Parkinson’s disease has been plaguing humans for thousands of years and was described in detail in ancient medical writings. Early sufferers from it effects were treated with varying results by a variety of plant-based treatments, some of which are still in use today. With the discovery of dopamine in the twentieth century and the subsequent development of dopamine replacement therapy, plus surgical techniques such as deep brain stimulation (DBS), many of the debilitating symptoms are now successfully treated—at least for a time.

Despite the increased attention on Parkinson’s, there is still no diagnostic test that is definitive. Diagnosis is made based on presenting symptoms and tested by medicating with levodopa. Only on postmortem can the diagnosis be confirmed.

There is an ever-increasing understanding that PD is more than a motor disorder. Research into the nonmotor symptoms of PD is the focus of intense research, and there is hope of developing treatments that not only arrest the progress of the disease but stop it in its tracks.

While research into the genetic basis of PD continues, pharmacologic treatment remains the mainstay. However, it is becoming more sophisticated as new delivery methods (such as inhaled dopamine and intestinal gel) are becoming available, allowing better control of symptoms. Rehabilitation therapy is showing promising results and may even affect the course of the disease by stimulating the production of protective neurotransmitters.

Despite these advances, the medical management of PD is complex, requiring knowledge of multiple medications that interact in sometimes unforeseen ways. Deep brain stimulation has helped some patients control some symptoms but does not provide across-the-board improvement. A number of gene therapy trials are under way and are showing promise, most focusing on the dopamine pathway. Stem cell therapy appears promising but results are currently inconclusive.

As PD progresses to the advanced stage, care becomes increasingly complicated. The side effects of years of PD medications begin to take their toll, requiring additional medications to address worsening sleep disorders, gastric dysfunction, and a host of other difficulties.

In light of these challenges, research into neuroprotective therapies is occurring at a feverish pace. The hope is to find the cause of PD, along with treatments that stop the disease from progressing. Of particular interest, PD research is uncovering what may turn out to be a common pathophysiologic mechanism underlying dementia and PD. For now, healthcare providers must continue to educate themselves about currently available treatments and hope for better alternatives in the near future.

Epilogue

Alan Cruikshank is a 65-year-old white male who has Parkinson’s disease. He is the founder and publisher of the Fountain Hills (Arizona) Times, an award-winning weekly newspaper. Cruikshank himself is the 2013 recipient of the Amos Award for Excellence by the National Newspapers Association. Recognized as the highest tribute in community journalism, the Amos Award is presented annually to a working or retired newspaperman who has provided distinguished service and leadership to the press and to his community.

The personal narrative in this course is his story, in his own words. Cruikshank published a longer version in his newspaper in the spring of 2012. We are deeply grateful to Alan Cruikshank for allowing us to share his personal experience with Parkinson’s disease.