parkinsonian

Your autonomic nervous system is the part of your nervous system that controls involuntary actions, such as the beating of your heart and the widening or narrowing of your blood vessels. When something goes wrong in this system, it can cause serious problems, including:

• Blood pressure problems
• Heart problems
• Trouble with breathing and swallowing
• Erectile dysfunction in men

Autonomic nervous system disorders can occur alone or as the result of another disease, such as Parkinson's disease, alcoholism and diabetes. Problems can affect either part of the system, as in complex regional pain syndromes, or all of the system. Some types are temporary, but many worsen over time. When they affect your breathing or heart function, these disorders can be life-threatening.

Some autonomic nervous system disorders get better when an underlying disease is treated. Often, however, there is no cure. In that case, the goal of treatment is to improve symptoms.

NIH: National Institute of Neurological Disorders and Stroke

Degenerative nerve diseases affect many of your body's activities, such as balance, movement, talking, breathing, and heart function. Many of these diseases are genetic. Sometimes the cause is a medical condition such as alcoholism, a tumor, or a stroke. Other causes may include toxins, chemicals, and viruses. Sometimes the cause is unknown.

Degenerative nerve diseases include:

• Alzheimer's disease
• Amyotrophic lateral sclerosis
• Friedreich ataxia
• Huntington's disease
• Lewy body disease
• Parkinson's disease
• Spinal muscular atrophy

Degenerative nerve diseases can be serious or life-threatening. It depends on the type. Most of them have no cure. Treatments may help improve symptoms, relieve pain, and increase mobility.

Lewy body dementia (LBD) is one of the most common types of dementia in older adults. Dementia is a loss of mental functions that is severe enough to affect your daily life and activities. These functions include:

• Memory
• Language skills
• Visual perception (your ability to make sense of what you see)
• Problem solving
• Trouble with everyday tasks
• The ability to focus and pay attention

There are two types of LBD: dementia with Lewy bodies and Parkinson's disease dementia.

Both types cause the same changes in the brain. And, over time, they can cause similar symptoms. The main difference is in when the cognitive (thinking) and movement symptoms start.

Dementia with Lewy bodies causes problems with thinking ability that seem similar to Alzheimer's disease. Later, it also causes other symptoms, such as movement symptoms, visual hallucinations, and certain sleep disorders. It also causes more trouble with mental activities than with memory.

Parkinson's disease dementia starts as a movement disorder. It first causes the symptoms of Parkinson's disease: slowed movement, muscle stiffness, tremor, and a shuffling walk. Later on, it causes dementia.

LBD happens when Lewy bodies build up in parts of the brain that control memory, thinking, and movement. Lewy bodies are abnormal deposits of a protein called alpha-synuclein. Researchers don't know exactly why these deposits form. But they do know that other diseases, such as Parkinson's disease, also involve a build-up of that protein.

The biggest risk factor for LBD is age; most people who get it are over age 50. People who have a family history of LBD are also at higher risk.

LBD is a progressive disease. This means that the symptoms start slowly and get worse over time. The most common symptoms include changes in cognition, movement, sleep, and behavior:

• Dementia, which is a loss of mental functions that is severe enough to affect your daily life and activities
• Changes in concentration, attention, alertness, and wakefulness. These changes usually happen from day to day. But sometimes they can also happen throughout the same day.
• Visual hallucinations, which means seeing things that are not there
• Problems with movement and posture, including slowness of movement, difficulty walking, and muscle stiffness. These are called parkinsonian motor symptoms.
• REM sleep behavior disorder, a condition in which a person seems to act out dreams. It may include vivid dreaming, talking in one's sleep, violent movements, or falling out of bed. This may be the earliest symptom of LBD in some people. It can appear several years before any other LBD symptoms.
• Changes in behavior and mood, such as depression, anxiety, and apathy (a lack of interest in normal daily activities or events)

In the early stages of LBD, symptoms can be mild, and people can function fairly normally. As the disease gets worse, people with LBD need more help due to problems with thinking and movement. In the later stages of the disease, they often cannot care for themselves.

There isn't one test that can diagnose LBD. It is important to see an experienced doctor to get a diagnosis. This would usually be a specialist such as a neurologist. The doctor will:

• Do a medical history, including taking a detailed account of the symptoms. The doctor will talk to both the patient and caregivers.
• Do physical and neurological exams
• Do tests to rule out other conditions that could cause similar symptoms. These could include blood tests and brain imaging tests.
• Do neuropsychological tests to evaluate memory and other cognitive functions

LBD can be hard to diagnose, because Parkinson's disease and Alzheimer's disease cause similar symptoms. Scientists think that Lewy body disease might be related to these diseases, or that they sometimes happen together.

It's also important to know which type of LBD a person has, so the doctor can treat that type's particular symptoms. It also helps the doctor understand how the disease will affect the person over time. The doctor makes a diagnosis based on when certain symptoms start:

• If cognitive symptoms start within a year of movement problems, the diagnosis is dementia with Lewy bodies
• If cognitive problems start more than a year after the movement problems, the diagnosis is Parkinson's disease dementia

There is no cure for LBD, but treatments can help with the symptoms:

• Medicines may help with some of the cognitive, movement, and psychiatric symptoms
• Physical therapy can help with movement problems
• Occupational therapy may help find ways to more easily do everyday activities
• Speech therapy may help with swallowing difficulties and trouble speaking loudly and clearly
• Mental health counseling can help people with LBD and their families learn how to manage difficult emotions and behaviors. It can also help them plan for the future.
• Music or art therapy may reduce anxiety and improve well-being

Support groups can also be helpful for people with LBD and their caregivers. Support groups can give emotional and social support. They are also a place where people can share tips about how to deal with day-to-day challenges.

NIH: National Institute of Neurological Disorders and Stroke

A tremor is a neurological condition that includes shaking or trembling movements in one or more parts of your body. It most often affects the hands. But it can also affect the arms, legs, head, vocal cords, and torso (trunk). A tremor is involuntary, meaning that you cannot control it. It happens because of muscle contractions.

A tremor may come and go, or it may be constant. It can happen on its own or be caused by another disorder. It is not life threatening, but it may cause challenges. It can make it hard to do daily life tasks such as writing, typing, eating, and dressing. In some cases, a tremor can even lead to disabilities.

There are several types of tremor, including:

• Essential tremor, sometimes called benign essential tremor or familial tremor. This is the most common type. It usually affects both your hands and arms while you are moving them. It can also affect your head, voice, or legs.
• Parkinsonian tremor, which is a common symptom in people who have Parkinson's disease. It usually affects one or both hands when they are at rest, but it can affect the chin, lips, face, and legs.
• Dystonic tremor, which happens in people who have dystonia. Dystonia is a movement disorder in which you have involuntary muscle contractions. The contractions cause you to have twisting and repetitive movements. It can affect any muscle in the body.

Generally, tremor is caused by a problem in the deep parts of the brain that control movements. For most types, the cause is unknown. Some types are inherited and run in families. There can also be other causes, such as:

• Neurologic disorders, including multiple sclerosis, Parkinson's disease, stroke, and traumatic brain injury
• Certain medicines, such as asthma medicines, chemotherapy, corticosteroids, and medicines used for certain psychiatric and neurological disorders
• Alcohol use disorder (AUD) or alcohol withdrawal
• Poisoning from certain toxic substances, including pesticides and heavy metals such as mercury and lead
• Hyperthyroidism (overactive thyroid)
• Liver or kidney failure
• Anxiety or panic
• Too much caffeine

Anyone can get tremor, but it is most common in middle-aged and older adults. For certain types of tremor, having a family history raises your risk of getting it.

Symptoms of tremor may include:

• Rhythmic shaking in the hands, arms, head, legs, or torso
• Shaky voice
• Difficulty writing or drawing
• Problems holding and controlling utensils, such as a spoon

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• A physical exam, which includes checking:
  • Whether the tremor happens when the muscles are at rest or in action
  • The location of the tremor
  • How often you have the tremor and how strong it is
• A neurological exam, including checking for:
  • Problems with balance
  • Problems with speech
  • Increased muscle stiffness
• Blood or urine tests to look for the cause
• Imaging tests to help figure out if the cause is damage to your brain
• Tests that check your abilities to do daily tasks such as handwriting and holding a fork or cup
• An electromyogram, a test that measures involuntary muscle activity and how your muscles respond to nerve stimulation

There is no cure for most forms of tremor, but there are treatments to help manage symptoms. In some cases, the symptoms may be so mild that you do not need treatment.

Finding the right treatment depends on getting the right diagnosis of the cause. Tremor caused by another medical condition may get better or go away when you treat that condition. If your tremor is caused by a certain medicine, stopping that medicine usually makes the tremor go away.

Treatments for tremor can include:

• Medicines. There are different medicines for the specific types of tremor. Another option is Botox injections, which can treat several different types of tremor.
• Surgery may be used for severe cases that do not get better with medicines. The most common type is deep brain stimulation (DBS). DBS uses electrodes that are implanted in the brain. The electrodes send electrical pulses to the parts of the brain that are causing the tremor.
• Physical, speech-language, and occupational therapy, which may help to control tremor and deal with the daily challenges caused by the tremor.

If you find that caffeine and other stimulants trigger your tremors, it may be helpful to cut them from your diet.

NIH: National Institute of Neurological Disorders and Stroke