You are never too young for Parkinson’s Disease

Young Onset vs. Late Onset Parkinson’s Disease

By Soania Mathur, MD

The symptoms of Parkinson’s disease (tremors, stiffness, slowness, and impaired balance) start gradually and typically begin after age 60.

While the average age of diagnosis is 62, roughly 10% of people with the condition experience symptoms under the age of 50, known as young-onset Parkinson’s disease.¹

This article discusses young-onset and late-onset Parkinson’s disease, its diagnosis, and its progression.

Diagnosis

Young-onset Parkinson’s disease can develop between the ages of 21 and 55 and brings a unique set of challenges. These patients often display different initial symptoms than older patients and may take longer to get a diagnosis.

Research published in the Journal of Neurological Sciences in 2012 shows that patients with young-onset Parkinson’s diseases take longer to get an accurate diagnosis, with one study finding the discrepancy in time to diagnosis was on average 15 months longer for younger patients.²

This may be due to a different presentation of symptoms and the disease being overlooked simply due to the patient’s age. In addition, the course the disease takes is also different in younger patients than older ones.

Symptoms

In young-onset patients, the first symptoms tend to be rigidity, pain, cramps, and dystonic posturing, which is often misdiagnosed as tendonitis.

Young-onset patients are also at increased risk for non-motor symptoms of Parkinson’s, including sleep disorders, depression, anxiety, constipation, low energy, urinary issues, and apathy.

However, these patients also have a lower rate of Parkinson’s-related dementia.

Regardless of the age of onset, Parkinson’s symptoms include:³

• Tremor or shaking typically starts in the hand or a limb and is usually most visible at rest. Some people develop a pill-rolling tremor, a repetitive motion of rubbing the thumb and forefinger together as if rolling a small object between them. Tremors can make writing difficult.
• Bradykinesia, or slowed movement, can make small tasks more difficult and time-consuming. One common feature is a shorter gate or shuffling motion when trying to walk.
• Muscle stiffness and rigidity can occur in any part of the body, resulting in pain and a limited range of motion.
• Maintain a good posture can be challenging, making it difficult to stand up straight.
• Balance problems can make walking or performing tasks difficult.
• Automatic movements, such as blinking, swinging your arms when you walk, smiling or making other unconscious facial or body movements can be lost in patients with Parkinson’s.
• Speaking can become difficult. Some people with Parkinson’s have trouble moderating the volume and tone of voice, slur their word, or develop a stutter.

Progression

Research shows the disease progresses slower in patients with an earlier diagnosis.

In one study, researchers at Baylor College of Medicine in Houston found younger patients took significantly longer to reach the first stage of progression in the disease on the Hoehn and Yahr Scale than older patients.⁴

Measured from the onset of symptoms to unilateral involvement only, older patients progressed to stage 1 in an average of 1.7 years, while younger patients took 2.9 years.

Another study published in the journal Archives of Neurology found that, at the same point in the duration of symptoms, patients with a later onset of the disease have greater motor impairment than patients with a younger diagnosis.

Patients who are diagnosed at a younger age live longer with the complications of the illness, but also more likely to die at a younger age.

Treatment

The same medications are used to treat both late-onset and young-onset patients, however, younger patients are at greater risk of certain side effects.

In particular, patients who are diagnosed at a younger age have an increased rate of dyskinesias, or involuntary movements often of the limbs, in response to levodopa treatment and are more likely to develop treatment-related complications such as motor fluctuations and dyskinesias earlier in the course of their disease.⁵

Coping

Being diagnosed with Parkinson’s disease is difficult at any age. People who are diagnosed earlier in life may encounter more challenges due to employment and family responsibilities.

Many people with Parkinson’s are still in the workforce at the time of diagnosis. While this does not necessarily mean you will need to take early retirement, you may need accommodations to be successful at your job.⁶

In most states, employers are legally required to provide accommodations to people with disabilities. Before disclosing your diagnosis to your employer, check your state’s laws.

Regardless of age, it is important to surround yourself with people who love and care about you and to reach out for support when needed. Check your local healthcare centers for support groups, or join an online support group at www.myparkinsonsteam.com.

By Soania Mathur, MD
Soania Mathur, MD, is a speaker, author, and advocate for people living with Parkinson’s disease.

Video: “Rehabilitation of the patients with Parkinson’s Disease”

Set of exercises 1 for Parkinson’s Disease: improving joint mobility and increasing body flexibility

For additional information about Rehabilitation of the patients with Parkinson’s Disease you can watch a video demonstrating exercises and rehabilitation recommendations.

GHRS physiotherapy and rehabilitation

Rehabilitation methods for Parkinson’s disease, prescribed by a qualified specialist in physiotherapy and rehabilitation, combined with drug therapy, can significantly improve the quality of life of patients, improve motor and cognitive functions, and reduce the symptoms of the disease.

To maintain the health of patients with Parkinson’s disease, it is important to combine different operations and activities. Every day, you can combine and vary as follows – strength training, walking training, exercise bike training, training to improve joint flexibility, improve posture and balance. Of course, it is important to combine training with daily activities and, therefore, to practice the functions used in everyday life: sitting, getting up (from bed, from a chair), mobility in bed, etc.

The process of rehabilitation and treatment of patients with Parkinson’s disease, of course, depends on the disease stage (primary or progressive). But regardless of this, the process of developing and forming a rehabilitation program should take into account four main areas:

1. Improve joint mobility and increase body flexibility

2. Strengthening the musculoskeletal and muscular system, endurance

3. Improving the coordination and “composition” of any movement – dividing it into components.

4. Improve balance, gait and fall prevention

As recent studies have shown, for patients with Parkinson’s disease, it is important to form a rehabilitation plan based on a stepwise, gradually changing training rhythm and increasing exercise difficulty. Constancy and monotony in the choice of physical activity and activity is not recommended.

Check out the demo version of our sets of exercises for Parkinson’s Disease on YouTube

Our website presents the following sets of exercises for the rehabilitation of the patients with Parkinson’s Disease:

1. SET OF EXERCISES №1 FOR PARKINSON’S DISEASE: IMPROVING JOINT MOBILITY AND INCREASING BODY FLEXIBILITY

2. SET OF EXERCISES №2 FOR PARKINSON’S DISEASE: STRENGTHENING OF THE MUSCULOSKELETAL AND MUSCULAR SYSTEM, ENDURANCE

3. A SET OF EXERCISES №3 FOR PARKINSON’S DISEASE: IMPROVING THE COORDINATION AND “COMPOSITION” OF MOVEMENT – DIVIDING IT INTO COMPONENTS

4. A SET OF EXERCISES №3 FOR PARKINSON’S DISEASE: IMPROVING THE COORDINATION AND “COMPOSITION” OF MOVEMENT – DIVIDING IT INTO COMPONENTS

Sources

1. American Parkinson Disease Association. Early Onset Parkinson’s Disease.
2. Rana AQ, Siddiqui I, Yousuf MS. Challenges in diagnosis of young onset Parkinson’s disease. J Neurol Sci. 2012;323(1-2):113-116. doi:10.1016/j.jns.2012.08.029.
3. American Parkinson Disease Association. Common Symptoms of Parkinson’s Disease.
4. Silver GA, Vuong KD, Jankovic J. Young-onset versus late-onset Parkinson’s disease: Clinical features and disease progression. Mov Disord. 2004;19 Suppl 9:S264.
5. Thanvi B, Lo N, Robinson T. Levodopa-induced dyskinesia in Parkinson’s disease: clinical features, pathogenesis, prevention and treatment. Postgrad Med J. 2007;83(980):384-388. doi:10.1136/pgmj.2006.054759
6. The Michael J. Fox Foundation for Parkinson’s Research. Workplace Challenges.

Additional Reading

• Diederich NJ, Moore CG, Leurgans SE, et al. Parkinson disease with old-age onset: a comparative study with subjects with middle-age onset. Arch Neurol. 2003;60(4):529-33. doi: 10.1001/archneur.60.4.529
• Ferguson LW, Rajput AH, Rajput A. Early-onset vs. Late-onset Parkinson’s disease: A Clinical-pathological Study. Can J Neurol Sci. 2016;43(1):113-9. doi: 10.1017/cjn.2015.244.
• Morgan JC, Currie LJ, Harrison MB, et al. Mortality in levodopa-treated Parkinson’s disease. Parkinsons Dis. 2014;2014:426976. doi: 10.1155/2014/426976.
• Spica V, Pekmezović T, Svetel M, Kostić VS. Prevalence of non-motor symptoms in young-onset versus late-onset Parkinson’s disease. J Neurol. 2013;260(1):131-7. doi: 10.1007/s00415-012-6600-9.