Michael J. Fox


Parkinson’s disease is a condition that we maybe hear about if it affects our grandparents or another older person in our lives. When actor Michael J. Fox announced he had been diagnosed with Parkinson’s disease, it shone a new light on the disease as one that afflicts young people and the elderly. Despite his disease, Fox has had a successful career and has become a tireless fundraiser and advocate for Parkinson’s. April is Parkinson’s Disease Awareness month, so Metro spoke with Dr. Matthew Swan, neurologist at Mount Sinai Union Square, about it.


What is Parkinson’s disease?

Parkinson’s disease is a progressive brain disease. It is the second-most-common neurodegenerative disease, after Alzheimer’s disease, affecting about 1 million Americans. Unfortunately, we currently don’t have a cure, although we have many treatments to alleviate the symptoms and reduce their impact on the lives of those affected.



What are the symptoms? How is it diagnosed?

The main features of Parkinson’s disease are a cluster of signs and symptoms we call “Parkinsonism.” Many people think of it as a motor disorder because it affects movement in very obvious ways: reducing dexterity, slowing movement and causing tremor. These symptoms are due to loss of brain cells that produce a brain-signaling chemical, or neurotransmitter, called dopamine.


Whom does it affect?

Parkinson’s disease is generally a disease of older adults. But it’s not only a disease of older adults. It can begin in the 20s, 30s, or 40s, though it develops in only about three people in 100,000 per year among those in their 30s and 40s. ... The challenges for those with young-onset Parkinson’s disease can be unique, but younger patients can indeed have families and successful careers, even while grappling with the disease. 


 Is it genetic or are there there lifestyle or external factors that contribute?

About 5-10 percent of those with Parkinson’s disease have a single, specific gene that causes it. For the remaining 90 percent, we can’t pinpoint a specific cause. Epidemiological studies, looking at large groups of people, have identified several risk factors: pesticide exposure, usually among agricultural workers; head injury; and possibly industrial metal and solvent exposure may increase the risk of the disease. A history of melanoma also seems to increase the risk of developing Parkinson’s disease. … As far as protective factors, studies have shown that caffeine and physical activity may lower the risk later in life. 


How does the disease progress?

Parkinson’s disease progresses slowly.  Most individuals start with tremor or loss of dexterity. Over time, they may develop worsening balance problems and frequent falls; in many cases, longstanding Parkinson’s disease can leave people confined to a wheelchair. They may experience difficulty swallowing or cognitive difficulties. They also may develop erratic, unpredictable responses to medications, with many ups and downs over the course of a day.


How is it treated?

Most of our treatment is directed toward alleviating the symptoms of the disease. We have numerous medications to improve the movement symptoms, most of which stimulate the dopamine system in the brain. ... Some patients may be candidates for neurosurgical interventions. We are also attentive to managing the many non-motor symptoms, as these can be at least as bothersome as the motor symptoms, if not more so. In some cases, we will refer patients to other specialists – a gastroenterologist when patients have severe constipation, for example, or a psychiatrist when they have depression or anxiety. We routinely refer patients for physical, occupational and speech therapy. There is also much compelling evidence that exercise, particularly aerobic exercise, may be neuroprotective in Parkinson’s, and might slow down the disease progression. … The goals of treatment are to maximize function and minimize the day-to-day impact of Parkinson’s disease. It can be a challenging disease, but our aim is to help patients continue to lead full lives. 


What else should people know about Parkinson’s disease?

There are many incredible organizations promoting awareness, advocating on behalf of those with Parkinson’s disease, and sponsoring research into the disease, including The Parkinson’s Foundation, the American Parkinson Disease Association and the Michael J. Fox Foundation. Also, on Saturday, April 28, the Parkinson’s Unity Walk will make its way through Central Park. Participants will be raising money for research, and trying to generate greater awareness of the disease. At Mount Sinai, we have frequent patient events, and we also have regular support groups, and movement classes such as tai-chi and chair yoga for those with Parkinson’s disease.  Anyone interested in our resources can contact our nurse practitioner, Joan Miravite, at joan.miravite@mountsinai.org or 212-844-6134.  


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