Susan was a 55-year-old, beloved by her community, for all her good deeds, and philanthropic work. Her best friends, since childhood knew and loved her for her edgy jokes, and her breaking social norms. She was often in trouble in the first half of her life, and everyone caulked it up to her special ‘something’. By the time she came to see me, for help with her Parkinson’s disease, she was having tremors, a shuffling gait, trouble initiating movement (bradykinesia), and some cognitive decline.
With our advanced methods we were able to eliminate her tremors, improve her gait and flexibility, and improve her balance and bradykinesia. But the most astounding understanding of her ‘personality’ came to me from reading an article in Neuron (113, June 18, 2025; page 1851-1853).
It turns out that the part of the brain involved in many Parkinson’s patients (but not all) is the Substantia Nigra, part of the basal ganglia. This part of the brain suffers a deficiency of dopamine. Dopamine activates a part of a higher group of cells (the ventral-anterior nucleus of the thalamus), which then helps the prefrontal cortex (the thinking brain) to encode rules, including social rules. With a dopamine deficiency, this process fails.
It is quite possible that Susan’s colorful personality, and frequent breaking of the normal social rules, was an early manifestation of Parkinson’s disease, perhaps due to a near drowning accident at 3.5 years of age, or other factors.
Research into Alzheimer’s disease indicates that neurons in patients with the genetic vulnerability actually misbehave from very early in life. The same may be true for some people with Parkinson’s.
