L A R G E P R I N T edition PARKINSON’S DISEASE A Johns Hopkins Press Health Book Parkinson’s Disease A Complete Guide for Patients and Families    William J Weiner, M.D Lisa M Shulman, M.D Anthony E Lang, M.D., F.R.C.P The Johns Hopkins University Press Baltimore & London N   R This book is not meant to substitute for medical care of people with Parkinson’s disease, and treatment should not be based solely on its contents Instead, treatment must be developed in a dialogue between the individual and his or her physician Our book has been written to help that dialogue © 2001 The Johns Hopkins University Press All rights reserved First edition 2001 Large print edition 2002 Printed in the United States of America on acid-free paper 987654321 The Johns Hopkins University Press 2715 North Charles Street Baltimore, Maryland 21218-4363 www.press.jhu.edu Library of Congress Cataloging-in-Publication Data Weiner, William J Parkinson’s disease / William J Weiner, Lisa M Shulman, Anthony E Lang — Large print ed p cm ISBN 0-8018-6880-7 (lg print) Parkinson’s disease — Popular works Large type books I Shulman, Lisa M II Lang, Anthony E III Title RC382 W45 2002 616.8Ј33—dc21 2001038915 A catalog record for this book is available from the British Library Illustrations on pages 7, 9, 38, 187, 189, 194, 234, and 292 by Jacqueline Schaffer To Monica and Miriam Weiner May you continue to pursue your dreams and goals WJW To Joshua and Corey Shulman We continue to learn together LMS To Matthew, Stephen, and Kathryn Lang Your happiness and joy in life are always in my thoughts and prayers And in memory of the remarkable inspiration and love of their grandfather Thomas Lang AEL Contents Preface ix Acknowledgments xiii PART I Introduction What Is Parkinson’s Disease? Who Gets Parkinson’s Disease? 25 PART II Signs and Symptoms of Parkinson’s Disease Early Symptoms 43 Moderate Parkinson’s Disease 59 Advanced Parkinson’s Disease 82 Behavioral Changes and Psychiatric Symptoms 104 Young-Onset Parkinson’s Disease 121 PART III Diagnosing Parkinson’s Disease How a Diagnosis Is Made 135 Types of Parkinsonism 152 10 Diagnosing Other Neurologic Problems 165 viii / CONTENTS PART IV Treatment of Parkinson’s Disease 11 12 13 14 How the Brain Works and How Treatment Works 185 Choosing the Correct Medications 202 Drug Therapies 221 Diet, Exercise, and Complementary and Alternative Therapies 266 15 Surgical Treatments 282 PART V Other Issues 16 Illness, Hospitalization, and Parkinson’s Disease 305 17 Parkinson’s Disease Research 313 18 Questions and Answers 328 Resources 349 Index 355 Preface This book has been in the planning stage for a considerable period of time Each of us has been involved in the care of patients with Parkinson’s disease for many years, and we have become keenly aware of the need for a book that will help patients and their families develop a fuller understanding of what living with Parkinson’s is like When people first learn of the diagnosis of Parkinson’s disease, they generally know very little about this illness Understandably, a myriad of questions arise Many patients and families become alarmed as they translate their limited experience and knowledge to themselves The fact is that the effect of Parkinson’s disease on people’s lives has been fundamentally altered in recent years, as new and better treatments have become available Indeed, in the last few decades, Parkinson’s disease has become a disorder that does not prevent people from living productive and satisfying lives for many years Understanding the symptoms of Parkinson’s disease and the management of the disease is the key to each person’s ability to preserve his or her sense of stability and control There are many examples of medical conditions that are chronic illnesses, including arthritis, asthma, diabetes, and Parkinson’s disease In every one of these examples, the recipe for living well with the disorder in- 354 / RESOURCES education and to foster improved communication and cooperation among patient organizations from different countries The Association also encourages the standardization of diagnostic procedures as well as medical and surgical therapies In addition to supporting research on Parkinson’s disease, the WPDA offers educational materials to patients both online and in print Although based in Italy, the official language of the WPDA is English WE MOVE (Worldwide Education and Awareness for Movement Disorders), 204 West 84th Street, New York, NY 10024 Toll-free number: 1-800-437-MOV2 Email: wemove@wemove.org Web site: www.wemove.org WE MOVE is a non-profit organization that works to educate health care professionals, patients, and the public about movement disorders, including Parkinson’s disease The organization offers several resources for medical professionals including training courses, instructional materials, and a research news service WE MOVE also provides resources for patients and their families including information on disorders and treatment, news on the latest research, and a schedule of regional and national support group events The organization seeks to promote patient advocacy organizations, in part through publication of International Guide to Patient Support Group Organizations, which is also available through the organization’s web site Index Page numbers in italics indicate figures; those followed by “t” indicate tables Acetophenazine, 160t Acetylcholine, 118, 188 – 91, 252 Acupuncture, 277–78 Adrenal cell transplantation, 294 Advanced disease, 82–103, 85t, 331 Advance directive for health care, 83 Age of onset, 29–30; before age 50, 121–31 Aging, 29–30 Akathisia, 80 Akinesia, 5, 6t, 11–12, 50, 65–66 Akineton See Biperiden Alcohol consumption, 168, 167–68, 333–34 Alprazolam, 162, 259, 268 Alprostadil, 97 Alzheimer’s disease, 8, 15t, 106, 147–50, 180, 332 Amantadine, 120, 253–55 American Parkinson’s Disease Association, 349 Americans with Disabilities Act, 22, 129 Amitriptyline, 256, 261 Amotivation, 55, 110–11 Amphetamines, 77 Amyotrophic lateral sclerosis (ALS), Animal testing of drugs, 316–17 Ankle swelling, 255 Anticholinergic drugs, 251–53; behavioral/psychiatric effects, 118–19; discontinuing, 253; for drooling, 90–91, 251; for elderly persons, 119, 253; how they work, 118–19, 192– 93, 252; side effects, 211, 252–53 Antidepressants, 108–9, 209, 256–58 Antioxidants, 248, 268– 67, 341–42 Antiparkinson drugs, 99–100, 143, 185–255, 222t; alcohol and, 168, 267– 68, 333–34; behavioral/psychiatric ef- 356 / INDEX Antiparkinson drugs (continued ) fects, 101–2, 112–20, 217– 20, 238, 340–41; changing regimen, 208– 9; choosing correct drugs, 202–20; discontinuing, 206, 238–39, 253, 262; dose, 206; drug interactions, 210, 257– 59, 338–39; forgotten dose, 343– 44; during hospitalization, 306–8; how they work, 191– 201; individualized regimen, 203 – 5; long-term use, 130– 31; for pain, 63–64; in pregnancy, 127; research on, 324–26; schedule for taking, 343; sedating effects, 77–78, 260; side effects, 99, 206–7, 210–20; specific drugs, 221– 55; trade/generic names, 336–37; travel and, 336–37; when to start taking, 228– 30, 339–40 Antipsychotics, 160t, 162, 262, 309–10, 338–39, 341 Anxiety, 54–55, 66, 100–1, 109–10, 209, 258–59 Apathy, 55, 66, 110–11 Apomorphine, 236 Artane See Trihexyphenidyl Aspiration pneumonia, 91, 310–11 Atamet See Carbidopa/levodopa Ativan See Lorazepam Atypical Parkinson’s disease, 135, 150–51, 176–81 Autonomic nervous system impairment, 73–77, 93–99 Awakenings, 196–97 Axons, 186, 199 Baclofen, 263 Balance problems, 5, 50–51, 70–72, 88–90, 141 Barium swallow, 91– 92 Basal ganglia, 156–58, 188–89, 190–91, 192–95 Behavioral problems, 100 –2 Behavioral/psychiatric symptoms, 23; anxiety, 54–55, 100–1, 109–10; apathy, 55, 110–11; cognitive dysfunction, 100, 104–7; depression, 51–54, 100–1, 107–9; druginduced, 101–2, 112–20, 217–20, 237–38, 340– 41; fatigue, 101, 111–12; medications for, 256–58; postoperative delirium, 309–10; side effects vs desired effects of medications for, 117–18, 209–10; social isolation and, 66 Belladonna, 192, 251 INDEX / 357 Benign prostatic hypertrophy, 95, 252 Benserazide/levodopa, 224– 25, 225t Benzodiazepines, 259 Benztropine, 90, 119, 252 Biperiden, 252 Bladder dysfunction, 76, 93–96 Blepharospasm, 173–74 Blood-brain barrier, 194, 195–97, 223 Body language, 66–67 Bowel problems, 73– 75, 345; constipation, 73– 74, 96, 210, 264; diarrhea, 74 –75, 244 Bradykinesia, 5, 11–12, 50, 65–66 Brain: basal ganglia, 156–57, 188, 190–91, 194–95; imaging, 56, 137–38, 156–57, 181, 319–20; motor control system, 185–90, 187, 189; neuronal degeneration, 4–10, 7, 9; structure, 186–88, 189; substantia nigra, 6–10, 7, 9, 158, 189, 190–91, 328–29; surgery on, 282–301; what happens in Parkinson’s disease, 190–91, 282–83, 322–23 Brain stem, 186–88, 189 Bromocriptine, 119, 214, 235–42, Butaperazine, 160t Cane use, 89 Carbergoline, 236 Carbidopa, 224 Carbidopa/levodopa, 203, 224–28; controlled-release, 78, 214, 226–228; involuntary movements and, 216; liquid, 214, 227; for motor fluctuations, 214, 227; preparations, 224–28, 225t; side effects, 77–78, 119–20; taking before meals, 227–28, 342–43 Carphenazine, 160t Catechol-O-methyltransferase (COMT) inhibitors, 242–46; dosing schedules, 243; how they work, 194, 199–200, 211, 242; for motor fluctuations, 214 –15, 243; side effects, 243–246 Caudate, 188, 189, 193–95 Caverject See Alprostadil Cell damage, 4–10, 7, 9, 332–33 Cerebellum, 186–88, 189 Cerebral cortex, 188 Cerebrum, 186–88, 189 Chelation therapy, 278 – 79 Chlordiazepoxide, 162 Chlorpromazine, 160t, 162, 338–39 Chlorprothizene, 160t Chorea, Huntington’s, 170–71 358 / INDEX Choreiform dyskinesia, 215 Choreodystonic dyskinesia, 216 Clinical trials, 18, 317–19, 326–27 Clorazepate, 268 Clozapine (Clozaril), 161t, 162, 262, 310, 340–41 Cogentin See Benztropine Cognitive dysfunction, 100, 104–7, 149–50, 180–81 Cogwheel rigidity, 63, 142 Communication aids, 88 Communication problems, 66; voice changes and, 22, 48, 53–54, 67–68, 87 Compazine See Prochlorperazine Complementary and alternative therapies, 276 – 81; acupuncture, 277–78; chelation therapy, 278–79; concerns about, 280–81; gamma knife, 325–26; research on, 289; spa treatments, 279– 80; tai chi, 277 Comtan See Entacapone Constipation, 73–74, 96, 210, 264 Coping with young-onset disease, 124–25 259–61 See also Sleep attacks Deep brain stimulation, 289–94, 292 Deep vein thrombosis, 310 Definition/description of Parkinson’s disease, 3– 4, 328–29 Degenerative diseases, 3, 27 Delirium, postoperative, 309–10 Delusions, 101, 115–16, 119, 180, 217–18 Dementia, 100, 106, 180; pugilistica, 158–59 Depression, 51–54, 66, 100–1, 107–9, 209, 256–58 Desyrel See Trazodone Detrol See Tolterodine Diagnosis, 17–18, 135–51; brain imaging, 137–38; clinical, 138–45, 152; clues leading away from, 147–51, 167t; delayed, 140; differential, 12–13, 15t, 135–36, 165–81; early, 56 – 57; levodopa trial for, 224; medical examination, 135–38; neurologic examination, 136–37, 139–40, 141–46; questions leading to, 145–47; tests, 135–38; of young-onset disease, 121 DATATOP trial, 247–51, 269 Diarrhea, 74–75, 244 Daytime sleepiness, 77–78, 111, Diazepam, 162, 259, 261, 268 INDEX / 359 Diet, 267–72, 333; alcohol, 168, 267–68, 333– 34; fiber, 74, 264; gastrostomy tube feeding, 92–93; MAO inhibitors and, 246–47; protein redistribution diet, 230–32, 270–71, 333; supplements, 271–72; swallowing problems and, 69 – 70, 90 – 93; taking medication before meals, 227–28, 342– 43; vitamins, 247–48, 268–70, 341–42 Diffuse Lewy body disease, 15t, 106, 147, 180 Disability, 22, 82 –83, 129, 330–32, 344– 47 Discontinuing medications, 206–7, 238–39, 253, 262 Ditropan See Oxybutynin Domperidone, 237–38 Dopa decarboxylase, 194, 196, 197–98 Dopa decarboxylase inhibitors (DDIs), 224–28; how they work, 197–98, 223 Dopamine: acetylcholine and, 118, 190–91, 252; bloodbrain barrier and, 194, 195–96, 223; deficiency of, 10–12, 193–97, 328, ; neuroleptics and, 159–62 Dopamine receptor agonists, 119–20, 233– 42; choosing best drug, 241 – 42; discontinuing, 238–39; how they work, 198–99, 211, 223–24, 233; for motor fluctuations, 214; new ways of using, 239– 41; side effects, 237–38 Dopamine receptor antagonists, 171 Dopamine receptors, 199, 236 Dopa-responsive dystonia, 174 Dreams, vivid, 113–14, 119, 218 Dressing, 49, 68, 102–3 Driving, 334 – 35 Drooling, 69–70, 90–91 Drug holiday, 346– 47 Drug-induced parkinsonism, 159 –64, 160–61t, 171; MPTP, 35, 153 –55, 247 Drug interactions, 210, 257–58, 338–39 Durable power of attorney for health care, 83 Dyskinesia, 215–17, 237–38, 340–41 Dystonia, 173–75, 216 Dystonic spasm, 47, 65, 86, 123, 173–75, 263 Early disease, 43– 58, 44t, 330– 31 Effexor See Venlafaxine Elavil See Amitriptyline 360 / INDEX Eldepryl See Selegiline Entacapone, 194, 214, 243– 46; dosing schedule, 243; side effects, 75, 120, 243– 46 Environmental factors, 25–27, 33–39, 38; illicit drugs, 35, 153–55; industrial toxins, 33–35; infection, 35–36 Epidemiology, 320–21 Erectile dysfunction, 75, 96–97, 345–46 Estrogen, 126 Ethopropazine, 90, 119, 252 Exercise, 101, 272–73 Facial expression, 48, 66–67, 82, 108, 144 Fainting after rising, 97 – 99 Falls, 71–72, 89, 205 Family: genetic factors, 25–27, 30–33, 37–39, 321–22, 329–30; helping research, 326 –27; resources for, 349– 54; symptoms observed by, 20, 139–40, 165– 66; telling about your disease, 20 –22; young-onset disease and, 127 –28 Fatigue, 77–79, 101, 111–12 Fetal cell transplantation, 295–98 Fluoxetine, 256–57 Fluphenazine, 160t Foot cramps, 47, 65, 86, 123 Forgetting to take medication, 343– 44 Freezing, 72, 89 Frozen shoulder, 46–47, 64 Gait difficulties, 50–51, 71–72, 88–90 Gamma knife, 289 Gastrointestinal motility, 74 Genetic factors, 25–27, 30–33, 37–39, 321–22, 329–30 Glial-derived neurotrophic factor (GDNF), 298–99 Globus pallidus, 188, 189, 283–84 Glutamate, 188–190 Haldol See Haloperidol Hallucinations, 101–2, 114–15, 119, 180, 217–19 Haloperidol, 160t, 162, 338–39 Hand cramps, 47, 86 Hand dexterity, 48 – 49, 68, 144 Handwriting, 48 – 49, 68, 88, 142; in essential tremor, 168 –70, 169 Head injury, 157–59 Head shaking, 168 Health maintenance organization, 19–20 Herbal preparations, 271–72 Hospitalized patients, 305–12; INDEX / 361 medical complications, 308–11; medications, 306–8; recovery time, 311–12 How Parkinson’s disease develops, 25–39, 38 Human fetal cell transplantation, 295–97 Huntington’s disease, 170–71 Hygiene, 102–3 Legal documents, 83 Levodopa, 221 – 24; for diagnosis, 224; dopa decarboxylase inhibitors and, 197–98, 223–24; effectiveness, 340; history, 196–97, 221–223; how it works, 193– 97, 194; limitations, 223–24; motor fluctuations and, 212 – 15; nausea/vomiting and, 223– Idiopathic Parkinson’s disease, 28; protein redistribution 11 diet and, 230 –32, 270 –71, Illicit drug use, 35, 153–55, 247 333; side effects vs desired Impotence, 75 –76, 96 – 97, effects, 117–18, 211; when to 345–46 start taking, 228– 30 Incidence of Parkinson’s disLevodopa-responsive dystonia, ease, 27–28 174 Inderal See Propranolol Lewy bodies, 10 Individual medication regimen, Life expectancy, 84, 305, 346 203 –5 Lioresal See Baclofen Industrial toxins, 33–35 Lisuride, 236 Infection: Parkinson’s disease Livedo reticularis, 255 development and, 35–36, Liver toxicity of drugs, 244– 46 330; urinary tract, 95 Lodosyn See Carbidopa Injuries from falls, 71, 89, 205 Lorazepam, 162, 259, 268 Insurance coverage, 125 Lou Gehrig’s disease, 157 Involuntary movements, Lower-half parkinsonism, 157 215–17, 238, 340– 41 Loxapine (Loxitane), 160t Kemadrin See Procyclidine Laxatives, 74, 210, 264 Lead pipe rigidity, 63 Madopar See Benserazide/ levodopa Masked face, 48, 66 –67, 108, 144 362 / INDEX Medical complications, 308 – 11; deep vein thrombosis, 310; pneumonia, 310–11; postoperative delirium, 309– 10 Medical examination, 135 –36 Mellaril See Thioridazine Memory loss, 106 Menstrual cycle, 125 – 27 Mental abilities, 100, 104 –7 Mesoridazine, 160t Methylphenidate, 77 Metoclopramide, 161t, 162, 339 Michael J Fox Foundation for Parkinson’s Research, 349–50 Micrographia, 49, 68, 88, 142 Mirapex See Pramipexole Moban See Molindone Moderate disease, 59– 81, 331 Molindone, 160t Monoamine oxidase (MAO), 200, 246–47 Monoamine oxidase (MAO) inhibitors, 242, 246–51; cheese effect, 246 – 47; DATATOP trial, 247–51, 269; how they work, 200, 242, 246–47; interaction with SSRIs, 258 Motor block, 72 Motor control system, 185– 90, 187, 189 Motor fluctuations, 212 – 15, 227; protein redistribution diet and, 230– 32, 270 – 71, 333 Movement disorder specialist, 19, 139 MPTP-induced parkinsonism, 35, 153 –55, 247 Multiple system atrophy (MSA), 14t, 97–98, 147, 177–79 Muscle cramps, 263 Muscle relaxants, 263 Mysoline See Primidone National Institute of Neurological Disorders and Stroke, 350 National Parkinson Foundation, 350 –51 Nausea/vomiting, 223–28, 237 Navane See Thiothixene Nerve cell transplantation, 294–98 Neuroimaging, 56, 137–38, 156, 181, 319–20 Neuroleptics, 159– 62, 160 – 61t, 262, 309–10, 338–39 Neurologic examination, 136–37, 139, 141 – 46 Neurons: communication between, 185– 90, 187, 199, 234; degeneration of, –10, 8, 9, 322 –23, 328–29 INDEX / 363 Neuroprotection, 323 Neuropsychological tests, 105–6, 137 Neurotransmitters, 10 –11, 187, 188–91, 199 Neurotrophic factors, 298– 99, 323 Nightmares, 113 – 14, 218 Nigrostriatal pathway, 191 Norepinephrine, 188– 90, 193–95 Nortriptyline, 256 Nursing-home care, 344– 45 Pamelor See Nortriptyline Panic attacks, 54–55, 258–59 Paranoid delusions, 115–16, 119, 219–20 Pargyline, 246 Parkinson Foundation of Canada, 351 “Parkinsonian personality,” 55–56 Parkinsonism, 12–13, 14–15t; drug-induced, 159– 63, 160– 61t; head injury and, 157– 59; MPTP-induced, 25, 153 – 55; stroke and, 155 –57; Occupational therapy, 103, symptoms, 135, 139– 40, 273–74 147 –51; types, 152 – 64, Olanzapine, 161t, 162, 309–10, 176 – 81 341 Parkinson’s Action Network, Olivopontocerebellar degenera352–53 tion, 14t, 177–79 Parkinson’s Disease FoundaOn/off fluctuations, 212–15, tion, 353 227; protein redistribution Parkinson’s-plus syndromes, diet and, 230 –32, 270 –71, 135, 176–81 333 Parkinson Study Group, 351–52 Orap See Pimozide Parlodel See Bromocriptine Oromandibular dystonia, Paroxetine, 256–57 173–74 Parsidol; Parsitan See EthoOrthostatic hypotension, propazine 97–99 Paxil See Paroxetine Oxybutynin, 91, 94 Peak-dose dyskinesia, 216– 17 Percutaneous endoscopic gasPain, 46–47, 63 – 64, 86 trostomy (PEG), 92–93 Pallidotomy, 284–89 Pergolide, 119, 214, 235– 42 364 / INDEX Permax See Pergolide Permitil See Fluphenazine Perphenazine, 160t, 257, 338–39 Perphenazine/amitriptyline, 160t, 162, 257 Personality traits, 55– 56 Pimozide, 160t Piperacetazine, 160t Pneumonia, 91, 310–11 Porcine fetal cell transplantation, 297–98 Postural reflex, 50–51, 70–71 Posture: instability, 5, 51, 70–71; stooped, 49 –50, 72–73 Pramipexole, 119, 214, 235 – 42 Pregnancy, 127 Primidone, 169 Problems of daily living, 102–3, 331–32 Prochlorperazine, 161t, 162 Procyclidine, 119, 252 Prognosis, 330– 33 Progression of disease, 3–5, 13–17, 82–84, 330 –33 Progressive supranuclear palsy (PSP), 14t, 147, 165– 66, 177, 179 Proketazine See Carphenazine Prolixin See Fluphenazine Prolopa See Benserazide/levodopa Promazine, 160t Propranolol, 169 Prostate enlargement, 95, 252 Protein redistribution diet, 230–32, 270–71, 333 Prozac See Fluoxetine Psychotic symptoms, 101–2 114 –15, 119, 180, 217–20, 262 Putamen, 188, 189, 193 – 95 Pyridoxine, 269 – 70, 342 Quality of life, 330 Quetiapine, 161t, 162, 262, 310, 341 Racial factors, 28 Rash, 79–80 Reglan See Metoclopramide Rehabilitation therapy, 273–74 REM behavioral disorder, 113–14 Repoise See Butaperazine Requip See Ropinirole Research, 313 –27; animal testing, 316 –17; basic and clinical, 314 –16; on causes, 320 – 23; clinical trials, 18, 317–19, 326–27; funding for, 327; patient/family help with, 326– 27; promising avenues of, 319 –20; on symptomatic therapy, 324 –26 INDEX / 365 Reserpine, 161t, 162, 338–39 Resources, 349 – 54 Restlessness, 80 Restoril See Temazepam Rigidity, 4–5, 11–12, 62 – 63, 85, 142, 263 Risperidone (Risperdal), 161t, 162 Ritalin See Methylphenidate Ropinirole, 119, 214, 235– 42 Sexual dysfunction, 46, 75–76, 96–97, 345– 46 Shaking See Tremor Shy-Drager syndrome, 14t, 177 –78 Side effects of medications, 99 – 100, 206 –7, 210–20; behavioral/psychiatric, 101–2, 112–20, 217–20, 238, 340– 41; vs desired effects, 117–18; involuntary moveSchedule for taking medicaments, 215– 17, 238, 240 – 41; tion, 343–44 motor fluctuations, 212 – 15; Seborrheic dermatitis, 79–80 synergistic effects, 117–18 Sedatives: behavioral/psychiSigns of Parkinson’s disease, 5, atric effects, 120; for sleep 6t problems, 79, 210, 261 Sildenafil, 96–97, 345– 46 Selective serotonin reuptake in- Sinemet; Sinemet CR See Carhibitors (SSRIs), 55, 110, bidopa/levodopa 256–58 Skin reactions to drugs, 79– 80, Selegiline, 214, 246–51; 255 DATATOP trial, 247 –51, 269; Sleep: disruptions in, 77 – 79; death rate and, 250–51; how drooling during, 69, 90; it works, 200, 242; interacmedications to aid, 79, 210, tion with SSRIs, 258; side ef267; REM behavioral disorfects, 119 der, 113–14; treating disrupSensory effects of disease, tions of, 259– 61; tremor 46–47 and, 61– 62; vivid dreams, Serentil See Mesoridazine 113–14, 218 Seroquel See Quetiapine Sleep attacks, 264–65 Serotonin, 188 – 89, 191 Slowness of movement, 5, Serotonin syndrome, 258 11–12, 50, 65– 66, 85, 144 Sertraline, 256 –75 Social isolation, 66 366 / INDEX Social phobia, 53–55, 258–59 Sparine See Promazine Spasmodic torticollis, 173 Spa treatments, 279– 80 Speech, 22, 48, 53–54, 67– 68, 87–88 Speech therapy, 70, 274–76 Stelazine See Trifluoperazine Stress, 332–33 Striatonigral degeneration, 14t, 177–78 Striatum, 188, 189 Stroke(s), 155–57; multiple small, 14t, 147, 156–57 Substantia nigra, –11, 7, 9, 157–58, 189, 190–91, 328 Sulpride, 160t Surgical treatments, 282–301; deep brain stimulation, 289– 94, 292; nerve cell transplantation, 294–98; neurotrophic factors, 298–99, 323; questions about, 300–1; research on, 325; risks, 285 –87; thalamotomy and pallidotomy, 287–289 Swallowing problems, 69–70, 90–93, 311 Sweating, 76–77 Symmetrel See Amantadine Symptoms, 4–5, 6t, 328; advanced disease, 82 –103, 85t, 331; behavioral/psychiatric, 51–55, 100 –2, 104–20; causes of, 8– 12; drug-induced, 99 –100, 112–17; early, 43–58, 44t, 330– 31; medication regimen tailored to, 203 – 5; moderate disease, 59– 81, 331; on one side only, 44 – 45; stress and, 332–33; young-onset, 122–23 Synaptic cleft, 186, 187, 199, 234 Tai chi, 276 – 77 Taractan See Chlorprothixene Tasmar See Tolcapone Telling others about disease, 20 –23, 128–29 Temazepam, 162, 261 Thalamotomy, 284 –88 Thalamus, 188, 189, 283–84 Thioridazine, 160t, 162, 338–39 Thiothixene, 160t Thorazine See Chlorpromazine Tics, 171–72 Tigan See Trimethobenzamide Tindal See Acetophenazine Tocopherol, 248, 269, 341 Tolcapone, 194, 214, 243–46; dosing schedule, 243; side effects, 75, 84, 243– 46 Tolterodine, 91, 94 Tourette’s syndrome, 172 Toxic effects of medications, 99–100, 211–12 INDEX / 367 Tranquilizers, 159–62, 160– 61t Tranxene See Clorazepate Travel, 335–38 Trazodone, 261 Treatment, 17–20; antiparkinson drugs, 191–255; of anxiety, 259; complementary and alternative, 276–81; of constipation, 264; of depression, 256–58; diet, 267 – 72; exercise, 272–73; goals, 207–8; of muscle cramps, 263; of psychotic symptoms, 262; rehabilitation therapy, 273–74; research on, 324–26; of sleep disruption, 260–61; speech therapy, 274– 76; surgical, 282–301 Tremor, 5, 11, 12, 22–23, 59–62, 84–85; essential, 166–70; internal, 45; kinetic, 166–70; mild, 45– 46; resting, 60, 166 Triavil See Perphenazine/amitriptyline Tricyclic antidepressants, 256 – 57 Trifluoperazine, 160t, 162, 338–39 Trihexyphenidyl, 90, 119, 252 Trilafon See Perphenazine Trimethobenzamide, 161t, 162 Twin studies, 31, 321 Urinary problems, 76, 93–96, 209–10, 345 Urinary tract infection (UTI), 95 Valium See Diazepam Vascular parkinsonism, 156–57 Venlafaxine, 256 Viagra See Sildenafil Visual hallucinations, 114–15, 180, 218–19 Vitamins, 268– 70; vitamin B6, 269 – 70, 342; vitamin C, 268–69, 341–42; vitamin E, 248, 268– 69, 341 Voice changes, 22, 48, 53–54, 67– 68; speech therapy and, 70, 274–76 Walkers, 89 Walking difficulties, 50, 89–90 Walking difficulties in moderate disease, 71–72 Wearing-off fluctuations, 213–14, 227 Weight loss, 102 WE MOVE, 354 Wheelchair use, 89–90 Who gets Parkinson’s disease, 25 –39, 328 – 30 Wilson’s disease, 175 –76 Work-related issues, 21 –23, 53–54, 124 – 25, 128 –29, 334 368 / INDEX World Parkinson’s Disease Association, 353–54 Writer’s cramp, 173 Xanax See Alprazolam 121 – 22; diagnosis, 123–24; family effects, 127 – 28; insurance coverage for, 125; services for, 129–30; symptoms, 122 – 23; treatment, 130– 31; in women, 125 – 27 Young-onset Parkinson’s disease, 121 – 31; career issues and, 124–25, 128 – 29; copZoloft See Sertraline ing with, 124–25; definition, Zyprexa See Olanzapine ... What Is Parkinson’s Disease? Who Gets Parkinson’s Disease? 25 PART II Signs and Symptoms of Parkinson’s Disease Early Symptoms 43 Moderate Parkinson’s Disease 59 Advanced Parkinson’s Disease. .. at who gets Parkinson’s disease, then we turn, in Chapter 3, to a description of the early symptoms CHAPTER Who Gets Parkinson’s Disease? • How common is Parkinson’s disease? • Is Parkinson’s. .. INTRODUCTION Table 1.2 Diseases That Can Be Mistaken for Parkinson’s Disease Image not available WHAT IS PARKINSON’S DISEASE? / 15 Table 1.2 (continued) Image not available toms of the disease will become