World Parkinson's Day 2023: Signs and symptoms of brain disorder in young people

Apart from tremors, young people with Parkinson's may experience stiffness of limbs, slow movement, and instability while walking. All you want to know.

Parkinson's disease is generally associated with elderly and the symptoms like tremors, stiffness, and difficulty in coordination is considered signs of an ageing brain. However, the disease can have an early onset and even affect young people of less than 50 years. People who have Young Parkinson’s disease may not develop apparent behavioural changes or memory loss which is usually seen in elderly patients. Tremors, slowness of movement, stiffness, reduced facial expression and changes in speech are the symptoms of Parkinson's in young people. World Parkinson's Day is celebrated every year on April 11. The day commemorates Dr James Parkinson's birthday the man who wrote 'An Essay on the Shaking Palsy' in 1817, the piece that first recognised Parkinson's as a medical condition. (Also read: Parkinson's Disease: Signs, non-motor manifestations one should watch out for)

People who have Young Parkinson’s disease may not develop apparent behavioural changes or memory loss which is usually seen in elderly patients. (Freepik)

What is Parkinson's Disease and why it affects young people

"Parkinson’s Disease is a common brain disorder which occurs with advancing age. However, this can occur even in young patients of age less than 50 years. Young Parkinson’s Disease patients form less than 10 % of total patients only. A few of them can have a genetic association, though most of the young patients may not have any specific causes for their symptoms and are called Idiopathic," says Dr Kapil Singhal, Director Neurology, Fortis Hospital Noida.

Parkinson's disease is a neurological condition that affects movement and can develop at any age. Although it is more common in older adults, approximately 4% of people with Parkinson's disease are diagnosed before the age of 50, says Dr. Vishal Chafale, Consultant Interventional Neurologist, Apollo Hospitals Navi Mumbai.

"Parkinson Disease is a neurodegenerative disease, which happens because of the deficiency of a chemical called dopamine in substantia nigra part of the brain. It is a usually a disease of elderly happens in the people who are more than 65 years of the age, but in few cases, it is also seen in people less than 50 years of age. In these it is called as young-onset Parkinson disease. It is usually seen in people who have family history of having Parkinson's disease. The difference between the Parkinson’s of young and the classic Parkinson’s is that it is usually associated with dystonia which is stiffness in muscles and more shambling. These patients are also very well responsive to deep brain stimulation and surgical therapy. The main thing is to identify the disease early start the treatment early, so that the quality of life can be improved,” says Dr Sahil Kohli, Senior Consultant, Neuroscience, Max Hospital Gurgaon.

Earlier considered a disease of old age with an average age of onset around 60 years, it is now found that symptoms may begin at a much earlier age. In fact, symptoms of PD are seen as early as 30s and 40s in around 10-20% of patients with PD. Patients with disease onset before 50 years of age are labelled as having Young onset Parkinson’s disease (YOPD) or Early onset Parkinson’s disease (EOPD), says Dr. Saraf Udit Umesh, Consultant and Movement Disorders Specialist, Dept of Neurology, Amrita Hospital.

Signs of Parkinson's disease in young people

"The usual symptoms of Parkinson’s Disease are tremors, shaking of hands which usually start on one side, change of voice which becomes low in volume, slowness in all activities. A person takes more time bathing, wearing clothes, eating food, the walk becomes slow, the person tends to drag feet while walking and can develop imbalance also. The body can become stiff, and with advancing symptoms, one can develop difficulty in turning in bed and gradually as the disease worsens, symptoms involve both sides of the body," says Dr Singhal.

"Classical clinical manifestations of PD include limb stiffness, tremors, slow movements, and gait difficulties leading to falls in advanced stages. Along with these symptoms, patients may experience sleep disturbances, constipation, urinary incontinence, abnormal sweating, depression, anxiety, and memory impairment, which can exacerbate the disease's disability. While PD has no permanent cure, several treatment options are available," says Dr Saraf.

"The usual motor symptoms include tremor in the wrist which starts with one side of the body and slowly progress to the other side. If there are bilateral symptoms (tremors on both sides), it would not be categorized as the usual type of Parkinson's disease. Apart from that, people may experience stiffness of the limbs, slow movement, and instability while walking. However, it is important to note that Parkinson's is not only limited to motor symptoms. There are other non-motor symptoms that happen 10-20 years before the person is actually diagnosed with this condition. Various studies have shown that constipation, anosmia or the loss of ability to smell, and even REM sleep behaviour disorder (RBD) are some of the non-motor symptoms that appear ages before the person is diagnosed. RBD is a sleep disorder in which the person physically acts out their dreams unknowingly while asleep. There can also be behavioural changes and the person is more prone to develop anxiety or depression. The progression of this condition differs based on the complication, says Dr. Shruti Vadke, Associate Consultant - Neurology, Manipal Hospital, Baner-Pune.

Dr. Vishal Chafale explains signs of Parkinson's disease in young people which may include:

Tremors: These are usually the first symptom of Parkinson's disease and often affect one hand or foot. They are most noticeable when the limb is at rest.

Slowness of movement: Also known as bradykinesia, this can make simple tasks like getting dressed or brushing teeth take longer than usual.

Stiffness: Parkinson's disease can cause muscle stiffness, particularly in the arms, legs, and neck.

Postural instability: This can cause problems with balance and coordination, making it difficult to stand or walk without falling.

Reduced facial expression: Parkinson's disease can cause a reduced range of facial expressions, making it difficult to convey emotions.

Changes in speech: Parkinson's disease can cause changes in speech, including slurred or hesitant speech, or a softer voice.

Micrographia: A small and cramped handwriting, which may become progressively worse over time.

"However, young Parkinson’s patients usually do not develop behavioural changes or memory loss which are seen in many elderly patients. The implications of a diagnosis of Parkinsons’ Disease in a young patient are different because it can have ramifications on work, family life and other long-term plans," says Dr Singhal.

Treatment of Parkinson's in young people

"The need for medicines may also be different in young patients. However, treatment is grossly the same and effective in young patients also. Oral medicines which replace Dopamine are the mainstay of treatment and treatment is designed as per the patient’s requirement. The role of exercise, and physical activity becomes even more important in young patients to improve movement and activity. Patients with Parkinson’s are able to run marathons, participate in sports activities, and adventure sports and lead a normal life. Parkinson’s Disease is a progressive disease, however, with advances in medicine, options of surgery (Brain pacemaker) in selected patients, and understanding of the disease, normal life can be achieved in patients. The goal is to break free from the slowness of PD to speed up the joys of life," says Dr Singhal.

"Lifestyle modifications can also significantly slow the progression of PD in all age groups. PD patients can benefit from various lifestyle measures such as dietary changes, physical exercise, and meditation. Studies have suggested that diets rich in fruits, vegetables, and fish can provide neuroprotective effects for PD. Adopting a well-balanced diet can help slow down the progression of PD. A healthy diet not only provides essential nutrients but can also influence the gut microbiota, which has a significant impact on the body. Regular, safe physical activity can delay the onset of PD or attenuate its consequences. Exposure to early life stress increases the risk of depression, which may exacerbate PD symptoms. Mindfulness or meditation practices have been shown to improve PD severity, particularly with regard to anxiety and depression. Additionally, yoga has been found to enhance balance and mental well-being in individuals with PD," says Dr Saraf.

"People diagnosed with this condition at an early age face more difficulty with the early symptoms. However, on a positive note, the progression is slower and the patients have less chance of developing dementia. They are more prone to the adverse effect of the medication with fewer side effects. Although there is no cure for this condition, timely intervention and medication after consulting the doctor play a major role in managing its progression. At the same time, a nutritious diet, and physical exercise also plays a major role in managing the early onset of this condition," says Dr Vadke.

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