Parkinson's Disease Terminology
Affect: The outward display of emotion. For instance, happiness is an emotion that is displayed by a smile, twinkling eyes, or laughter. Neurological diseases can cause "flattened affect" with little or no change in facial expression or voice, despite the person feeling normal emotions.
Akathesia: Restless movements of the body, usually the arms and legs, usually described by others as "nervousness." Usually associated with the use of anti-psychotic medications.
Akinesia: Lack of body movements. Normally, we move around constantly to some extent unless asleep or actively trying to suppress movement, but people with PD and other neurological disorders can look frozen, despite being awake and aware.
Alzheimer Disease: A condition of progressive loss of short-term memory and other cognitive problems, with relative preservation of long-term memory (at least initially), caused by buildup of abnormal protein inside and outside of neurons, especially the hippocampus, which is a specialized brain area that registers new memories before they are passed into long-term storage. Early diagnosis and early treatment are very important to overall quality of life and, hopefully, slowing down disease progression.
Anhedonia: Inability to experience pleasure in activities that would normally be enjoyable.
Anticholinergic: Blocking the action of acetylcholine, an important neurotransmitter. This can be on-purpose or as a side-effect of certain medications. Symptoms include dry mouth and difficulty urinating, which can also be used to the patient's advantage.
Apathy: Lack of interest. Patients with akinesia (see above) may look disinterested or apathetic, despite feeling normal inside. Patients with true apathy may be depressed or have other problems.
Bradykinesia: Slowness of movement. This can be at rest (see akinesia above) or with voluntary movements. Can be related to PD, depression, stroke and some medications.
Cholinesterase inhibitors: Medications responsible for blocking the breakdown of an important neurotransmitter, acetylcholine, which is found in the brain and the nerve endings. In the brain, these medications seem to improve or preserve short-term memory.
Cognition: Thought processes. Usually refers to problem solving, which involves distant and distinct parts of the brain and requires them to work in a coordinated manner, such as making out bills and balancing the checkbook.
COMT inhibitors: These medications block the action of catechol-O-methyltransferase, an enzyme that breaks down dopamine, an important neurotransmitter. In PD, these medications allow more Levodopa (the active ingredient in Sinemet) to get into the brain and make it to the right sites before being broken down. They are used to level out the amount of Levodopa in the serum, which seems to help PD patients move better without the on-off fluctuations in motor movements that tend to go along with taking Sinemet 3 or 4 times daily. Because these medications help Sinemet, they also may increase the side-effects of SInemet; they also turn urine a bright orange color.
Corpus striatum: A group of nuclei in the brain that interact to modulate motor functions; dysfunction is associated with abnormal movements, such as in PD or Huntington's Chorea.
Dementia: Decrease in normal mental abilities, due to neurological problems such as Alzheimer Disease, Stroke, Parkinson Disease, or Hydrocephalus. It can be "static" (unchanging) or progressive.
Dopamine: An important neurotransmitter necessary for normal movement and cognition. In PD, death of dopamine-producing cells in the Substantia Nigra is one of the key problems; as a result, PD is treated with the chemical precursor Levodopa, which is converted to Dopamine inside the brain. Too much dopamine causes increased movements and hallucinations.
Dopamine Agonists: These important medications act directly upon the Dopamine receptors in the brain, but bind to the recetors very tightly, causing alot more stimulation with much smaller amounts of chemical (1/100th the amount of Dopamine). Evidence suggests they may help delay the onset of dyskinesia (see below). They have side-effects similar to Levodopa (Sinemet), although the side effects may be more robust.
Dyskinesias: Unwanted writhing movements of the head, arms, legs, or even the trunk that are considered to be involuntary, but can be supressed by the patient to some extent. Usually associated with PD medications, especially Levodopa and dopamine agonists. Dyskinesia may not bother the patient at all or it may be disabling and embarrassing or dangerous.
Festination: Inability to stop or slow down forward progress while walking, can result in falls, seen with Parkinson Disease.
Hallucinations: The appearance of sights, sounds, or sensations that are not related to any stimulus. This is different from illusions, which are associated with actual stimuli (for example, believing that a curtain in the dark is moving or that a reflection in the mirror is a person). Most frequently, visual hallucinations occur of people, children or animals. They may be benign or threatening. They may be associated with certain neurological diseases or they may be the direct result of certain medications, such as Levodopa (Sinemet).
Lewy Body Disease: Also known as Dementia with Lewy bodies, this is an interesting and not uncommon condition that mimics both Alzheimer Disease and Parkinson Disease, but is quite different in that it causes early hallucinations and behavior problems.
MAO inhibitors: These medications block the action of monoamine oxidase, an enzyme that breaks down some neurotransmitters, especially Dopamine. Blocking this enzyme allows more Dopamine to act in the brain. MAO inhibitors help symptoms of PD and have been used for depression in the past. Recenty, Rasagiline (also known as Azilect) has been suggested to slow down the progress of Parkinson Disease. Side-effects tend to be similar to any other medication that improves the usage of Dopamine in the brain, although the FDA also warns about dietary restrictions to avoid excessive amounts of the amino acid Tyramine as well as certain medications.
On-Off: Also called Motor Fluctuations, this term describes the changes in motor movements that occur with medications used for Parkinson Disease. When "on," patients are able to move around well, usually associated with the peak of their medications. When the medication level is too low, an "off" period ensues and the patient may be immobile even to the point of being frozen in place.
Orthostatic Hypotension: Low blood pressure with changes in body position. Usually associated with weakness, light-headedness or fainting, can be worsened by standing (called orthostatic hypotension). May be associated with many neurological and blood pressure medications, but also with certain conditions, such as PD or Shy-Drager syndrome.
Pallidotomy: Partial destruction of a small part of the brain called the globus pallidus, which is also a target of the deep brain stimulation procedure. This may improve symptoms of tremor, rigidity, and bradykinesia for a year or more.
Parkinsonism: Symptoms mimicking Parkinson Disease, such as slowness of movement, blank expression, shuffling feet while walking, and problems, usually without tremor. Can have many causes, such as strokes, medications, or depression.
Postural instability: poor balance with standing in one place, often associated with increased falling and may require the use of a cane or walker.
Punding: Purposeless, seemingly obsessive motor or cognitive behaviors which are pleasurable for the patient. These can interfere with activities of daily living and relationships because the patient does not want to cease the activity.
Retropulsion: Stepping or falling backward unintentionally, such as when getting up from a chair, often causing the patient to fall. Usually associated with postural instability (see above).
Rigidity: Stiffness of muscles. Associated with poor and slow motor responses, pain or discomfort in the arms, legs, trunk and neck. Patients often report feeling better after exercise or with certain medications or deep brain stimulation.
Substantia Nigra: A motor nucleus located deep in the brain. Part of this nucleus has dopamine-producing cells which may die off over time, causing many of the symptoms of Parkinson Disease. However, modern evidence shows that this is just one of the abnormal brain structures seen in PD and that Dopamine is not the only affected neurotransmitter.
Thalamotomy: Partial destruction of a deep part of the brain, usually with radiofrequency waves, in order to calm tremor and improve muscle tone. Effects tend to be transitory (about 1 year), but may last longer.
Tremor: Trembling of the hands, legs or head. All tremor, regardless of cause, tends to be worse when upset or excited and will respond to calming situations or medications. Tremor at rest is associated with Parkinson Disease and Stroke. Tremor with action is usually associated with Familial Tremor, Benign Essential Tremor, or medications. Most tremors are treatable.
Wearing-Off: Increased symptoms of Parkinson Disease as the medication level in the blood falls (hours after taking pills). As PD progresses, there tends to be a shorter and shorter benefit from taking the medications, with earlier wearing-off, requiring more frequent medication dosages or even surgery.
Akathesia: Restless movements of the body, usually the arms and legs, usually described by others as "nervousness." Usually associated with the use of anti-psychotic medications.
Akinesia: Lack of body movements. Normally, we move around constantly to some extent unless asleep or actively trying to suppress movement, but people with PD and other neurological disorders can look frozen, despite being awake and aware.
Alzheimer Disease: A condition of progressive loss of short-term memory and other cognitive problems, with relative preservation of long-term memory (at least initially), caused by buildup of abnormal protein inside and outside of neurons, especially the hippocampus, which is a specialized brain area that registers new memories before they are passed into long-term storage. Early diagnosis and early treatment are very important to overall quality of life and, hopefully, slowing down disease progression.
Anhedonia: Inability to experience pleasure in activities that would normally be enjoyable.
Anticholinergic: Blocking the action of acetylcholine, an important neurotransmitter. This can be on-purpose or as a side-effect of certain medications. Symptoms include dry mouth and difficulty urinating, which can also be used to the patient's advantage.
Apathy: Lack of interest. Patients with akinesia (see above) may look disinterested or apathetic, despite feeling normal inside. Patients with true apathy may be depressed or have other problems.
Bradykinesia: Slowness of movement. This can be at rest (see akinesia above) or with voluntary movements. Can be related to PD, depression, stroke and some medications.
Cholinesterase inhibitors: Medications responsible for blocking the breakdown of an important neurotransmitter, acetylcholine, which is found in the brain and the nerve endings. In the brain, these medications seem to improve or preserve short-term memory.
Cognition: Thought processes. Usually refers to problem solving, which involves distant and distinct parts of the brain and requires them to work in a coordinated manner, such as making out bills and balancing the checkbook.
COMT inhibitors: These medications block the action of catechol-O-methyltransferase, an enzyme that breaks down dopamine, an important neurotransmitter. In PD, these medications allow more Levodopa (the active ingredient in Sinemet) to get into the brain and make it to the right sites before being broken down. They are used to level out the amount of Levodopa in the serum, which seems to help PD patients move better without the on-off fluctuations in motor movements that tend to go along with taking Sinemet 3 or 4 times daily. Because these medications help Sinemet, they also may increase the side-effects of SInemet; they also turn urine a bright orange color.
Corpus striatum: A group of nuclei in the brain that interact to modulate motor functions; dysfunction is associated with abnormal movements, such as in PD or Huntington's Chorea.
Dementia: Decrease in normal mental abilities, due to neurological problems such as Alzheimer Disease, Stroke, Parkinson Disease, or Hydrocephalus. It can be "static" (unchanging) or progressive.
Dopamine: An important neurotransmitter necessary for normal movement and cognition. In PD, death of dopamine-producing cells in the Substantia Nigra is one of the key problems; as a result, PD is treated with the chemical precursor Levodopa, which is converted to Dopamine inside the brain. Too much dopamine causes increased movements and hallucinations.
Dopamine Agonists: These important medications act directly upon the Dopamine receptors in the brain, but bind to the recetors very tightly, causing alot more stimulation with much smaller amounts of chemical (1/100th the amount of Dopamine). Evidence suggests they may help delay the onset of dyskinesia (see below). They have side-effects similar to Levodopa (Sinemet), although the side effects may be more robust.
Dyskinesias: Unwanted writhing movements of the head, arms, legs, or even the trunk that are considered to be involuntary, but can be supressed by the patient to some extent. Usually associated with PD medications, especially Levodopa and dopamine agonists. Dyskinesia may not bother the patient at all or it may be disabling and embarrassing or dangerous.
Festination: Inability to stop or slow down forward progress while walking, can result in falls, seen with Parkinson Disease.
Hallucinations: The appearance of sights, sounds, or sensations that are not related to any stimulus. This is different from illusions, which are associated with actual stimuli (for example, believing that a curtain in the dark is moving or that a reflection in the mirror is a person). Most frequently, visual hallucinations occur of people, children or animals. They may be benign or threatening. They may be associated with certain neurological diseases or they may be the direct result of certain medications, such as Levodopa (Sinemet).
Lewy Body Disease: Also known as Dementia with Lewy bodies, this is an interesting and not uncommon condition that mimics both Alzheimer Disease and Parkinson Disease, but is quite different in that it causes early hallucinations and behavior problems.
MAO inhibitors: These medications block the action of monoamine oxidase, an enzyme that breaks down some neurotransmitters, especially Dopamine. Blocking this enzyme allows more Dopamine to act in the brain. MAO inhibitors help symptoms of PD and have been used for depression in the past. Recenty, Rasagiline (also known as Azilect) has been suggested to slow down the progress of Parkinson Disease. Side-effects tend to be similar to any other medication that improves the usage of Dopamine in the brain, although the FDA also warns about dietary restrictions to avoid excessive amounts of the amino acid Tyramine as well as certain medications.
On-Off: Also called Motor Fluctuations, this term describes the changes in motor movements that occur with medications used for Parkinson Disease. When "on," patients are able to move around well, usually associated with the peak of their medications. When the medication level is too low, an "off" period ensues and the patient may be immobile even to the point of being frozen in place.
Orthostatic Hypotension: Low blood pressure with changes in body position. Usually associated with weakness, light-headedness or fainting, can be worsened by standing (called orthostatic hypotension). May be associated with many neurological and blood pressure medications, but also with certain conditions, such as PD or Shy-Drager syndrome.
Pallidotomy: Partial destruction of a small part of the brain called the globus pallidus, which is also a target of the deep brain stimulation procedure. This may improve symptoms of tremor, rigidity, and bradykinesia for a year or more.
Parkinsonism: Symptoms mimicking Parkinson Disease, such as slowness of movement, blank expression, shuffling feet while walking, and problems, usually without tremor. Can have many causes, such as strokes, medications, or depression.
Postural instability: poor balance with standing in one place, often associated with increased falling and may require the use of a cane or walker.
Punding: Purposeless, seemingly obsessive motor or cognitive behaviors which are pleasurable for the patient. These can interfere with activities of daily living and relationships because the patient does not want to cease the activity.
Retropulsion: Stepping or falling backward unintentionally, such as when getting up from a chair, often causing the patient to fall. Usually associated with postural instability (see above).
Rigidity: Stiffness of muscles. Associated with poor and slow motor responses, pain or discomfort in the arms, legs, trunk and neck. Patients often report feeling better after exercise or with certain medications or deep brain stimulation.
Substantia Nigra: A motor nucleus located deep in the brain. Part of this nucleus has dopamine-producing cells which may die off over time, causing many of the symptoms of Parkinson Disease. However, modern evidence shows that this is just one of the abnormal brain structures seen in PD and that Dopamine is not the only affected neurotransmitter.
Thalamotomy: Partial destruction of a deep part of the brain, usually with radiofrequency waves, in order to calm tremor and improve muscle tone. Effects tend to be transitory (about 1 year), but may last longer.
Tremor: Trembling of the hands, legs or head. All tremor, regardless of cause, tends to be worse when upset or excited and will respond to calming situations or medications. Tremor at rest is associated with Parkinson Disease and Stroke. Tremor with action is usually associated with Familial Tremor, Benign Essential Tremor, or medications. Most tremors are treatable.
Wearing-Off: Increased symptoms of Parkinson Disease as the medication level in the blood falls (hours after taking pills). As PD progresses, there tends to be a shorter and shorter benefit from taking the medications, with earlier wearing-off, requiring more frequent medication dosages or even surgery.