Parkinson’s disease is a progressive degenerative disease characterized by resting tremors, decreased movements and rigidity caused by a diminishing level of dopamine, a neurotransmitter, needed for smooth and coordinated muscle movements. Behavioral changes are associated with dysfunctional dopaminergic and non-dopaminergic receptor activity. Parkinson’s disease is often staged according to the Hoehn and Yahr scale and the Movement Disorder Society-sponsored Unified Parkinson’s Disease Rating Scale (MDS-UPDRS.
A “pill-rolling tremor” of one hand may be an initial sign of Parkinson’s disease. Tremor is maximal at rest, lessening during movement and is absent during sleep. The tremor progresses from the hands to the arms and legs.
Ensuing rigidity is characterized by slow movements (bradykinesia), decreased movements (hypokinesia) and difficulties initiating movements (akinesia), accompanied be depressed facial expressions and movements.
The muscles of the mandible, tongue and face may also be affected. Inability to swallow (dysphagia) may also be present.
Reduced activity of daily living, depression, cognitive impairment and dementia are not uncommon.
Levodopa is the mainstay medication and is associated with orthostatic hypotension, dyskinesia and hyperactivity.
Different catechol O-methyltransferase (COMT) inhibitors are used to prevent the breakdown of levodopa before reaching the brain.
Segiline or rasagiline is used to slow down the metabolism of levodopa in the brain.
Be aware of medications that are given to treat comorbidities, such as depression.
- Oral Health Care Considerations