Each year, 60,000 people in the United States are diagnosed with Parkinson's disease, not including the thousands of people with the disease who go undiagnosed each year.

"It is becoming more and more prevalent because baby boomers are turning 60," said Beth Hatcher, secretary of the Coeur d'Alene Parkinson's Support Group, who also knows first-hand the struggles with Parkinson's.

Hatcher said for some people, the diagnosis can come earlier or later, but the average age is 60. She said the progression of the disease is generally slower in younger people diagnosed with Parkinson's. Hatcher, now 65 years old, said she was diagnosed about six years ago. The first symptom she noticed was her handwriting was getting smaller and smaller. She said the symptom that plagues her most now is tremors, a common symptom of Parkinson's.

Dr. Charles Britt, a neurologist with Kootenai Health in Coeur d'Alene, explained Parkinson's is a neurodegenerative disease of the brain, meaning some of the nerve cells become "intrinsically sick" and die prematurely. He said it is a degenerative process like Alzheimer's disease.

Initial symptoms vary among those afflicted with Parkinson's, but Britt said the disease is recognized when disturbances of movement develop. The four characteristic disturbances of movement are slowness of movement, stiffness of muscle, rest tremors — a tremor that occurs when the muscles are relaxed — and over the years postural instability, or balance difficulty, will occur.

"At least the first three are due to loss of cells that produce a chemical called dopamine," Britt said. "Those cells deliver dopamine to pathways that control movement, so when those pathways become deficient in dopamine, the symptoms of Parkinson's disease develop."

He said symptoms unrelated to movement include loss of sense of smell, constipation, depression, anxiety and disturbance of sleep, such as violent dreams. Later phases can include cognitive disturbances and Parkinson's disease dementia. Softening of the voice is a common symptom as well.

"It's not just a motor disease, but it's recognized when the motor components come along," Britt said.

The Coeur d’Alene Parkinson’s Support group meets at 1 p.m. the first Friday of each month at the Lake City Center in Coeur d'Alene. At last week’s meeting, Parkinson’s patients and family members discussed doctors, medication and learned about speech and exercise programs from Life Care Center workers Suzan Rheault and Rebecca Langager.

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Medication was a topic among the group because some of those with Parkinson's had to change their daily dose of medication from a couple times a day to several times a day.

"One of the biggest problems with Parkinson's is we have on times and off times because our medicines keep wearing off," Hatcher said. "You have to be absolutely fastidious about when you eat, what you eat, and taking (medication) on time."

Hatcher said one reason people with Parkinson's who take the medication have to watch what they eat is because protein slows down the absorption rate of Levodopa, the most common drug for treatment of Parkinson's. Britt said Levodopa partially replaces the dopamine deficiency and improves motor symptoms. He said the typical dose is three times a day, a half-hour before each meal, but over time the effects wear off sooner, and one solution is to increase the dosage.

A number of other solutions exist as well, Britt said, including Selegiline, which allows the dopamine effects to last longer. Carbidopa is an extended-release drug often paired with Levodopa to help the Levodopa absorb at a steady rate so the effects will last longer. It also helps ease side effects of Levodopa, such as nausea or vomiting.

A couple other options include the surgical procedure commonly referred to as DBS (deep brain stimulation), or Duodopa, which is worn like a "fanny pouch" around the waist and pumps a gel of Levodopa through the stomach into the upper small intestine. Britt said the Duodopa keeps a slow, steady flow of Levodopa into the system, which he said is "ideal" for some of the older people who are not very mobile.

Rheault and Langager gave a presentation to the support group focused on LSVT (Lee Silverman Voice Training), consisting of two parts. LSVT "Loud," addressed by Langager, is a program to improve voice and speech of individuals with Parkinson's. LSVT "Big," addressed by Rheault, is focused on improving motor function, such as walking, balance, rotation and daily life activities.

Everyone in the group agreed that voice and physical exercise is an important part of Parkinson's therapy, and Hatcher said exercise is "almost as good as medicine." She said some of the local Parkinson's community keeps up on voice training and exercise with singing and Tai Chi classes at the Silver Lake Mall each Thursday.

Rheault said with the LSVT program, the exercises are geared to the patient and their specific trouble areas, such as arms or legs.

"With exercise, intensity is key," Rheault said. "You can just go for a walk and it's not going to impact you, it's the intensity that you do the exercise."

Information is available at: http://www.spokaneparkinsons.org/coeur-dalene-parkinsons-support-group.