In the awake of the recent passing of the greatest boxing icon, the late Muhammad Ali, who battled Parkinson’s disease for most of the later part of his life, may his soul rest in peace, this week we look at this debilitating disease. The disease is named after James Parkinson, who first described disease in his “An Essay on the Shaking Palsy” in 1817. It is a chronic and progressive movement disorder, meaning that the symptoms continue and worsen over time after diagnosis.
It is estimated that Parkinson’s disease affects approximately seven million people globally. Parkinson’s disease (PD) involves the malfunction and death of vital nerve cells in the brain, called neurons. Parkinson’s primarily affects neurons in an area of the brain called substantia nigra. Some of these dying neurons produce a chemical known as dopamine that sends messages to the part of the brain that controls movement and coordination.
As Parkinson’s disease progresses over time, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement voluntarily. Boxer’s Dementia (or Dementia Pugilistica) is a type of chronic traumatic brain injury, a neuro-degenerative disease with features of dementia. It may affect amateur or professional boxers, wrestlers as well as athletes in other sport who suffer concussions. The condition is caused by repeated concussive and sub-concussive blows (blow below the threshold of force necessary to cause concussion), or both. The symptoms and signs of Boxer’s Dementia similar to those of Parkinson’s disease, referred to as Parkinsonism, develop progressively over a long latent period, with the average time of onset being about 12 to 16 years after the start of a boxing career.
The condition is thought to affect around 15-20% of professional boxers. Muhammad Ali showed signs of Parkinson’s disease when he was 38, but was not diagnosed until he was 42. Whether he had PD or a Parkinsonism-related to boxing is unresolved. To date, despite decades of intensive studies, the causes of Parkinson’s remain unknown. It is, however, believed that the disease is caused by a combination of genetic and environmental factors, such exposure to certain pesticides, which may vary from person to person. In some people, genetic factors may play a role; in others, illness, an environmental toxin or other event may contribute to PD. Ageing has been identified as an important risk factor, especially among people over age 60.
The specific group of symptoms that an individual experience varies from person to person and may include the following involuntary shaking (tremors) of the hands, arms, legs, jaw and face; slowness of movement; speech changes; stiffness of the limbs and trunk or impaired balance and coordination. Each person with Parkinson’s will experience symptoms differently. For example, many people experience tremors as their primary symptom, while others may not have tremors, but may have problems with balance. Also, for some people the disease progresses quickly and in others it does not. Most people with PD experience non-movement symptoms such as sleep disturbances, bladder problems, constipation, depression and dementia.
There are many medications available to treat the symptoms of Parkinson’s, although none yet that actually reverse the effects of the disease. It is common for people with PD to take a variety of these medications, all at different doses and at different times of day in order to manage the symptoms of the disease. While keeping track of medications can be a challenging task, understanding your medications and sticking to a schedule will provide the greatest benefit from the drugs and avoid unpleasant ‘off’ periods due to missed doses.
Dr David N. Emvula is a qualified medical doctor who holds a MBChB degree from the University of Pretoria. He is currently a fellow in Obstetrics and Gynecology at the University of Pretoria and co-runs Westcare Medical Center in Windhoek.