Alan Alda Goes Public with Parkinson’s disease Diagnosis

By Michael N. Brant-Zawadzki, M.D., F.A.C.R.

Categories: Articles

Another celebrity courageously announces he has been diagnosed with Parkinson’s, in the most recent case Alan Alda of movie and TV fame. Why does it, or should it, take courage? Why should it be announced? Do those diagnosed with Diabetes announce it? Maybe because the inappropriate stigma attached to the diagnosis makes it courageous to admit to the disease. One conjures up images of the stiff, non-communicative Mohammed Ali, or the wildly contorting Michael J. Fox when the word “Parkinson’s” is heard. Yet the reality is, Parkinson’s is very much a chronic disease like diabetes, and most people with it can lead relatively normal lives without even being noticed, while under proper management. Because it is the second most common neurodegenerative disease of aging (after Alzheimer’s), it is becoming more common as our baby boomers get older.

Diabetes is a disease where the cells of the pancreas manufacture insufficient insulin to process sugars properly leading to numerous potential symptoms if not properly managed with insulin stimulating medication or replacement and proper behavioral habits like diet and exercise. Similarly, in Parkinson’s certain cells in the deep parts of the brain begin to produce insufficient amounts of dopamine. Dopamine is a valuable molecule, a so-called neurotransmitter, because it enables proper communication of nerve impulses in the brain. In certain parts of the brain, dopamine imbalance can impact motivation, and addictive behavior like substance abuse and gambling. Even excessive gaming and cell phone use are related to the secretion of dopamine, affecting the pleasure centers of the brain.

In Parkinson’s, the cells devoid of normal dopamine production reside in those specific areas of the brain that control subconscious motor activity…activity vital for smooth motion of our extremities, coordinating balance, voice regulation, even those muscles that control our swallowing, salivation and tear production, that we willfully don’t think about.

Tremors, rigidity and imbalance are some typical symptoms. In a minority of patients, cognition can suffer, as severe dopamine depletion in advanced stages of the disease affects clear thinking.

Yet much like diabetes, with proper stimulation of, and replacement of dopamine, patients can be well-managed for decades. Exercise is a critical component of management, likely because of the improved blood flow to the brain, as well as the intentional use of muscles that could become overly rigid, or uncoordinated due to sedentary life style. Targeted physical therapy for specific issues like balance problems is a mainstay of therapy, as is the use of Botox, to help with certain rigidities, or even excessive salivation (injecting the salivary glands relaxes the smooth muscles that can improperly squeeze saliva into the mouth). In certain cases, minimally invasive electrode placement into the areas of the brain harboring the dopamine depleted cells is a surrogate for the stimulation of nearby nerve cells waiting for the dopamine effect.

Having a multi-disciplinary team composed of experts in neurology, physical therapy, neurosurgery, and a supportive set of everyday resources like exercise classes that include targeted motion activity is vital. Balance exercises area huge component of living well with Parkinson’s. The Pickup Family Neurosciences Institute at Hoag has a Parkinson’s and movement disorders program that is a robust resource for those with the disease, providing all the various evidence based treatment approaches overseen by our multi-disciplinary team. We also conduct clinical trials with the latest medications aimed at mitigating the effects of the disease. It’s here for anyone affected, no courage needed.

Michael N. Brant-Zawadzki, M.D., F.A.C.R.
The Ron and Sandi Simon Endowed Chair,
Executive Medical Director, Pickup Family Neurosciences Institute