With all the problems Dad has been having lately, could he be suffering from Parkinson's disease?

2 answers | Last updated: Sep 26, 2016
B girl asked...

My 78 yr-old father for the past 1.5 yrs has progressively had a very difficult time walking, has both incontinence and urgency, and has occasionally lost bowel control. He's said to have 'magnetic apraxia', he can't seem to sit up without falling back or to the side, he's forgotten how to manage his bills (was always very strong in accounting), he has fallen and shows short-term memory loss issues, though he still knows geography/streets. It was thought he may have normal pressure hydrocephalus but a spinal tap didn't help. He's taking exelon / rivastigmine, prescribed right away and before normal pressure hydrocephalus was considered. At first it seemed to help a bit but since then things have gotten worse. An MRI last month indicates central atrophy. Recently his prostate cancer came back and will undergo chemo but this is not what caused the walking problem as the PSA was below one just one-two years before. The prostate cancer was discovered as two masses between the kidney and bladder (has only one functioning kidney) caused edema & then very high bp, then TIA, then kidney failure. He has a temporary stent so now kidney OK. Since all of this happened he is so weak he can't even take a few steps now without someone holding him up. He can't do much at all with his legs, and seems to have zero core strength or flexibility. Is there any chance this is lyme's disease (lived in the country for 20 years), or a B12 (other vitamin/mineral) deficiency? His hands aren't very stable and he has a bit of trouble feeding himself but it's not too bad. Could it be Parkinson's? He's quite bright-eyed and is coherent when you speak with him, even if he is forgetful of some things. No trouble with names or identifying family or famous people. Is quite able to discuss politics and news, including e.g. recession and 'derivatives' scam, earthquake in Japan or even local news that is nothing exceptional.

Expert Answers

Graham A. Glass, MD, is the deputy director of the San Francisco Parkinson's Disease Research, Education, and Clinical Care Center (PADRECC) and an assistant clinical professor of neurology at the University of California, San Francisco (UCSF). He completed a fellowship in movement disorders at the Mayo Clinic.

I'm sorry to hear that things have been getting pretty rough for your father. This is a very difficult situation and based on the symptoms and signs that you describe there are a number of possibilities. My sense is that visiting a "behavioral neurologist" who specializes in memory loss issues or a movement disorders specialist would help. This doesn't sound like "classic" PD, but could potentially be something like Lewy Body Dementia. A comprehensive neurologic exam and extensive neurocognitive testing may help shed light on the underlying diagnosis.

We often "rule out" things like B12 deficiency and sometimes even Normal Pressure Hydrocephalus (although this is very controversial area) because they are some of the very few "reversible" or treatable causes of these symptoms. Unfortunately, we rarely find these to be the cause. Lyme disease is also a very controversial topic and Lyme has been blamed for a lot of symptoms but in my practice, I have never seen a patient with these types of symptoms get better by treating supposed Lyme disease.

I'm sorry that I can't really provide a more clear answer to you but hopefully this was somewhat helpful.

Community Answers

Emoji answered...

Sounds like many of the problems that my mother had. She was 91 when we first noticed her symptoms but realized later that the onset was much earlier. I talked with her dr. who told me there was no test for PD. he suggested we simply try treating her for it and see if there was improvement. She began taking sinemet (not sure about spelling) and within a week she could stand, unaided, and walk normally. She didn't have the freezing in place and gained a lot more control of her hands for feeding her self. It was a lot of help for a year or a little longer but soon the symptoms returned and the drug was no longer helping. But it bought her some quality of life for a while so we are so glad we pursued a treatment.