The Rezak Report

PARKINSON'S DISEASE IN THE YOUNG, by Michael Rezak, MD. Ph.D.

It is difficult to receive the diagnosis of Parkinson's disease (PD) at any age, but to develop this chronic, neurodegenerative disease at a younger age is barely imaginable. While the neuropathology and most clinical symptoms are the same at whatever age PD develops, the psychological, social and medical management implications are very different in the young - onset category of PD. Despite varying estimates, it is believed that approximately 8 to 10 % of all people with PD fall into the young - onset variety (arbitrarily defined as between ages 21-40).

Special attention must be paid to the effects of PD on the family. In the young - onset group individuals are just beginning families and some have children of school age. This is the time of life when family activities begin and financial growth occurs. The stress of dealing with a chronic disease is difficult and can take its toll on intafamilial relationships. Added to this is the frequent accompaniment of depression, anxiety and sexual dysfunction, resulting in a chaotic situation that often requires counseling in order to preserve the family unit. The need to remain open to psycho-logical counseling should be kept in mind, since timely intervention may be the key to preventing a disasterous outcome for the family.

Counseling regarding long-term financial planning is also essential for the younger patient with a slowly progressive, chronic disease.

Counseling regarding long-term financial planning is also essential for the younger patient with a slowly progressive, chronic disease. The need to financially provide for the daily requirements of a young family at a time when it is most needed is a major stress for the patient and spouse. Consideration of setting aside funds for future goals needs to be addressed, e.g., college tuition. The high cost of medical care for the long term also requires planning to optimize insurance benefits and be aware of the resources and options that are available, such as HMO, VA benefits, workmen’s compensation and social security disability. Finding reputable professionals such as insurance agents and financial planners with whom you can discuss these issues may certainly relieve much anxiety.

The medical management of the young-onset Parkinson’s patient requires an functions when taking levodopa. It is interesting to note that unlike the older-onset PD patient, dystonic contractions of a focal area of the body (commonly the foot) may actually be the presenting complaint of the young person with Parkinson’s. It therefore becomes mandatory to employ all levodopa sparing strategies at our disposal when attempting to treat symptoms in the young PD patient. This includes the anticho-linergics, amantadine and substantial use of the dopamine receptor agonists for more potent, symptomatic treatment. Often these drugs are used in combination. Nevertheless, Levodopa is our most efficacious drug in all PD patients and should be used at the lowest doses possible at the appropriate time, i.e., when an inadequate response is obtained with the use of other medications and/or side effects are encountered at doses necessary to achieve a desirable response. It is in the patient’s best interest to seek a physician who has an understanding of the unique requirements of the young PD patient. This will allow long-term control of symptoms and thus maximize functional independence.

Those affected by PD at younger ages comprise a special group. When attention is paid to the many important issues that may arise over the years of living with this disease, long-term psychological and medical health can be maximized.

Parkinson's Disease Research Society (PDRS)
Central DuPage Hospital

0N150 Winfield Rd., Suite A-2
Winfield, IL 60190