later. A specifi c cause is unclear, but it results when the brain has an inadequate amount of dopa- mine. A few cases seem to have a hereditary origin; some others might be linked to ex- posure to toxins, including Agent Orange. The shaking Parkinson described is often one of the early signs of the disease. A trem- or usually begins in one hand (or fi nger) or foot, occurs when the extremity is resting or relaxed, and resolves temporarily when it is moved. The disease often progresses to include both sides of the body. The other three classic motor signs of Parkinson’s disease are rigidity (stiff ness), bradykinesia (slowed movements), and postural instabil- ity (impaired balance late in the disease). An individual patient might experience one or more of these, as well as other symptoms. A peculiar early symptom of Parkinson’s dis- ease is a diminished sense of smell. With early Parkinson’s disease, a per-

son’s handwriting often changes — letters become smaller and more diffi cult to read. Fine motor coordination and dexterity can be reduced, resulting in problems engaging in activities of daily life such as buttoning buttons, closing zippers, and eating. Some

patients have decreased facial movement and can take on a mask-like facial expres- sion. Speech can become diffi cult to under- stand, and diffi culty swallowing can cause drooling and problems with eating. A person’s posture might become bent

forward. Some experience “freezing,” or diffi culty getting started walking. The natu- ral swinging of their arms might decrease, and their gait might be shuffl ing. Impaired gross motor coordination can result in clumsiness and falls. Parkinson’s disease also might cause weight gain or loss; con- stipation or bladder problems; sleep distur- bances; restlessness; and sexual problems. Fatigue and loss of energy are common, as are depression, anxiety, and other emotion- al problems. Some experience decreased memory, slowed thinking, confusion, or de- mentia, especially later in disease. Parkinson’s disease generally has a sub- tle onset with a chronic progressive course. Its variable symptoms make it diffi cult to diagnose early on. There is no specifi c test for Parkinson’s; diagnosis is based on symp- toms coupled with clinical fi ndings from a complete physical and comprehensive neurological exam and often by testing to exclude other diseases. There is no cure for Parkinson’s, but various medications can help manage its symptoms.

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— Rear Adm. Joyce Johnson, USPHS (Ret), D.O., M.A., is a health care consultant in Chevy Chase, Md. Find more health and wellness resources at www.moaa.org/wellness. For sub- mission information, see page 6.

PHOTO: STEVE BARRETT