Dr. Rajesh Pahwa 00:00:05
The way Parkinson's disease is diagnosed is a clinical diagnosis. By which I mean that the physician usually takes a history and performs an examination. We usually don't do any tests, such as a brain scan like an MRI of the brain, unless there is a certain reason the physician feels an MRI is needed.

To make an assessment that they have features of parkinsonism, a patient has to have at least two out of these three present: tremor, slowness or bradykinesia, or rigidity. Once that is established, a physician usually assesses that there are not any other reasons or other neurological findings. In addition, the physician usually will assess that the presentation is not atypical, by which I mean that the symptoms did not begin with an atypical symptom such as falling.

Dr. Rajesh Pahwa 00:01:09
Finally, we look at certain other characteristics, such as: Did the symptoms begin on one side? Did the patient have a tremor when they were just resting, which is called a resting tremor? A resting tremor starting on one side is the most common presentation for Parkinson's disease. We often assess: Have the symptoms progressed over time? We assess if they have been on medications, not only whether they have responded well to the medications, but if a patient has developed any involuntary movements due to their medications.

Taking all this together, a physician will come to a clinical diagnosis of Parkinson's disease.

Dr. John Nutt 00:00:12
What I recommend is an exercise program that has four parts. One of the components of an exercise program is aerobic fitness. This is bicycling, rowing, doing things like this. The second one is strengthening, and a lot of this is either weight machines or small weights. The third is stretching.

And yoga can be really good for this. And the fourth part, and I think this is really important, is agility. Looking for things that will help you with your balance and help prevent falls.

The recommendations are that you exercise for 30 minutes a day, at least five days a week. More is better. That should really be a minimum. And you don't have to try to have all four components in each day.

Dr. John Nutt 00:01:06
One or two days could be cardiovascular fitness. Other days could be strengthening, and other days could work on balance and stretching.

Well, this is not known for certain. There are some studies that suggest that exercise may either help repair the dopamine system that's damaged in Parkinson's disease or prevent further damage.

What is known is that exercise changes what happens in your brain, and it actually has a lot of beneficial effects on the basic chemistry in the brain. And this is sometimes referred to as neuroplasticity.

Dr. John Nutt 00:01:52
So even though it may not directly combat Parkinson's disease, it helps the brain compensate. And there's no doubt that people do better if they are exercising, and it does prevent consequences of Parkinson's disease from being as severe as they might be without exercise.

Another thing that can be very helpful to people to either reduce the number of falls or prevent any further falls are exercise programs such as Tai Chi or Pilates.

Simply walking in a straight line or getting out and walking around the block is not going to challenge the balance system as much as trying to dance, doing Pilates, doing Tai Chi.

Dr. John Nutt 00:02:41
The other benefit is if they're done in a group, there's great social interaction, and it's really fun. People really enjoy that as well. In many parts of the country now, there are classes that are specifically for people with Parkinson's disease.

Can't emphasize enough that we think it's very important for people to keep moving and moving in a way that helps improve their balance and their agility.

Dr. Joseph Jankovic 00:00:07
Parkinson's disease is certainly one of the diseases where a cure has not yet been found. That does not necessarily mean that Parkinson's disease is not a treatable disease. It clearly is a treatable disorder, and we can treat it in different ways. We can treat the symptoms of Parkinson's disease. There are many medications that have been proven to be very effective and safe in the treatment of symptoms of Parkinson's disease, particularly the dopaminergic drugs, drugs that stimulate the dopaminergic system. Levodopa is the best example. It replaces dopamine, which is the neurotransmitter that is missing in the brains of patients with Parkinson's disease. Then there are drugs, so-called dopamine agonists, that stimulate the dopamine receptors.

Dr. Joseph Jankovic 00:00:55
They can also improve the symptoms of Parkinson's disease. There are certain medications that we have found delay the progression of the disease and may in fact be disease-modifying drugs. These medications include, for example, monoamine oxidase inhibitors such as selegiline or rasagiline. It has been shown that early introduction of these medications in the initial phase of the disease may delay the need for levodopa, which is the main medication that we use for Parkinson's disease.

Dr. Joseph Jankovic 00:01:34
Our goal in the therapeutics of Parkinson's disease, of course, is to develop truly neuroprotective drugs, drugs that actually protect the dying neurons and protect the brains from developing the dopamine deficiency.

Dr. Joseph Jankovic 00:02:15
Another form of therapy that is very important in more advanced stages of Parkinson's disease involves surgery, particularly deep brain stimulation. This is usually reserved for patients who respond to levodopa but, as a result of chronic levodopa therapy, have developed side effects such as motor fluctuations and involuntary jerking movements, called dyskinesia.