- [Narrator] So we're going to talk a little bit
about Parkinson's disease.
I have Matt Jensen here with us, a neurologist.
And Matt, I thought maybe we could just start out,
I have a little video clip which I think is pretty cool.
It goes through some of the symptoms.
Do you mind if I just start with that?
- Hi, my name is Duncan.
I'm age 55 and I've had Parkinson's now for 10 years.
After I got diagnosed, one of the first things
the doctor told me was to get exercise,
get regular exercise.
Parkinson's can interfere with the way you walk.
My left leg will drag sometimes.
My left hand has got a tremor to it.
It will get stiff.
So walking can be a challenge for me, sometimes.
And, of course, as the illness progresses, it gets worse.
- [Narrator] You know, when he's talking
about all these symptoms, you know,
he's talking about walking and his tremor in his hand,
is this pretty typical for Parkinson's disease?
- [Matt] Yeah, that's a very typical story.
There are a kind of large number of symptoms.
Kind of the three biggies that we look for
when we're trying to decide on diagnosis
of Parkinson's disease is, uh, first,
a tremor, which is very common,
kind of shaking movement of body parts,
like the hands, that are involuntary.
And then, the next one is slow movements.
A person just can't, when they do a movement,
it's just not the normal speed.
The movements get slower as the disease progresses.
And then the third big one
is a kind of stiffness of the muscles.
And, patients often notice this as a feeling of stiffness.
And then, we particularly notice it
when we're doing the physical examination
of people with Parkinson's disease.
We ask them to relax the muscles,
and then we move parts of their body.
And we feel this stiffness that's also involuntary,
they're not trying to do that.
It seems to affect kind of the larger muscles,
or at least it's more noticeable
in the larger muscles early in the disease.
For instance, it often, like our patient here said,
it often affects the walking quite a bit.
- [Narrator] And is that a separate symptom
or is that basically, just kind of,
these symptoms rolled into just walking?
- [Matt] Yeah, it probably,
the slowness and the stiffness contribute
to the trouble walking.
And it also is probably somewhat separate,
that they are kind of areas in the nervous system
that tell our muscles how to do walking normally.
And with Parkinson's disease,
some of these areas are not functioning normally,
so a person can't walk like they normally would.
- [Narrator] How do they walk usually?
It's just like a slow walk,
or just, they can't walk at all?
- [Matt] It's slow, and as the disease progresses,
it gets slower and slower.
They're often somewhat kind of stooped over
and they're often taking these short, shuffling steps.
And then, they also do develop some poor balance
and become prone to falls,
which becomes a real problem as the disease progresses
'cause people can get injuries from falls.
- [Narrator] So, when you say stooped over, like,
literally their back is stooped over?
- [Matt] Yeah, kind of, often the shoulders
are kind of rounded and they're stooped over
and, you know, it's pretty common
to see folks with Parkinson's disease walking around.
So, probably lots of people watching this
have seen somebody walking by that's kind of slow
and stooped and shuffling.
And then, often they'll have a tremor
of their hands happening at the same time.
- [Narrator] So I usually think of walking as like,
something that your legs do,
but the way you're describing it with, stooped over,
and, you know, hands kind of shaking,
you're kind of describing all of the movements
that a body needs to do while it's walking, right?
- [Matt] Yeah, walking is definitely a very complex thing.
And the nervous system has to do a lot of work
to kind of organize all the muscles for walking.
- [Narrator] So what's causing all these problems
in Parkinson's disease?
I have the drawing up, so that's going to help us
kind of talk through it.
But, do you mind just telling me exactly
what the issue is in Parkinson's?
- [Matt] Yeah, so you've drawn a very nice illustration
of the brain, and we're looking up
at the brain from the bottom.
- [Narrator] Yeah.
- [Matt] And right in the center there,
you've drawn the brain stem
where we've kind of cut through the brain stem
to disconnect the brain from the spinal cord.
And then you've drawn that bigger
over just to the right of that.
- [Narrator] Mm-hmm.
- [Matt] And that top image is a normal brain stem,
the part of the brain stem that's involved
with Parkinson's disease, and particularly those.
Yeah, and then the one underneath
would be a typical one of Parkinson's disease.
- [Narrator] Okay.
- [Matt] And those black lines that you've drawn
are really the part that's affected in Parkinson's disease.
Those black lines
are called the substantia nigra,
and the cells there are connected
with other parts of the brain
that do all sorts of functions,
but particularly a lot of movement functions.
And in Parkinson's disease, those cells are lost.
They gradually die over decades.
And just like you're drawing there,
we see way less of those cells in there.
- [Narrator] Mm-hmm.
- [Matt] And, why those cells are lost is the mystery.
We're actually not sure what the cause
of Parkinson's disease is.
What is actually killing the cells is the big mystery.
We actually do lose, um,
cells in other parts of the brain.
And that turns out to contribute some symptoms,
but usually much later in the course of the disease.
Most of the kind of movement abnormalities
that we see early in the disease
seem to be related to these specific cells right here.
- [Narrator] So that makes sense.
So these cells, we don't know why they're dying,
but in people with Parkinson's, they're dying.
And as a result,
they get these problems that we saw in the first video.
I'm gonna play the second video
'cause I think it's pretty cool
and I'm gonna ask you what you think of it.
- I'm Steve and I'm 67 years old,
and I was diagnosed with Parkinson's nearly 5 1/2 years ago.
My tremor is pretty obvious right at this point.
But I've never, uh,
demonstrated a tremor when I've been playing an instrument.
(flute whistles)
- [Gary] Hi, I'm Gary. I'm--
- [Narrator] I'm gonna pause before Gary, but you know,
when we're talking with Steve,
he's playing the instrument,
and it's really interesting, right?
You can literally see the shaking as you go though there,
and as he picks up the instrument, it's just gone.
- [Matt] Well, there are a number of types of tremor.
There are a number of different kinds of tremor
and conditions that cause tremor,
and they all look a little different.
And one of the things that's very distinctive
about Parkinson's disease is that
it's what we call a rest tremor.
So, it's actually when the body part is resting
and the muscles are not contracting
and there's no movement happening,
that's when we see the worst tremor.
And then, it actually goes away when a person starts moving.
Now, there are a number of other types of tremor
that are exactly the opposite,
where when a person is resting their body parts,
there's no tremor,
but when they try to move, they actually get a tremor.
Why that is, we're not sure,
'cause there's a lot we don't understand
about how the wiring of this particular system is,
and how it both controls movements
and kind of suppresses movements
that you don't want to happen, like this tremor.
- [Narrator] That's really interesting.
I'm gonna play the final video, then.
And this one brings up, I think,
a pretty interesting point as well.
Let me play that.
- Hi, I'm Gary. I'm almost 74 years old.
I was diagnosed with Parkinson's in February of 2008.
I lost the ability to write a check.
Many people don't realize that
there are so many different symptoms
that you get with Parkinson's.
But my handwriting got smaller
and smaller and unrecognizable.
And one day, I wrote a check, and I put the,
I tore the check out of the book
and put it on the table, my desk.
The phone rang and I took the call.
And after I finished the call, I picked up the check,
I put it in an envelope and I looked at it,
and I couldn't read it.
and that was very frustrating for me,
That was the day that I think I hit bottom.
- [Narrator] So that's actually pretty powerful.
I mean, the idea that an everyday activity
like writing a check can be impossible with these movements.
I mean, are people able to do things like brush their teeth
or eat food with Parkinson's when it gets that bad?
- [Matt] Yeah unfortunately, early-on Parkinson's
is more annoying than disabling.
A lot of the tremors are bothersome to people
and they don't like a lot of the symptoms,
but they're often able to do everything they were,
but unfortunately, Parkinson's progresses.
We're not sure why these cells are being lost,
but there's progressive loss to these cells
and people's symptoms get worse.
And when Parkinson's gets severe,
a person often isn't able to take care of themselves,
and that can be very disabling.
- [Narrator] Yeah wow, and you can see,
he had it on both sides, both arms.
And the other, the other two gentlemen,
it looked like it was just one arm.
Is that because he's worse?
- [Matt] Yeah, these three people are interesting
because they show an important point
that while Parkinson's patients
often have all of the symptoms,
they often can have them in different patterns.
With Parkinson's disease, we usually see
the symptoms come out on one side worse than the other.
And as it gets more severe,
we do tend to see people become more symmetric,
where they're involved very similarly on both sides.
- [Narrator] Cool, well thank you so much
for going over that with me, Matt.
I really appreciate it.
- [Matt] You're very welcome.