Can I Get Disability Benefits for Parkinson's Disease?

If you have Parkinson's disease, Social Security disability benefits may be available. To determine whether you are disabled by Parkinson's disease, the Social Security Administration first considers whether your Parkinson's disease is severe enough to meet or equal a listing at Step 3 of the Sequential Evaluation Process. See How to Get Disability Benefits for Parkinson's Disease by Meeting a Listing. If you meet or equal a listing because of Parkinson's disease, you are considered disabled.

If your Parkinson's disease is not severe enough to equal or meet a listing, Social Security Administration must assess your residual functional capacity (RFC) (the work you can still do, despite your Parkinson's disease), to determine whether you qualify for benefits at Step 4 and Step 5 of the Sequential Evaluation Process. See Residual Functional Capacity Assessment for Parkinson's Disease.

About Parkinson's Disease and Disability

Original Description

Parkinson’s disease is named after an English physician, James Parkinson. Dr. Parkinson’s original name for the disorder was paralysis agitans, which he described in the following way: “Involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported; with a propensity to bend the trunk forward, and to pass from a walking to a running pace: the senses and intellect being uninjured.”

Dopamine Deficiency

Parkinson’s disease is a common, chronic and progressive neurological disorder caused by deficiency of the neurotransmitter dopamine in an area of the brain called the basal ganglia.

Neurotransmitters like dopamine are chemicals that jump the synaptic gaps between brain cells, and are the way the brain communicates with itself. The number of neurotransmitter chemicals used by the brain is unknown, but probably exceeds several hundred. In many instances, their function is poorly understood, but dopamine is an important neurotransmitter that has been extensively studied and is clearly very important in many other aspects of brain function besides its role in the basal ganglia.

About 80–90% of the dopamine has to be depleted before symptoms appear.

The basal ganglia consist of groups of distinctly identifiable cells working together deep under the cerebral hemispheres. The dopamine deficit is particularly significant in a special group of basal ganglia cells known as the substantia nigra. The dopamine produced in the substantia nigra activates nerve tract projections into neighboring basal ganglia cells, which need input from the substantia nigra to function properly to control movement.

Thus, Parkinson’s disease is principally a movement disorder. Dr. Parkinson’s belief that the intellect is “uninjured” is not necessarily true in the advanced stages of the disease, and there can also be emotional problems.

Onset and Treatment

The peak age of onset is in the mid-fifties, but the possible range of onset in adults is much wider and the juvenile form can start in childhood or adolescence. Both men and women are affected.

Primary Parkinson’s disease and most other forms of Parkinsonism are incurable. Attempts at brain cell transplantation, human and animal, have been less than satisfactory. The major current treatment involves replacement of dopamine, as well as drugs to treat associated neurological problems that may be present.

Naming Inconsistencies

Parkinson’s disease is usually understood to mean the disorder is of unknown cause, and is the most common cause of Parkinsonism.

However, it is also called primary Parkinson’s disease and primary Parkinsonism. Parkinsonism abnormalities associated with other diseases are known as secondary Parkinson’s disease or Parkinsonian disorders. To make matters more confusing, Parkinson’s disease is sometimes meant to refer to the idiopathic form, and Parkinsonism is used to refer to secondary Parkinson’s disease. Also, some neurologists use various other classification schemes.

Types of Parkinsonism

There are four categories or types of Parkinsonism:

  • Primary Parkinsonism.
  • Hereditary Parkinsonism.
  • Parkinsonism-plus syndromes.
  • Secondary Parkinsonism.

Primary Parkinsonism consists of primary Parkinson’s disease and juvenile Parkinsonism.

Hereditary Parkinsonism are hereditary neurological disorders that can produce Parkinsonism because of damage to basal ganglia structures. There are many different hereditary Parkinsonisms, such as Huntington’s disease and Wilson’s disease.

Parkinsonism-plus syndromes account for about 12% of cases of Parkinsonism. These are disorders in which Parkinsonism is one of the features of some other neurodegenerative diseases. In these disorders, Parkinsonian signs and symptoms do not respond as well to treatment and they have a worse prognosis than Parkinson’s disease.

Secondary Parkinsonism disorders are those in which Parkinsonism is acquired, rather than being the result of some intrinsic neurological disorder. Drug-induced types are usually reversible; toxic damage is usually irreversible. Drug-induced Parkinsonism accounts for about 8% of cases of Parkinsonism.

General Signs and Symptoms

The major signs and symptoms of Parkinson’s disease are the following:

Resting Tremor

The tremor may affect the arms, legs, face, or tongue.

The tremor of Parkinson’s disease may begin on one side of the body, but will progress to a bilateral presence as the disease advances. The most notable tremor is often in the hands, where the oscillations produce a repetitive motion that has been described as “pill-rolling” because it is the kind of movement that would be present if a person were rolling something between the index finger and thumb. Forearm tremors are more of a rolling motion oscillation, first one way and then the other. Stress, fatigue, and excitement may cause the tremor to worsen.

The resting tremor of Parkinson’s disease is important, because it is an easily identifiable movement characteristic of the disorder. However, Parkinson’s disease can also produce a postural tremor either during use of the hands or evident when the arms are extended out from the body. The tremor of Parkinson’s disease results from the lack of sufficient dopamine to oppose the actions of another important neurotransmitter known as acetylcholine.

Muscle Rigidity

Muscle rigidity is characterized by stiffness and difficulty bending the extremities. In advanced stages of Parkinson’s disease, difficulty in bending the limbs, such as at the wrist, was classically described as like trying to bend a lead pipe. Hence, the term lead pipe rigidity is used to describe this abnormality.

If a tremor is also present, then the individual is likely to have what is called cog wheel rigidity, because when the examining doctor moves the wrist or elbow joint, it moves and stops repetitively, like a cog wheel (ratchet wheel).

Rigidity results in the patient feeling like their limbs are weak and clumsy. Functional loss from rigidity can be marked.

Bradykinesia and Hypokinesia

Bradykinesia means slowed movement, and hypokinesia means a poverty of movement. Both are a part of the Parkinsonian syndrome.

In bradykinesia, there is slowness in starting a task, whether getting out of a chair or taking a first step in walking. With walking, the individual characteristically has the most difficulty starting his or her gait. In bradykinesia, all activities of daily living (dressing, bathing, eating, etc.) are affected by increased slowness in their performance. The hypokinesia manifests as minimal movement in activities.

Bradykinesia/hypokinesia also affects the facial muscles, resulting in the impoverished facial expressions known as masked facies (hypomimia). There is an associated decrease in blinking frequency, so that the individual may give the impression of staring. In advanced disease, even swallowing can be difficult (dysphagia). Eating is slowed, and drooling (sialorrhea) may occur. The handwriting is very small and painstakingly executed. The voice is affected: softer speech, poorly articulated speech (dysarthria), a poor range of speech modulation (monotone speech) and hoarse speech may be present.

Advanced Parkinsonism results in a phenomenon known as freezing, which is characterized by transient inability to start or change some type of movement. Freezing is a further extension of the severity of bradykinesia/hypokinesia. For example, the individual may suddenly stop walking - freeze in place - when he or she enters a narrow passage or attempts to turn. But freezing can occur with other types of movements, such as with use of the hands. It takes a few moments to get the movement started again.

Autonomic Nervous System Dysfunction

The autonomic nervous system is that part of the nervous system that functions partly or wholly outside of conscious awareness or control. Important examples include regulation of blood pressure, pupillary size, salivation, bladder and bowel functions, erectile function, sweating, piloerection (hair standing up), pallor or flushing, and heart rate. The autonomic nervous system is divided into the sympathetic and parasympathetic nervous systems.

Parkinson’s disease can cause a decrease in available nerve endings in the sympathetic nervous system, particularly the heart. Showing a decrease in sympathetic nerve endings in the heart and other organs, using fluorodopamine with positron emission tomography, implies a sympathetic dysfunction also exists in the rest of the arterial system.

Postural Instability and Abnormal Gait

The previously described abnormalities conspire to produce a flexed (stooped) posture and a slow, shuffling gait. Starting to walk is the most difficult, characteristically starting off with small steps. Freezing may occur while walking and falls are frequent, as a result of poor postural reflexes. A festinating gait may be encountered in which small, faster and faster steps are taken in an attempt to prevent falling forward. Festination is an involuntary tendency to fall forward (propulsion) or backward (retropulsion).

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