More than ten million people are living with Parkinson's disease worldwide, with about one million cases expected to be in the United States by 2020.1 This is more than the number of people with multiple sclerosis, muscular dystrophy and Lou Gehrig's disease combined.1 With the rising prevalence of Parkinson's disease, its important to understand the signs and symptoms of the disease. Likewise, physicians and radiology departments may need to know what role magnetic resonance imaging (MRI) may play.
What is Parkinson's disease?
Parkinson's disease is a disorder that affects the nervous system and movement.2,3 The symptoms typically begin gradually, and it may take a while for patients to notice them. These symptoms may include tremors, slow movement, rigid muscles as well as speech and writing changes. Patients may also experience impaired posture and balance or loss of automatic movements, such as blinking, smiling or swinging their arms.
Parkinson's has a variety of risk factors that should be considered. In many cases, Parkinson's usually affects people who are 50 years of age or older.2,3 However, some patients may experience young onset Parkinson's disease, also called early-onset Parkinson's disease, which affects roughly 2-10% of the population with Parkinson's in the United States.3 Men may be more likely to develop Parkinson's disease than women.2 If a close relative has Parkinson's disease, a patient may be more likely to develop the disorder. The risk may still be small unless there are a large number of relatives with Parkinson's disease. Finally, long-term exposure to herbicides and pesticides may slightly increase a patient's risk.2
Once the disease has begun to progress, there are five stages that patients may experience.
- Stage one: Patient may have mild symptoms that don't affect daily activities. Movement-based symptoms, such as tremors, happen on one side of the body. Patients may experience changes in their posture, gait and facial expressions.2
- Stage two: Patients may still be able to live alone, but daily activities may be more difficult and take longer to complete. Their symptoms are getting worse. Movement-based symptoms, such as tremor and rigidity, may affect both sides of the body and posture and gait issues may become apparent.2
- Stage three: Patients may experience significant impairments in dressing and eating, though they are still independent. Patients may experience more loss of balance and falls, as well as slowed movements. This stage is considered mid-stage.2
- Stage four: Symptoms are severe and limit daily activities. Patients are still able to stand on their own, but they may need a walker to assist them. At this point, people cannot live alone and need help completing tasks.2
- Stage five: It may be impossible to stand or walk, and the patient may require a wheelchair or may be bed-ridden. The patient needs help with all activities and may experience hallucinations or delusions. A nurse may need to attend to the patient all day and night.2
How can magnetic resonance imaging help?
Magnetic resonance imaging is used to monitor a large variety of disorders and diseases throughout the body. the images produced during an MRI scan may show tissue structures and organs in excellent detail. Functional MRI (fMRI) is one technique that can provide information about the body during certain activities. Both conventional and functional MRI may help show the progress of diseases, including Parkinson's disease, and may show the response to treatments.
Functional MRI may be used to image the brain during movement. Research for Parkinson's disease has included fMRI to monitor what regions are activated during automatic motion.4 This study of 12 patients with Parkinson's disease practiced sequences of finger movement until they were able to be done automatically. Then, they underwent fMRI to compare their scans before and after they had learned the sequences. The results showed that the most of the same areas of the brain were active while performing the sequences before or after they became automatic. Subjects without Parkinson's had significantly reduced activity in the brain after automaticity. This means that patients with Parkinson's disease had more trouble performing the actions than the people without.
Functional MRI has also been used at the research level to demonstrate the deterioration level of five different areas of the brain.5 This was done with a baseline MRI scan and one a year later. Patients with Parkinson's had two areas of deterioration, which is less than the areas of deterioration of two other Parkinsonian disorders, disorders that are similar to Parkinson's. This could potentially lead to a biomarker for Parkinson's disease after more research.
Functional MRI can provide useful information during research of Parkinson's, which may eventually impact the preferred treatment methods for the disease. Because of the ability of MRI to image the brain, it may lead researchers to understand the changes that occur in the brain throughout the five stages of Parkinson's. This would help the roughly 10,000,000 people worldwide who have been diagnosed with the disorder.
1. "Statistics." Parkinson.org. Web. 10 April 2019. <https://www.parkinson.org/Understanding-Parkinsons/Statistics?_ga=2.102920195.2037584946.1554920949-1913728038.1554920949>.
2. Mayo Clinic Staff. "Parkinson's disease." MayoClinic.org. 30 June 2018. Web. 10 April 2019. <https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/symptoms-causes/syc-20376055>.
3. Ahmad Elkouzi. "What is Parkinson's?" Parkinson.org. Web. 10 April 2019. <https://parkinson.org/understanding-parkinsons/what-is-parkinsons>.
4. Tao Wu and Mark Hallett. "A functional MRI study of automatic movements in patients with Parkinson's disease." Brain. October 2005; 128(10): 2250-2259. Web. 11 April 2019. <https://academic.oup.com/brain/article/128/10/2250/274631>.
5. Ines Martins. "MRI Scans That Capture Parkinson's Progression May Aid in Research." ParkinsonsNewsToday.com. 25 August 2016. Web. 10 April 2019. <https://parkinsonsnewstoday.com/2016/08/25/mri-scans-as-parkinson-progression-biomarker-may-aid-treatment-research/>.