New research shows an innovative brain stimulation therapy called transcranial magnetic stimulation (TMS) treatment can improve and ease the symptoms of Parkinson’s disease (PD) related to motor control. This offers PD patients with tremors or problems walking or standing new hope that they can return to typical daily activities made difficult by the onset of PD.
Parkinson’s Disease and Our Aging Population
We recently published an article here on our blog on the use transcranial magnetic stimulation (TMS) for Alzheimer’s Disease (AD) and AD-related dementia and cognitive decline. To learn about TMS for AD, please navigate to our blog and read that piece:
Transcranial Magnetic Stimulation (TMS) for Alzheimer’s Disease
One thing we share in that article is the fact that in the United States, the percentage of people over age 65 is steadily increasing. In the year 2021, records showed a total of 73.4 million people (22.7%) under age 18 and a total of 455.8 million people (16.8%) over age 65. Experts estimate that in just over ten years, those percentages will shift. By 2034, people over age 65 will number 77 million (23.2% of the population) and people under 18 will number 76.5 million (18.8% of the population). And by 2060, the differences will be dramatic: estimates place the number of people over 65 at 94.7 million (23.4 % of the population) and the number of people under age 18 at 80.1 million (19.8% of the population).
That’s why it’s important for researchers to explore new ways to treat – and possibly prevent – the health challenges facing older people, especially those over age 65. Parkinson’s disease is one of those significant health challenges. After Alzheimer’s disease, PD is the second leading cause of dementia and cognitive decline among seniors in the U.S.
In this article, we’ll discuss the results of a study on the use of transcranial magnetic stimulation (TMS) on people with PD published in 2022.
First, however, we’ll explain exactly what Parkinson’s disease is and share the latest information on the prevalence of PD in the U.S. Then we’ll review the most common treatments for PD and share the new research on TMS for PD, and explain how it may improve outcomes for current and future patients diagnosed with Parkinson’s disease (PD).
What is Parkinson’s Disease (PD)?
Parkinson’s disease is the second most common neurodegenerative disease in humans, after Alzheimer’s disease. The Mayo Clinic and the Parkinson’s Foundation define Parkinson’s disease as follows:
“A progressive neurodegenerative disorder that affects predominately the dopamine-producing neurons in the brain, which have an impact on motor function, executive function, and various components of memory and cognition.”
The symptoms of PD fall into two categories: motor control/movement-related symptoms and non-motor control/movement-related symptoms.
Motor/movement-related symptoms include:
- Tremors in hands, legs, arms, jaw, and/or head
- Muscle stiffness
- Slow movement
- Impaired balance
- Problems walking
- Decreased coordination
- Slowed/slurred speech
- Problems chewing and eating
- Bladder issues
- Problems swallowing
Symptoms not related to motor/movement include:
- Depression
- Anxiety
- Apathy
- Hallucinations
- Constipation
- Sleep disorders
- Loss of smell
In addition, PD is associated with a phenomenon called orthostatic hypotension, which is a type of low blood pressure that occurs when a person stands up or sits down. Orthostatic hypotension can cause dizziness, lightheadedness, fainting, blurred vision, nausea, and confusion.
While the precise cause of PD is unknown, researchers identify several risk factors associated with the development of Parkinson’s disease. These include:
- Age: Parkinson’s is most common in people over age 60 but may occur in people under age 45.
- Genetic factors, i.e. hereditability
- Smoking
- Air pollution containing some herbicides and/or pesticides
- Water pollution contains herbicides and/or pesticides
Prevalence of Parkinson’s Disease
According to the World Health Organization (WHO), rates of PD have shown larger increases than other neurodegenerative disorders over the past 25 years. Here are the worldwide statistics:
- The prevalence of PD doubled in the past 25 years.
- Global estimates published in 2019 showed over 8.5 million individuals with PD.
- Experts estimate that disability associated with PD increased 81% between 2000 and 2019.
- IN 2019, 329,000 people died of PD-related complications
- PD-related mortality increased over 100% between 2000 and 2019
The latest information from the Parkinson’s Association and Nature/NPJ Parkinson’s Disease, published in 2022, show the following prevalence rates of PD in the United States:
- Average diagnoses per year: 90,000 people
- That’s a 50% increase from the 60,000 annual diagnoses reported in 2014
- Around 850,000 – 1,000,0000 people in the U.S. live with PD
- Experts estimate that number will increase to 1.2 million by the year 2030
- Rates of PD per 100,000 people:
- Age 65+: 160 per 100,000
- Age 45+: 62 per 100,000
- Roughly 4% of people receive a PD diagnosis before age 50
- Men are 1.5 time more likely than women to develop PD
Additional facts and figures related to PD:
- Incidence and risk of PD increases with age
- Older age is the primary risk factor for PD
- At all ages, men show higher rates of PD than women
- Overall increase in PD diagnoses mirror the increasing number of people 65+ in the U.S
- Compared to other areas of the U.S., PD is more common in:
- The northwestern and midwestern U.S., in the area now called the rust belt, an area formerly known for a high level of industrial manufacturing
- Southern California, Southeastern Texas, Central Pennsylvania, Florida
That information clearly defines the public health challenge we face. As of today, close to a million people in the U.S. live with Parkinson’s, and that number is on the rise.
Traditional Treatment for Parkinson’s Disease
There is no cure for Parkinson’s disease. However, with a combination of medication, supportive therapies/lifestyle changes, and in extreme cases, surgery, many people with PD can manage the symptoms of the disease and continue with many of the activities that make life full and rewarding.
Common Medications for Parkinson’s Disease
- Dopamine supplements such as levodopa
- A medication called carbidopa that prevents breakdown of levodopa before it enters the brain
- Dopamine agonists including but not limited to medications such as apomorphine hydrochloride and pergolide
Supportive Therapies/Lifestyle Changes for Parkinson’s Disease
- Physical, occupational, and speech therapy:
- These help with walking problems, speaking problems, tremors, rigidity, and cognitive decline
- A healthy diet that improves overall health and wellness:
- 6-8 glasses of water a day
- Foods rich in whole grains and fiber
- Fruit
- Beans
- Reduced white sugar intake
- Snacks like nuts and berries
- Lean protein like salmon
- Plenty of leafy green vegetable
- Exercise:
- Improves muscle health
- Improves balance
- Enhances coordination
- Improves balance
- Reduces falls
- Massage:
- Reduces tension
- Helps ease pain in sore muscles
- Yoga and tai chi:
- Improve balance
- Improve coordination
- Increase joint health and flexibility
- Low impact
- Include mental health and stress relief benefits
Specialists in treating PD recognize that it can be challenging, but with a combination of the approaches above, a person diagnosed with PD can manage their symptoms and engage in many of the activities they love and give their life meaning. To learn about surgical options for people with advanced PD, please visit this page maintained by the Parkinson’s Foundation.
That’s the current situation with regards to the treatment of Parkinson’s – but there’s new hope for people diagnosed with PD: evidence indicates transcranial magnetic stimulation (TMS) can help reduce the motor symptoms that cause severe disruption in the lives of people with PD.
TMS Treatment for Parkinson’s Disease
A study published in 2022 called “Comparative Efficacy of Transcranial Magnetic Stimulation on Different Targets In Parkinson’s Disease: A Bayesian Network Meta-Analysis” examines the impact of TMS on people with PD.
To learn more about transcranial magnetic stimulation, please navigate to our page TMS treatment page here:
Relief TMS
Here’s a quick run-down on TMS, in case you don’t want to click through to that page:
TMS is a non-invasive brain stimulation therapy that uses mild electromagnetic pulses to active specific brain areas related to the mental health disorder or degenerative condition in need of treatment. TMS is an attractive option for many people because in most cases its fast-acting and long-lasting. Also, in contrast to many medications, TMS has no systemic side effects.
This study piqued our interest because it pooled an analyzed the results of 36 clinical trials involving 1,122 patients diagnosed with PD. To gauge the effect of TMS treatment on the motor-control symptoms of Parkinson’s disease, researchers used the Unified Parkinson’s Disease Rating Scale Part-III (UPRDS-III). Researchers included studies that applied high-frequency TMS on brain areas called the bilateral M1, the bilateral dorsolateral prefrontal cortex (DLPFC), and both the M1 and the DLPFC.
The bilateral M1 brain area is associated with:
- Voluntary motion and motor control
- Empathy
- Emotional processing
- Working memory
- Language processing
The dorsolateral prefrontal cortex (DLPFC) brain area is associated with:
- Executive function
- Working memory
- Cognitive planning
- Movement planning
- Inhibition
Here’s what they found:
- TMS significantly improved motor symptoms in PD patients.
- High-frequency stimulation in the M1 and DLPFC separately led to significantly reduced UPDRS-III scores in PD patients, compared with sham treatments.
- High-frequency stimulation over both M1 and DLPFC at the same time led to more significant UPDRS-III scores in PD patients, compared with sham treatments.
Those results are important: not only do they confirm the efficacy of TMS for Parkinson’s, but they also confirm the brain areas that, when targeted with TMS, yield the most positive results for people with PD. However, these results beg a question:
Does TMS treatment help the non-motor symptoms of Parkinson’s disease?
While more research is needed, we can observe that improvements in the ability to walk, talk, and engage in the typical activities associated with daily life mean an older person who engages in TNS treatment for PD will be able to live a more active lifestyle, which is a protective factor for cognitive decline, memory, and mental health diagnoses such as depression and anxiety that often accompany Parkinson’s disease.
Takeaways: How TMS Treatment Can Help Parkinson’s Disease
What we want family members of people with PD to learn from this article is critical. It’s possible to manage the symptoms of PD and live a life that’s not dictated or severely impaired by the presence of tremors and the challenges tremors cause with simple activities walking and eating. In addition to TMS treatment, a wealth of resources for people with PD are available online. We’ll share those below. First, we’ll share the ten most common early signs of PD that anyone with an older relative or loved one should be able to recognize.
Ten Early Signs of Parkinson’s Disease: What to Watch For
(Parkinson’s Foundation)
1. Tremors
During the initial stages of PD, tremors (shaking) are most commonly observed in hands, fingers, or chin.
2. Handwriting
Writing may become difficult. Letter sizes may shrink and words may become crowded together in a phenomenon called micrographia.
3. Sense of Smell
People with PD may have problems smelling some foods, like licorice, bananas, or pickles.
4. Sleep Problems
Most people move around a small amount when they sleep, while others toss and tun all night. People with PD may display quick, jerky movements when sleeping.
5. Problems Walking and Moving
People with PD may feel stiff in the arms, legs, and torso. Early signs include arms not swinging naturally while walking, or pain in shoulders and hips. People with PD may report their feet feel stuck to the floor.
6. Constipation
The need for excess or unusual strain during bowel movements may be an early sign of PD.
7. Soft, Quiet, Low Speech
A change in speaking volume resulting in low, soft, breathy, or hoarse speech may be an early sign of PD.
8. Facial Masking
In some cases, PD causes the muscles of the face to become stiff and hard to move. This can impair or prevent smiling, raising eyebrows, or making facial expressions common to everyday communication. The result is a blank, frozen look, called facial masking or masked face.
9. Fainting/Dizziness
It’s common to feel dizzy upon standing quickly: most people call this a headrush. However, if this happens regularly, it may be an early sign of PD.
10. Stooping/Hunching
Muscle stiffness and tiredness, along with a decrease in reminders automatically generated by the brain to stand upright, may cause rounded shoulders, low-back flexion, and a forward lean of the head or the entire body. While some of these may simply be symptoms of fatigue, chronic hunching and stooping may be a sign of PD.
If a friend, family member, or loved one shows any of those symptoms – and they aren’t associated with a common, temporary illness – we recommend arranging a full screen for Parkinson’s disease administered by an experienced, qualified neurologist: they can diagnose PD and recommend a viable course of treatment.
Parkinson’s Disease: Resources for Patients and Families
The Parkinson’s Foundation Resources and Support Page offers the following resources for individuals and families impacted by PD:
- Parkinson’s Helpline. Call 1-800-473-4636 for help and information Monday through Friday from 9 a.m. to 7 p.m., or email helpline@Parkinson.org at any time.
- New to Parkinson’s. This page has a wide range of information on PD for people newly diagnosed with PD. This information is important for friends and family members to read and understand, as well.
- Local Support Finder. This page allows people with PD – and friends and family – to type in a zip code and search radius to find Parkinson’s treatment and support that’s been vetted by the Parkinson’s Foundation.
Please do not hesitate to use the resources provided by the Parkinson’s Foundation. That’s why they’re there. They want everyone impacted by PD to understand help is available, and above all, that they are not alone. Millions of people live with the effects of PD, and the people at the Parkinson’s Foundation are ready to share that collective knowledge to anyone who reaches out and asks for help.