What is Parkinson’s disease?
A progressive neurological disorder, Parkinson’s disease (or PD) usually develops in the latter years of life, and worsens over time. The disorder develops when a gradual degeneration of nerve cells (neurons) occurs in the mid-brain which are responsible for controlling body movements.
Dopamine is a substance which aids smooth and coordinated muscle movements of the body, and is produced in the ‘substantia nigra’ portion of the brain. When dopamine levels reduce, the cells of this portion of the brain begin to degenerate or ‘die’, and problems with movement begin to occur. A person is effectively unable to control movement normally as a result of the malfunction.
As a result, the first signs are usually physical – a stiffness in one limb, feelings of weakness in the body, and a fine trembling of one hand. New sensation changes may be barely noticeable at first, and are often easy to dismiss, but gradually worsen and become more apparent.
Muscles become stiffer, balance and coordination begins to deteriorate and a person’s movements slow down. A person may also begin to show little or no facial expression, appear unable to swing their arms while they walk, and speech may begin to slur a little or become soft. Gradual physical deterioration leads to other cognitive problems as well as mental or emotional troubles such as depression.
Typically diagnosed in a person’s latter years, between the ages of 50 and 65, Parkinson’s affects more men than women. The condition is chronic and as yet, is not curable. To date, medications have provided the best source of medical intervention, treating symptoms of the disorder. Surgery is another treatment option, whereby specific regions of the brain can be regulated as a means to help alleviate symptoms. Surgery can provide some improvement, but cannot completely rectify a person’s condition.
The degree of impairment in a person diagnosed with Parkinson’s disease varies. Many are able to adequately manage symptoms with medication and live relatively productive lives. Others experience degeneration that leaves them disabled at a quicker pace.
Did you know? Conditions showing similar symptoms and progressive patterns have been written about as far back as 5 000 BC. Ancient Indian civilisations called the disorder ‘Kampavata’ which they documented treating with seeds containing therapeutic levels of what is now known as ‘levodopa’ (an amino acid used in medication to treat Parkinson’s Disease). In 1817, a British physician, James Parkinson, described the disorder as ‘shaking palsy’, later the condition was named after him, becoming known as ‘Parkinson’s Disease’.
What is early-onset Parkinson’s disease?
As a disorder, Parkinson’s disease is more commonly diagnosed among seniors (adult-onset Parkinson’s Disease), but can occur in younger generations too. Symptoms and stages of the condition are more or less the same, no matter at what age a diagnosis is made.
Early-onset Parkinson’s disease typically occurs between the ages of 21 and 40. It can also happen that individuals who are younger than 21 develop the condition. This is known as juvenile-onset Parkinson’s disease.
Research into Parkinson’s disease is ongoing, but has yet to determine a direct causal link, no matter the age at which the condition is diagnosed. Research is extensively looking at genetic and environmental factors (chemical toxins such as fungicides, herbicides and insecticides), and a combination of these. Many experts agree that these areas of focus do play a role in the development of the condition due to the nature of similarities found in large population notes and studies.
Research has noted that 65% of individuals diagnosed with juvenile-onset Parkinson’s disease appear to have a stronger genetic mutation link. Genes appear to play less of a role when diagnosed as early-onset Parkinson’s disease (around 32%).
What has research been able to determine?
Medical experts and research teams have been able to determine some strongly linked contributing factors when it comes to the underlying cause of Parkinson’s disease.
The deterioration (breaking down) of neurons in the brain affects the production levels of dopamine. This causes a malfunction in brain activity and interferes with the normal ‘messaging system’ in the body that signals and controls motion ability, ultimately leading to signs and symptoms of the condition.
With that in mind, research has looked at the following contributing causal factors:
- Genes: It has been noted that at least 15% to 25% of those diagnosed with Parkinson’s disease have a family history of the condition. This sizable percentage is enough to assess level of potential risk. Having a close relative (first-degree relative), such as a sibling or parent, or a known history with multiple family members having been diagnosed with Parkinson’s appears to place a person at higher risk of developing the condition themselves. Gene mutation, a permanent alteration in DNA sequence, is thought to have the heaviest influence as to why Parkinson’s disease runs in families. Research in this area is ongoing.
- Environment: Chemical exposure has been researched as another potential causal link. On the list of researched substances are insecticides, fungicides, herbicides and ‘Agent Orange’ (a defoliant chemical used by U.S military troops during the Vietnam War as part of its herbicidal warfare programme). Other possible environmental links being researched include ingesting manganese (a chemical) and the drinking of well water (that is not filtered or purified). Exposure to chemicals is thus, largely tied to occupations, such as those that deal with toxic substances on a regular basis. Occupations in agriculture, welding or of an industrial nature are potentially at the most risk. Research has not shown that toxin exposure alone leads to Parkinson’s disease. Many believe it may play a role, but in combination with other factors, more specifically gene mutations.
- Lewy bodies: Abnormal clumps of proteins in the brain stem (as well as the midbrain and olfactory bulb) are known as ‘Lewy bodies’. Cells of protein (alpha-synuclein or A-synuclein) that are unable to adequately break down form clumps and cause disruption in normal brain function. Clusters of these protein clumps lead to the gradual degeneration of function over time and ultimately lead to impairments with motor coordination.
- Dopamine reduction / loss: A lack of dopamine production leads to a malfunction of neurotransmission function in the brain. The brain, effectively, is unable to send and receive messages that control smooth function and normal movement. Dopamine levels are balanced with another substance, known as acetylcholine (another chemical in the brain responsible for the transmission of nerve impulses). Imbalance between the two leads to coordination impairment and begins affecting a person’s capacity to walk or balance properly. It also affects non-motor functions such as sleep regulation and sense of smell. This cellular degeneration is being researched extensively in combination with gene mutation, as some experts believe that genes may have an influence and be the key to explaining why a breakdown occurs. Researchers believe that if it is possible to determine the sequence of events that lead to the development of symptoms, specifically the loss of dopamine and cell degeneration, better treatment methods can be developed to gain more control or reverse signs of the disease altogether.
- Gender and age: Research has taken into account the age and gender of the majority of diagnosed cases. As the body ages, dopamine production naturally alters, making an older person vulnerable to developing Parkinson’s disease. It has also been noted that men are more prone to developing Parkinson’s disease than women.
What genes have been linked to Parkinson’s disease?
Parkinson’s disease is classified as an idiopathic illness (one which occurs without a known cause), but through intense research, experts have identified several genes associated with the condition.
Scientific experts have investigated the possible causal links among family members who have all been diagnosed with the condition.
This research has proved incredibly valuable as it allows experts the ability to better understand the nature of Parkinson’s disease, which in turn allows medical professionals an opportunity to potentially develop and implement more effective treatment and therapies.
Through research, the following genes have been conclusively identified with strong links to Parkinson’s disease:
- PARK2 (Parkinson’s disease autosomal recessive, juvenile 2): This gene produces parkin (a protein), which has been identified mostly in those diagnosed with juvenile Parkinson’s disease. Normally this protein assists cells with functions of breaking down and recycling proteins but in those with juvenile Parkinson’s disease, mutations of the gene occur causing dysfunction within this process.
- PARK7 (Parkinson’s disease autosomal recessive, early onset 7): This gene produces the DJ-1 protein, which is responsible for protecting cells from oxidative stress. Mutations of PARK7 were identified in early-onset Parkinson’s disease.
- PINK1 (PTEN-induced putative kinase 1): Researchers have not been able to conclusively establish what the purpose of the protein made by PINK1 is, but they suspect that it protects the mitochondrial cell structures from stress. Gene mutations have been identified in early-onset Parkinson’s disease.
- SNCA (Synuclein, alpha non A4 component of amyloid precursor): This gene produces the protein, alpha-synuclein, which is known to form clumps called Lewy bodies. Research has identified these genes in early-onset Parkinson’s disease and noted distinctive mutations in the SNCA gene.
- LRRK2 (Leucine-rich repeat kinase 2): This gene produces dardarin (a protein). Gene mutations have been identified with late-onset Parkinson’s disease.
Other genes have been identified and are being researched as potential links to Parkinson’s disease. These are SNCAIP (synuclein alpha interacting protein), GBA (glucosidase beta acid) and UCHL1 (ubiquitin carboxyl-terminal esterase L1).
How does Parkinson’s disease affect the body?
Recognising the signs
A combination of signs can help a doctor make an early diagnosis. If Parkinson’s disease is diagnosed early, the chances of being able to treat and manage the condition are greater. Individual signs may not be an indication of Parkinson’s disease. Some signs such as loss of smell could be caused by an infectious illness, or joint stiffness by conditions like arthritis.
Parkinson’s is most commonly diagnosed with a very physical examination and assessment of a person’s medical history. There are very specific markers for diagnosis which doctors use to assess for possible Parkinson’s disease. These markers have a lot to do with a combination of very specific signs and symptoms and if recognised early enough, can be better managed.
1. Primary motor symptoms
- A resting tremor (usually in the hand or foot on one side of the body when a person’s muscles are relaxed and not performing any specific function): A tremor may begin in one finger and typically ceases when a person begins an action or keeps the hand in a flexed grip. Tremors can be triggered or aggravated by excitement or stress. As the disease progresses, so too do tremors, occurring elsewhere in the body, such as a twitching sensation in the limbs. Tremors typically affect one side of the body initially. The most commonly noticed tremor occurs in the hands, fingers or thumbs, but can also occur in the chin or lips. Many develop a pin-rolling tremor which is a back-and-forth rubbing of the forefinger and thumb. For those without Parkinson’s disease, it is fairly normal to experience some shaking at the tail end of vigorous exercise of following injury, as well as a side-effect of some medications. Tremor that is not influenced by these factors and typically occurs during periods of rest may be a sign of possible Parkinson’s disease.
- Slow movement (Bradykinesia): A reduction of spontaneous movement can create an appearance of abnormal stillness, a masked expression, as well as affect speech. Bradykinesia can lead to a decreased ability to perform basic daily tasks such as dressing, using cutlery or brushing hair and teeth. As the condition progresses difficulties with repetitive movements, like tapping fingers, or developing a shuffle when walking, as well as a limited range of movement can also occur. Speech may become softer and muffled, making audibility difficult for others (due to poor enunciation). Speech may also become monotone, losing normal inflections and attributes. Some may experience vocal changes in that they become a little hoarse when speaking. If there have been no recent experiences with viral illnesses which can affect a person’s voice, sudden unexplained changes could indicate Parkinson’s disease. Body stiffness that does not ease with movement, especially in the limbs, shoulders, trunk or hips may be another sign. A person may develop a ‘stiff’ look and not swing their arms naturally when walking. Some also begin to shuffle their feet and do not lift them very high when walking.
- Rigidity and inflexibility: Stiffness in the neck, trunk and limbs is most common. Muscle tone becomes rigid on a more constant basis (muscles do not stretch normally when moving and relax again when resting), which leads to a decreased range in motion. Stiffness can become increasingly uncomfortable, even painful.
- Postural instability and retropulsion: When standing upright, a person may become involuntarily unstable due to a loss of reflexes needed for maintaining posture. A person may easily fall backwards or develop a tendency to sway, especially when standing, turning (pivoting or making other quick movements) or rising from a seated position.
2. Secondary motor symptoms
Other motor symptoms include:
- Freezing of gait: Hesitation when stepping forward is a temporary sensation, but common for Parkinson’s sufferers. Many describe the sensation as feeling as if their feet are stuck or glued to the floor. Freezing typically affects the first step and is overcome once it is taken. From there a person generally resumes a normal movement stride. Freezing is also common when pivoting or when approaching objects, such as a chair. Many temporarily overcome freezing by taking exaggerated first steps. In severe forms, freezing can render a person incapable of being able to walk, but most often increases a person’s risk of falling forwards. Hesitation can also be noted in speech, where a person takes a little time to respond (speak).
- Micrographia: As Parkinson’s disease progresses, handwriting becomes smaller as a result of increased difficulty with repetitive actions (bradykinesia). If it is noticed that the change is sudden and words look crowded together and letter sizes decreased, it could be a sign to take note of. It is normal for other signs of aging to influence handwriting changes – stiffening of hands and fingers and deteriorating vision can lead to handwriting becoming smaller and even crowded. The thing to note here is a sudden change. Aging influences happen gradually, over time.
- Mask-like expression and flexed posture: The combination of bradykinesia and rigidity can lead to the face becoming less expressive and a decrease in unconscious facial movements. A person experiences a decrease in blinking motion as well, and appears as if they are staring.
- Uncontrollable accelerations: On occasion, movements that are experienced may be too quick instead of slowed down. Uncontrollable accelerations can affect speech, as well as movement. Speech may become excessively quick and also develop a rapid stammer (tachyphemia). Others may experience uncontrollable acceleration when moving, known as festination, which can lead to frequent falls.
Some individuals may also experience the following:
- Hunched over / stooped posture (forward leaning) - When standing, the body may begin to slouch or lean inwards, causing a hunched over appearance.
- Impaired gross motor coordination
- Impaired fine motor dexterity and motor coordination
- Difficulties with swallowing or chewing
- Production of excess saliva (due to reduced swallowing movements) and drooling
- Sexual dysfunction (erectile dysfunction in men)
- Dystonia (involuntary muscle contractions which result in twisting or repetitive movements)
- Akathisia (sense of restlessness and a compelling need to constantly be in motion)
3. Non-motor symptoms
Symptoms that do not involve physical movement or coordination, and often precede motor problems, can include:
- REM behaviour disorder and other sleep disturbances (restlessness or talking during sleep and vivid dreams) - Many experience restlessness while in deep sleep, and sometimes find themselves falling out of bed. Movements that are sudden may signal possible Parkinson’s disease.
- Changes in sense of smell (anosmia) - Deterioration of neurotransmitters can lead to impairment of smell. Certain smells of foodstuffs, such as liquorice, bananas or even dill pickles may become difficult to distinguish. Loss of smell is common when suffering an infection, such as a cold or flu, but typically returns once cleared. Unexplained sense of smell changes should be checked by a medical doctor.
- Constipation - Strained bowel movements on a regular basis could also indicate Parkinson’s disease. It’s important to rule out other common causes such as a lack of fibre or water in the body, or a side-effect of certain medications.
- Bladder / urinary problems (urination frequency or urgency)
- Problems with vision
- Dental issues
- Problematic skin, such as oily patches and flaky yellow or white scales or dandruff
- Cognitive changes, such as difficulties with memory, confusion, attention span, slow thinking capability and sometimes the development of dementia
- Mood disorders, such as anxiety and depression
- Low blood pressure, especially when rising from a seated position (known as orthostatic hypotension) - this can lead to spells of dizziness when rising from a seated position, or fainting. Unexplained low blood pressure experienced on a regular basis will need to be assessed by a medical doctor as soon as possible.
- Problems with weight (gain or loss)
- Increased sweating
- Lethargy and fatigue
- Impulsive behaviours (most often as a side-effect of medications)
- Visual-spatial difficulties (spatial awareness)
It’s important for a doctor to assess a series of symptoms to either make a Parkinson’s disease diagnosis and begin treatment, or rule out other conditions with similar characteristics or symptoms.
Symptoms are initially mild, even if they develop suddenly, and typically affect one side of the body at first.
It has been noted by medical professionals that by the time a person generally notices a series of symptoms, dopamine producing cells in the brain would have already affected between 60% to 80% of the neurons needed to maintain and control movement.
What are the stages of Parkinson’s disease?
As a progressive disease, Parkinson’s disease symptoms occur in stages:
- Stage one: Symptoms are mild and generally not severe enough to interfere with typical daily function or tasks. Symptoms during this stage may also be easily missed. If any are noticed, it is usually subtle changes that are picked up by friends and family. The easiest changes to note are a person’s walk or gait, posture and facial expression. Alternatively, a person may note subtle changes in their own movement ability or a tremor that has developed on one side.
- Stage two: Symptoms are classified as moderate and typically become more noticeable (more developed or occurring more frequently). The most obvious symptoms are usually tremors, shaking, body stiffness, and changes in facial expression. A person may note that it takes a little longer to complete a task (requiring muscle movement) or a change in posture or speech. Symptoms such as tremors may begin to affect both sides of the body (one side may be worse than the other). Progression from stage one to two can take anywhere between a few months to several years. Progression rate is unique to an individual and cannot be medically predicted.
- Stage three: This stage typically marks a turning point in the progression of the condition. Symptoms generally are similar to stage two, but a person will now begin to notice problems with balance and a decrease in reflexes. A person may experience frequent falls and also struggle with slower overall movements, which affect the ability to independently perform many daily tasks. A person is not incapable of completing tasks by themselves at all at this stage, but will certainly notice a distinctive change that may require assistance from time to time.
- Stage four: At this stage, living alone (independence) may become problematic. Significant decreases in movement (and delayed reaction times) may mean that a person is unable to walk or function unaided. Standing unaided may be possible, but not usually walking. Assistive devices such as a walker (or Zimmer frame) may be necessary and make moving about less problematic (i.e. preventing falls). A person will require assistance with most tasks from this stage onwards.
- Stage five: Progressively decreased motion and freezing may make it increasingly difficult for a person to walk, even with an assistive device. At this advanced stage, a wheelchair may become necessary, as well as around-the-clock assistance. Delusions, hallucinations and confusion are common and often result in the development of dementia. Up to 75% of individuals at this advanced stage can develop dementia.
How do doctors determine these stages?
Many doctors make use of a Unified Parkinson’s Disease Rating Scale (UPDRS), which allows them rate cognitive difficulties which hinder day-to-day lifestyle and ability to perform regular tasks. This scale also enables doctors to assess the effectiveness of treatment during the progressive stages of the condition. The scale is thorough and complex and allows doctors the ability to gain a detailed perspective of a person’s condition. It examines the overall state of health of a person, and not just motor or mobility troubles.
Others make use of another rating system known as Hoehn and Yahr, which rates a person’s symptoms on a scale of 1 to 5, assessing motor difficulties. A doctor uses the rating scale to assess the progression of symptoms – early stages will be marked as 1 and 2, mid-stages are rated at 3, with the advanced stages being 4 and 5. This rating does not take into account cognitive difficulties that the UPDRS system uses.
Risk factors and potential complications
What factors may increase risk of Parkinson’s disease?
Through research, certain similar characteristics have allowed experts to determine a handful of potential risk factors when it comes to developing Parkinson’s:
- Age: The majority of Parkinson’s disease diagnoses occur in the latter stages of life, beginning in a person’s late-50s or around 60 years of age and older.
- Sex: Men are more prone to developing Parkinson’s disease than women (approximately one and a half times more likely).
- Genetics and toxin exposure: Heredity research is still ongoing, but it is believed that having a close relative with the condition increases the chances somewhat. The more relatives with Parkinson’s disease the higher the chances of development. Long-term exposure to toxins and chemicals can also increase risk.
Common complications and side-effects of Parkinson’s disease
As Parkinson’s disease progresses (not all will develop symptoms and associated complications in advanced stages), symptoms have a knock-on effect. Deterioration and impairments in the body can lead to a variety of other health concerns that cause a person great difficulty.
As much as these potential concerns cause discomfort for a person, all are treatable with appropriate medication or therapies.
Associated complications which can arise include:
- Mood and behavioural changes: Having a chronic condition can alter emotions and mental state quite dramatically. It’s not uncommon for many Parkinson’s sufferers to go through periods of depression while trying to get the better of their condition and physical symptoms. Managing a chronic condition can become overwhelming at times and make a person feel less motivated, fatigued, anxious and even fearful.
- Problems with sleep: With physical and emotional disruptions, sufferers of Parkinson’s disease often experience unusual sleeping patterns. Some wake up frequently during the night, while others find that their body clock changes – waking earlier than normal or drifting off to sleep during the day. Some develop REM sleep behaviours (rapid eye movement disorder), making them restless during sleep and frequently ‘acting out’ vivid dreams.
- Fatigue and lethargy: When overwhelmed physically, emotionally and mentally, a person quickly loses energy, and fatigue can set in.
- Thinking difficulties: Being able to think clearly and respond appropriately may begin to trouble a person with Parkinson’s disease, especially during the more advanced stages.
- Other physical difficulties: Inability to swallow comfortably, drooling (due to increased saliva accumulation in the mouth), inability to control urination or difficulty in urinating, bowel movement troubles and constipation (due to a slower digestive tract), sudden drops in blood pressure (orthostatic hypotension) causing dizziness, difficulties with identifying odours or the difference between multiple odours, painful spells in specific areas of the body (or throughout) and a decrease in sexual desire or performance.
How to manage some of the more common side-effects of Parkinson’s disease
The nature of Parkinson’s disease progression means that the condition manifests in a variety of ways, not just in areas of mobility. Non-motor symptoms can sometimes be of more distress to a sufferer, troubling their day-to-day lives even more so than their physical ailments.
Once certain non-motor symptoms are recognised, it is easier to understand why and how they are adversely affecting quality of life, as well as gain control through appropriate treatment.
- Depression and other mood disorders: As many as 50% of Parkinson’s disease sufferers will develop some degree of depression. Anxiety extends beyond nervousness, apprehension and worry. Between 25% and 45% of individuals will develop an anxiety disorder, where chemistry alterations in the brain occur (not due to Parkinson’s). If a person develops constant feelings of anxiousness, phobias, panic attacks and an intense perception that their state of health is worse than it actually is, medical intervention is necessary. Medications, therapy sessions and general lifestyle changes, such as regular walks or yoga sessions can help to ease off troubles affecting a person emotionally and mentally. It’s important not to confuse depression with apathy. Apathy is more of Parkinson’s disease symptom due to a lack of dopamine in the brain. Apathy and depression may bring about similar characteristics such as a lack of interest in participating in normal activity. Depression is tied to emotions (feelings of guilt or worthlessness), apathy is more emotionally flat (no mood in particular) and a person simply can’t be bothered to make an effort. A doctor can distinguish between the two and treat appropriately.
- Sleep difficulties: As many as 75% of Parkinson’s disease sufferers have trouble with sleep. Night-time difficulties include trouble getting comfortable and falling asleep, staying asleep, waking frequently (due to a need to use the bathroom or as a result of noises made while restless), vivid dreams and nightmares, restless legs syndrome, sleep apnoea, REM sleep behaviour disorder, and disruptions to normal sleep patterns (sleeping more during the day). Day-time trouble may include excessive sleepiness during the day, sudden sleepiness (sometimes due to medication), and taking frequent or long daytime naps. Sleep disturbances can worsen cognitive troubles and depending on the nature of the specific problem, a doctor can prescribe or recommend effective treatment, such as medication or sleep aids. Recommendations may also include changes in lifestyle habits, such as limiting screen time, getting in regular exercise sessions or avoiding heavy meals at night, and developing a different routine.
- Digestive and gastrointestinal troubles: As the digestive tract slows down (due to stiffness and slow movement), muscle function and activity of the enteric nervous system (nerves that line the digestive tract) reduces, causing gastrointestinal problems. Many experience difficulties with their bladder and bowel (often fewer than 3 bowel movements a week), chewing and swallowing and frequent bouts or nausea (due to a slow emptying of stomach contents) and abdominal bloating. Medications can help to treat any of these troubles, along with eating a well-balanced diet with plenty of fibre and liquids, as well as daily exercise. An occupational therapist can assist with regaining some control of facial muscles to help alleviate fears of choking and drooling while trying to eat. This can help with chewing and swallowing (dysphagia) troubles (as well as biting motions and the ability to use the tongue effectively) and keep the risk of inadequate nutrition, dehydration and aspiration at bay. Therapy can also include changes in certain food textures that are consumed, such as thickened liquids.
- Dental problems: Physical symptoms of rigidity and tremor can make it challenging to adequately care for the mouth, teeth and jaw. Sitting still in the dentist’s chair can also aggravate feelings of fear and anxiety. Pain or discomfort in the lower jaw is also common and often results in tooth wear, cracked teeth, tooth grinding and alterations in the fit of dentures (if applicable). Fungal infections (especially at the corners of the mouth when drooling) due to excess saliva in the mouth are also common. Cavities are also common is there is a lack of saliva in the mouth (dry mouth). Dental problems are often better managed with regular check-ups during the earlier stages of Parkinson’s disease. Home-care is also very important and may prove useful to modify toothbrushes for easier grip, such as placing a toothbrush handle inside a bike handlebar grip or tennis ball. Electric toothbrushes may also be easier to use and grip. Tips include regular brushing, flossing and rinsing (with antimicrobial rinses or solutions) using the stronger side of the body or with the aid of a caregiver.
- Range of movement problems: Physical therapy and regular exercise are important in order to improve range of motion, build muscle tone and ultimately aid in improving overall mobility. Parkinson’s affects muscle tone adversely, and by making efforts to counter this, exercise can help to build lost strength. Muscle stress can be alleviated with massage therapies.
- Problems with balance and skeletal issues: Changes in the spine, hands and feet occur as a result of muscle rigidity. It is more problematic in the muscles that flex, such as the limbs and the trunk of the body. A person may begin to slump their shoulders (or have frozen ‘stiff’ shoulders), bend their neck (anterocollis), curl the trunk of the body (camptocormia or stooped posture), or bend (or flex) the wrists, fingers, toes, hips, knees and elbows (worsening as the disease progresses). Postural changes can lead to extreme leaning to one side (Pisa syndrome), sometimes forwards. Muscle spasms (or involuntary muscle contractions – dystonia) and cramps can also contribute to weakening of the bones and even twisting of the spine (scoliosis), which can also affect balance and increase the risk of falls and fracture injuries. If low bone density develops, Parkinson’s disease sufferers are at greater risk of developing osteoporosis. Joint damage can result in osteoarthritis, arthritis of the spine and disorders of the fibrous discs between the spinal bones. Medication or surgery are options to gain control of additional side-effects to the bone and skeletal structures, as are lifestyle or behavioural changes, such as making the home environment safer and maintaining regular exercise routines. Physical therapy and regular check-ups with a doctor can also help to pick up problems at their earliest.
- Problems with pain: As many as 85% of Parkinson’s disease sufferers experience physical pain as their condition progresses. Most often pain is as a result of the separation of tissue pain receptors from the nerves which transmit pain signals in the body (known as nociceptive pain). This results in common Parkinson’s symptoms of rigidity dystonia, and musculoskeletal injuries. Pain which is neuropathic (not directly associated to Parkinson’s disease) can also occur and doctors will be able to distinguish between the two and adequately treat this. Neuropathic pain can be as a result of cancer, shingles, diabetic neuropathy or even carpel tunnel syndrome. Medications taken for Parkinson’s disease may also exacerbate side-effects of pain, which is most often resolved with dosage adjustments. Treatment will involve a thorough evaluation and diagnosis, medications, physical therapy, exercise, nutrition management, stretching and even psychotherapy.
Other problems which can also be effectively managed include:
- Respiratory problems, such as shortness of breath (due to medication ‘wearing off’), respiratory dyskinesia (irregular and rapid breathing), non-Parkinson’s disease associated conditions such as asthma, allergies and others causing shortness of breath, and aspiration pneumonia.
- Cognitive impairment (disorganisation, distraction, short attention span, memory and difficulties with thinking, planning or carrying out tasks) or severe loss intellectual ability (dementia).
- Hallucinations, vivid dreams and unusual visions (usually treated with medication adjustments).
- Impulsive behaviours, such as an irresistible urge to abuse the taking of medications, shop, eat or gamble. Some even experience hypersexuality. Medication adjustments can also help correct this.
- Low blood pressure, skin problems (such as oily, flaky or inflamed skin, dryness, excessive sweating, too little perspiration or skin cancer), and vision changes can all be assisted with medication treatment.
Diagnosing Parkinson’s disease
How will a doctor diagnose Parkinson’s disease?
It can prove a little tricky to make an accurate diagnosis for Parkinson’s disease. Tests are generally recommended to rule out a variety of other illness and conditions which may show similar symptoms. There is no specific diagnostic test for Parkinson’s as yet.
A doctor will generally make a diagnosis through careful and thorough evaluations, assessing medical health history, physical examinations and neurological examinations. These will assess the functions of the brain, nervous system, muscle strength, level of coordination and reflexes, fine motor skills (especially the hands), walking ability and mental function.
A doctor will also request as much detail as possible regarding use of medications and supplements (including those of a herbal nature), other existing conditions, family medical history and the possibility of chemical exposure.
As many as 40% of Parkinson’s disease cases may not be diagnosed during the early stages of the disease, and 25% of occurrences may be misdiagnosed due to disease symptom similarities. Many symptoms mirror other medical conditions, such as osteoporosis. As many as a third of Parkinson’s disease sufferers may not even develop tremor.
There is no single symptom which can distinguish Parkinson’s disease from any other known medical condition. Doctors will use their thorough evaluations, including a chosen rating system to assess the combination of symptoms before making a diagnosis. Tests will likely be recommended to start narrowing down possibilities and eliminating conditions which are usually easily diagnosed using specific methods.
Recommended tests will include:
- Computerised tomography (CT scan): The use of X-rays and computer imaging technology can assist doctors with gaining a clear view of the inside of the body, especially the brain. A dye (contrast material) injected intravenously helps to highlight internal structures. A scanner will then be used to take a series of images. A scan can take between 15 and 60 minutes to complete.
- Magnetic resonance imaging (MRI scan): This scanner makes use of a large magnet, radio waves and computerised technology in order to produce highly detailed images (several dozen) of the body’s internal structures. Used to make a diagnosis, this scan is safe to use for testing (provided there are no other existing conditions or devices such as a heart pacemaker or cerebral aneurysm clip, which prohibit the use of this imaging test). If already being treated for Parkinson’s and using a brain stimulator, additional care will need to be taken beforehand. In most instances, an MRI scan can take between 45 and 60 minutes, or up to an hour and a half.
- Positron emission topography (PET scan): This will be used to assess how the body’s cells are functioning. A small amount of radioactive material (a tracer) is injected into a vein in the arm (intravenously) and sends out positively charged particles (positrons) which interact with negatively charged ones (electrons). An image is then produced using a doughnut-shaped scanner (moving in circles around the body), showing every angle of the body and its organs to assist the doctor in detecting possible abnormalities and problems. Of specific interest will be regions in the brain responsible for movement and the spinal cord (where Parkinson’s disease is concerned). The scanning process usually takes between 45 and 60 minutes.
- Other imaging tests: An ultrasound of the brain or SPECT scan (single-photon emission computerized tomography) using radioactive substances and a camera to analyse the function of certain bodily organs.
- Blood tests: These may be recommended according to specific symptoms as a means to potentially rule out other possible conditions.
As tricky as it may be, making an accurate diagnosis as early as possible can have a profound effect on the progression of the condition. Early intervention can be the most effective treatment in the long-term and potentially prevent (slow down) more advanced stages during a person’s lifetime. A primary care physician (general practitioner or GP) may refer a person to a neurologist if they suspect Parkinson’s disease following a thorough evaluation process (which can sometimes take multiple consultations). A specialist with more experience in diagnosing Parkinson’s disease can implement treatment quicker and more effectively, but it may take several follow-up appointments, tests and evaluations before a diagnosis is made.
A diagnosis of Parkinson’s disease is typically made if:
- Between two and three major symptoms of Parkinson’s disease are present
- Onset of these major symptoms began on one side of the body
- No secondary causes appear to have brought on the symptoms (such as medication side-effects or the effects of a stroke and other medical conditions)
- A short period of using levodopa medication (L-DOPA) shows improvement of symptoms
Once a diagnosis is made, a comprehensive treatment plan may begin. A combination of medication, lifestyle adaptations and various therapies provide the most effective treatment of the condition. If these prove unsuccessful, surgical intervention methods may be recommended.
The approach to treatment is most often a ‘team effort’ involving various specialist professionals:
- Physical and occupational therapists
- Speech therapists
- Social workers
- Registered dieticians and nutritionists
Treatment objectives involve:
- Improving and maintaining overall quality of life
- Improving daily function and mobility
- Improving posture, balance, gait, writing ability and speech
- Improving or maintaining mental sharpness
- Reducing symptoms of tremor and rigidity
- Reducing or reversing slow movement
- Levodopa (L-dopa): This medication is the most commonly used as it has been found to improve most Parkinson’s disease symptoms (specifically bradykinesia and rigidity) up to 75% of the time. The drug replenishes levels of lost dopamine, and is most effective when used in combination with another medication, known as carbidopa or Sinemet (which delays the breakdown of levodopa, making more available in the brain). Levodopa is easily metabolised by the body, stimulating dopamine production (dopamine itself, given directly as a medication is not effective – the brain reacts to the substance by blocking its intended function). The drug converts to dopamine in the brain instead, which can be used for neurotransmission function. The carbidopa-levodopa combination helps to suppress side-effects of nausea, vomiting and heart rhythm disturbances. Carbidopa eases the side-effects of levodopa. If levodopa is taken alone, a doctor will advise on taking the medication on an empty stomach – up to an hour before or after meals (not at the same time as having food or vitamins, especially those containing vitamin B-6) to avoid adverse interference. Carbidopa is available in controlled release (CR) or immediate-release forms. These medications are most effective in the short-term. Care may be taken for long-term use.
- Dopamine agonists: Less effective than levodopa, these medications imitate the action of dopamine in the brain. Medications which may be prescribed in this class are ropinirole (Requip), rotigotine (Neuropro) and pramipexole (Mirapex). These medications may be prescribed alone or in combination with levodopa (dopamine agonists will be prescribed first and if symptoms are not improving, levodopa may be prescribed to be taken in combination to achieve better treatment results). Long-term complication / side-effect risks with these medications are not as high as levodopa use.
- Anticholinergics: To treat symptoms of rigidity, these medications may be prescribed as a way to block the parasympathetic nervous system. These medications restore balance between dopamine and acetylcholine (reducing acetylcholine), effectively treating muscle stiffness and tremor. Medications in this class are Cogentin (Benztropine) and trihexyphenidyl. Common side-effects include dry eyes and mouth, constipation and memory impairments.
- Amantadine (Symmetrel): Often prescribed along with levodopa and carbidopa, this glutamate blocking medication offers some short-term relief from dyskinesia (involuntary movements as a side-effect of levodopa). Side-effects of this medication include patchy skin discolouration or hallucinations.
- Catechol O-methyltransferase inhibitors (COMT): These medications help to prolong the effects of levodopa (taken in combination with) by blocking the action of enzymes (MAO B) which break down the drug (levodopa). Medications in this class include Comtan (Entacapone), Tolcapone (Tasmar) and Stalevo. Tolcapone use runs the risk of liver damage and is usually only prescribed when all other therapies have not proved successful. Stalevo combines levodopa, carbidopa and entacapone (which lengthens the period of time levodopa is active in the brain) in one pill-form medication.
- Monoamine Oxidase B (MAO B) inhibitors: These medications inhibit the enzyme (MAO B) which naturally breaks down dopamine in the brain. Medications which may be prescribed include rasagiline (Azilect) or selegiline (Eldepryl). Side-effects such as headaches, confusion, dizzy spells, stomach pain, joint pain, indigestion and hallucinations can happen. A doctor will prescribe these with care as they can adversely react with a variety of other medications including anti-depressants and those used to treat Parkinson’s disease.
Apart from side-effects of medication use, effectiveness over the long-term has proved problematic for many. It appears that medication use over the long-term begins to diminish (or become less reliable or consistent) beneficial treatment effects as the disease progresses. Thus, other treatment options such as surgery, may come into play.
General guidelines for medication use include:
- All medication must be taken exactly as directed by a medical doctor. Pills must not be split, broken or the content of capsules emptied.
- Plenty of liquids (water) should be drank each day (between six and 10 glasses)
- Physical activity and warm baths can help to aid the absorption and digestion of medications.
- Develop a routine for taking medications daily (ensuring that these are taken at the same time each day) – If memory is problematic, it may be easier to make use of a pillbox or calendar marking off pill-taking on a daily basis or to set a reminder on one’s mobile phone.
- Care must be taken not to double dose. Missed doses can be taken if the time is not too close to the next one. If a dosage is missed and it is almost time for the next, rather skip the missed dose and return to the regular schedule.
- It is strongly advisable not to change medications without the express consent of the treating medical doctor, nor discontinue medication use during treatment. If side effects are experienced, rather discuss these with a doctor before discontinuing use.
- Outdated or expired medication should not be used (dispose of this as per the medication label instructions).
- Medications should be stored in dry areas away from moisture (unless specific medications require refrigeration) and out of reach of others, especially children and pets. No medication should ever be shared with others.
- It is advisable to be well-informed about the potential side-effects for all medications to be taken. Most side-effects will take place when starting a course of medication and ease off as the drug settles in the system. Some side-effects may be delayed or occur if a new medication is introduced into the treatment plan.
Another important part of treatment, along with medications, is to physically work with the effects of Parkinson’s disease with a variety of different, but beneficial therapies …
This method of treatment aims to restore normal alignment of the body, and thus enhance motor responses, balance and the ability to initiate movement (or motion). Muscle strengthening exercises also extend into areas of speaking, chewing and swallowing by working with the affected physical portions of the face. Physical therapy, like medication or surgery is not a means to cure the disease.
It is an effective method to help a person compensate for the neurological damage brought on by the condition. A variety of movement techniques, equipment uses and strategies will be used to teach a Parkinson’s sufferer how to loosen and strengthen affected muscles. Much of these techniques are aimed at allowing a person the ability to perform exercises outside of medical facilities and on their own on a regular, day-to-day basis. This helps to improve movement and function, relieve pain, correct problems with balance and coordination, body weakness, gait difficulties, alleviate fatigue and promote an independent lifestyle.
A thorough initial evaluation will determine how many sessions will be required with follow-ups to assess progress being made.
This method of treatment focusses on helping a Parkinson’s sufferer achieve an active daily lifestyle. An occupational therapist will work with an individual to fine-tune skills that will enable them to complete a variety of different tasks without great difficulty, sometimes with the use of equipment.
Changes to the home or place of work may be required for additional comfort and an occupational therapist can advise the best means to do this and maintain a comfortable, independent lifestyle. Areas of focus for this means of treatment include arm and hand therapy, aids for handwriting, vehicle modification and driver evaluations, home, home-making and cooking changes and adaptations, adaptations for more comfortable eating, adaptations to the bathroom (bath tub and toilet equipment), grooming and dressing aids, computer or workplace equipment adaptations, leisure skills development and effective lifestyle changes that preserve energy levels. If needed, an occupational therapist can also teach an individual how to best use a manual or electric wheelchair.
As with physical therapy, a thorough evaluation will determine the number of necessary sessions, with an appropriate number of follow-ups thereafter to assess progress or make adaptations to increase levels of comfort.
Speech therapy (speech-language pathologist or speech therapist):
Aside from some of the other physical symptoms of Parkinson’s disease, speech difficulties are a source of intense frustration for many sufferers. Difficulties present another area of continuous struggle and even embarrassment. As many as 89% of Parkinson’s disease sufferers develop vocal and speech difficulties, especially a low or soft voice. Normal speaking volume is compromised as the necessary amount of air required to leave through the voice box (or larynx) is restricted, thus weakening the vocal cords and producing an inadequate amount of vibration needed to produce sound.
Some therapy techniques teach an individual how to speak “loud and low”. The fundamental purpose of this treatment is to assist an individual with being able to learn how to re-programme the brain (‘speak loud, think shout’ or ‘think loud, think low’), modifying speech and improving vocal ability. The process is a little complex and finding a balance that does not create an overly high-pitched or loud sound which is often less intelligible takes time and practice. ‘Think loud, think low’ methods have effectively shown an improvement in volume and an enhanced voice quality without placing additional strain on the larynx.
Therapy also focusses on non-verbal communications skills, and also offers day-to-day maintenance tips such as trying to talk in environments with reduced noise levels (instead of trying to compete with televisions or crowds of people), making an effort to speak slowly and using short phrases, ensuring face-to-face conversation for easier understanding, prolonging vowels and exaggerating consonants, ensuring adequate periods of vocal rest or making use of a voice amplifier. Non-verbal techniques (augmentative and alternative communication or AAC) can help where others have difficulty understanding an individual with speech difficulties. These include writing things down or using an alphabet board, or expressive gestures. Some therapists may recommend the use of devices to enhance communication.
- A palatal lift: This is a soft plate prosthesis, similar to a dental retainer, which prevents air from escaping out of the nose while speaking.
- Amplification device: Increases voice volume and aids in decreasing vocal cord fatigue.
- TTY telephone relay system: This a telephone that has a built-in keyboard, allowing for communication to be typed and read aloud (or relayed by an operator) to a listener. A Parkinson’s sufferer can make use of full sentence messages or just words if a listener is having trouble understanding them.
- High technology electronic speech enhancers or devices for communication: These include computer enabled voice synthesisers.
Surgical procedures are generally last-resort options when medication use has not proved effective for the control of Parkinson’s disease symptoms.
- Pallidotomy: Research has shown that the globus pallidus in the brain becomes overactive in a person with Parkinson’s disease. The overactivity contributes to the slowing down or degeneration of movement. As a surgical procedure, Pallidotomy works to reduce Parkinson’s disease symptoms by permanently destroying the globus pallidus in the brain. An added benefit is that the surgery outcome can contribute to enhancing the effects of medication use as well, especially in those in the advance stages of the disease.
- Thalamotomy: Research has also established that the abnormal brain activity that causes symptoms of tremor is processed through the thalamus portion of the brain. A thalamotomy procedure works to block abnormal brain activity by destroying part of the thalamus, effectively preventing it from reaching the body’s muscles. This procedure is only effective for treating tremors, and as such is not commonly performed for overall treatment.
Deep brain stimulation (DBS)
A far more favoured method of treatment is DBS which targets Parkinson’s symptoms by making certain parts of the brain inactive without having to surgically destroy them. Electrodes are implanted in the thalamus, globus pallidus and subthalamic nucleus portions of the brain with the help of CT or MRI scans. These electrodes are connected to an impulse generator (or IPG) which is implanted beneath the skin (usually in the chest, just beneath the collarbone). The loose ends of the electrodes are surgically placed (via incisions) beneath the skin of the head and stitched up. The IPG serves as something like a pacemaker which sends continuous electrical pulses to the targeted areas of the brain when active.
Radio signals are linked to a computerised programme, which can also be activated (or turned off) by a Parkinson’s disease sufferer using special devices or magnets. Batteries for an IPG can last between three and five years, depending on the amount of use and can easily be replaced when needed.
Stimulators are only activated four to six weeks after the surgical implantation and may take several months to take effect, in combination with medication adjustments (reduced dosages). A patient will remain in hospital for a period of 24 to 48 hours following the procedure.
The effect is similar to that of a pallidotomy or thalamotomy, but without surgically destroying the targeted areas of the brain and with very few side-effects. Other benefits are that stimulation is adjustable and can be changed according to a person’s disease progression without the need for further surgery, and that the procedure targets most of the major Parkinson’s disease symptoms.
These benefits improve a person’s quality of life considerably, especially if the subthalamic nucleus was targeted, which has shown the best results with reducing the use of medication. Up to 70% of patients having had the treatment experience a significant improvement in symptoms.
If side-effects are experienced, the stimulator can be turned off or deactivated. Other disadvantages include a small risk of infection (due to implantation of a foreign object) and bleeding in the brain.
Surgery for implantation carries a 2% to 3% risk of paralysis and other complications such as permanent memory, thinking or personality changes and seizures. A doctor must be called immediately if severe or persistent headaches, bleeding, swelling, vision loss or sudden vision changes, a persistent fever or chills develop post op.
This procedure will only be recommended if an adequate trial of medications has shown to be unsuccessful (or unstable) in treatment Parkinson’s disease symptoms. Deep brain stimulation procedures should be performed in an environment where there is a multi-disciplinary team of experts (neurologists and neurosurgeons with specialised skills and training for this procedure).
It’s important to keep in mind that the procedure cannot reverse damage caused by Parkinson’s disease, not prevent the progression of the condition. It can, however, work to stabilise symptoms and in so doing, alleviate effects of mobility problems, tremor and rigidity.
Gamma knife treatment (a non-invasive surgical approach)
Those who are not good candidates for deep brain stimulation surgery may be able to treat their symptoms with a gamma knife procedure instead. Parkinson’s disease sufferers who are not able to discontinue their medication for a short period of time or are also taking blood thinning drugs may be better off opting for this surgical procedure in order to treat Parkinson’s disease symptoms. Others may elect to have this as it is a less invasive option. A doctor will consider this treatment method when medication use is not proving successful in alleviating symptoms.
Unlike the name of the procedure, there is no actual ‘knife’ involved in the actual process. A machine which emits hundreds of highly focussed, and powerfully concentrated (precise) gamma radiation beams is used instead. The beams are accurately programmed to target the affected areas of the brain without heavily influencing the healthier portions.
In order to gain this level of accuracy, the process requires the efforts of a team of specialists – neurosurgeons, neuro-radiologists, radiation physicists, radiation oncologists and specialised nursing teams.
Using specialised imaging scans (MRI and CT) this multi-disciplined team are able to pinpoint exact locations in the brain to work with. A Parkinson’s sufferer is given a local anaesthetic and fitted with a head frame which is positioned inside a helmet which will allow radiation to be accurately directed to the targeted areas. From there he or she lays down on a table that slides into the gamma knife machine.
Radiation beams are delivered through 201 ports inside the helmet, which intersect at the targeted area. This process can take between 15 and 40 minutes. Discomfort may be mild and very few experience side-effects following the treatment. Once completed, a Parkinson’s disease patient can return home (as this is an outpatient procedure).
The success rate for this procedure is between 70% and 90%, depending on the condition of the individual being treated and the extent of their disease progression. Success is measured over a period of time, with effects usually showing positive signs within at least several months. The treatment option is not as successful for symptom management as deep brain stimulation.
Research is ongoing and extensive when it comes to finding ways to better understand this disease and how to gain control of symptoms or reverse their damaging effects altogether. To date, most treatment focusses on the effects (symptoms) of Parkinson’s disease, largely because the fundamental cause still has so many grey areas (i.e. is not fully understood).
Many a clinical trial has been done and continues to be implemented to find new ways to better target the source of Parkinson’s disease symptoms. Although much has been done, research has come a long way, particularly during the past decade. Research is not only taking potential genetic factors and medicinal treatment into consideration, but also ways to better enhance the effects of treatment for the patient living with Parkinson’s (i.e. taking into account their feelings and noting specific experiences on a day-to-day basis while undergoing treatment).
Neurosurgeons and neurologists are exploring ways to graft dopamine-producing cells (stem cells) in the brain as an alternative method to medication treatment which works to correct neurotransmission imbalance.
Glial cell-derived nerve growth factor is also an area of intense research. Nerve growth factor is a substance which is naturally produced in bodily tissues. Injections of the substance is being researched as a means to potentially preserve or restore the brain and spinal cords’ nerve cells, specifically those responsible for producing dopamine.
Research of this nature is time-consuming and is yet to turn out results that show potentially new treatment options. A critical question remains unanswered – how does Parkinson’ begin? While research tackles the clues, using what is known about the disease, a cure is still a long way off. For now, medication in combination with various therapies and deep brain stimulation procedures appear to offer the best results, enhancing a Parkinson’s disease sufferer’s quality of life considerably.
Living with Parkinson’s disease
Progression of the disease is not sudden, and gradually begins to impact just about every aspect of a person’s life. From basic day-to-day routines to working ability, relationships and social engagements. The gradual loss of independence can be increasingly difficult and frustrating.
There is, however, plenty that can be pre-planned for when it comes to ‘what lies ahead’ following a diagnosis. Sure, critical aspects of the disease are not yet known, but there is plenty to work with in terms of preserving the best possible quality of life with a variety of different experts on hand to assist with making the adjustments that enable a person to achieve this in the best way possible.
It is very important for a newly diagnosed Parkinson’s sufferer to make an effort to develop strong relationships with his or her medical care team and seek consistent support from counselling groups, and loved ones.
As the disease progresses, treatment across all areas of expertise will need to be adjusted in order to maintain the best quality of life possible. Preparing for this mentally may make for smoother transitions when the time comes.
By taking an active role in managing Parkinson’s disease, a sufferer can ensure that treatment is successful in targeting degenerative symptoms. As there are multiple disciplines involved, it is wise to ensure that each of the various areas of expertise are well aware of one another, so that treatment can be effectively coordinated.
What can a Parkinson’s disease sufferer do for themselves?
Once a healthcare team has been established and a level of comfort is achieved taking medications, and managing symptoms and side-effects, an individual can begin implementing a variety of other coping mechanisms into daily life.
Lifestyle considerations and coping mechanism tips include:
1. Making efforts to improve walking ability: Develop habits of walking at a controlled pace (not too quickly) and carefully, placing the heel on the ground first and adjusting posture as best possible. Standing up as straight as possible will help to reduce foot shuffling when walking.
2. Making efforts to reduce the risk of falling: Never backtrack or walk backwards, avoid carrying objects that can influence balance while walking, refrain from leaning or reaching when moving around and avoid sharp movements or pivoting on the feet in order to turn (rather make a U-turn).
3. Dressing adjustments: Clothing choices may need to be changed so as to avoid finicky things such as buttons and zips which can become difficult to use when dressing and undressing. Clothing that is easy to put on and take off is best – Velcro and elasticated waist bands will make for easier dressing. It may take a little longer to dress and undress, requiring a little more patience than was once necessary.
4. Diet and nutrition adjustments: There is no set diet plan for Parkinson’s disease, but healthier ways of eating can certainly work in a person’s favour for optimum all-round health. A balanced diet can help to reduce the amount associated complications such as constipation. Omega-3 fatty acids, whole grains, fruits and vegetables, dairy products, protein-rich foods such as beans and meat, as well as healthy fats found in olive oil, nuts, fish and eggs are all good options to include in a daily diet. Adapting one’s diet may be a little challenging, but working with a registered dietician may help to make smoother changes, especially when made one at a time. An occupational therapist can also introduce helpful devices which aid in making swallowing difficulties easier. What a person is able to eat in terms of textures (those which are easier to swallow) may need to be adapted as the disease progresses, but for the most part, an individual will need to develop the habit of being in tune with their bodies and how symptoms affect certain areas:
- Digestive difficulties and urinary issues can be alleviated with enough water intake (or consuming foods with high water content such as watermelon, grapefruit, strawberries, butternut squash and celery) and fibre-rich foods such as wholegrains, brown rice, beans and fruit.
- Medications can be taken with a full glass of water so as to assist in easier drug breakdown and absorption in the body. Most medications are best taken on an empty stomach (or sometimes with a small snack) and certainly not before consuming a protein-rich meal (which can slow down absorption and make the drug less effective).
- Reducing intake of sugar, caffeine and alcohol can help to alleviated trouble with sleep.
- Vitamin D intake in either supplement form or via milk products can help to promote better bone health.
- Improved brain function can be achieved with regular consumption of nuts (in small quantities) such as walnuts and cashews, as well anti-inflammatory foods such as salmon, dark leafy green vegetables and tuna, as well as berries which contain high concentrations of antioxidants.
5. Developing an exercise routine: It’s all too easy to want to give in to mobility problems and hide away, but regular exercise (long-term) is the best way to achieve muscle strength, balance and flexibility, which in turn can help to improve many physical Parkinson’s disease symptoms. Developing a personalised exercise programme can be hugely satisfying and help to counteract symptoms, by working against degeneration of walking, balance and general mobility. A physical therapist can assist with developing a programme of activity that best suits a person’s interests and physical capabilities.
A programme that includes areas of aerobic exercise and resistance training, can include activities such as swimming, water aerobics, rowing, walking, dancing, barre work, golf, gardening, boxing (non-contact), weight lifting, resistance bands, yoga, tai chi, Pilates and stretching. Benefits of exercise can extend to managing non-motor symptoms such as emotional distress, anxiety and depression, as well as improving overall cognition.
Caring for a loved one with Parkinson’s disease
As much as treatment focuses on enabling a Parkinson’s disease sufferer to develop newly adjusted ways to maintain an independent lifestyle, disease progression cannot be curbed. This means that many will reach an advanced stage of the disease and become almost completely dependent on a caregiver.
Basic functions such as help with dressing, eating, bathing or getting to an appointment with a doctor or therapist can reach a point of total dependency. A caregiver can be known to a person with Parkinson's disease (a loved one – family member or friend) or an individual involved in caregiving professionally.
The impact of care not only affects the life of a Parkinson’s sufferer, but also the caregiver too. Caregiving is taxing physically, mentally and emotionally too and best serves an individual with Parkinson’s disease when the caregiver ensures to take care of him or herself too. Caregiving requires patience from both sides – the caregiver, as well as the individual with Parkinson’s disease.
A caregiver can ensure that caring for an individual with Parkinson’s disease is a lot less complicated by:
- Attending all medically related appointments and assisting with explaining to relevant medical professionals how the person is faring with treatment, day-to-day function, possible side-effects and the overall progressive nature of the disease. A Parkinson’s sufferer may lack in being able to communicate important information, especially if memory has become problematic. A caregiver who takes an active role in a person’s Parkinson’s disease treatment can be of great help to them.
- Ensuring the best quality healthcare is available for an individual with Parkinson’s disease. This may also involve ensuring that a sufferer receives appropriate vaccinations, especially when it comes to annual flu shots or the pneumococcal vaccine to keep infections at bay.
- Involving friends and family in a Parkinson’s disease sufferer’s day-to-day life. This will not only do them good by having frequent company, but also allow for easier management of other errands, such as grocery shopping or picking up children from school (if early onset Parkinson’s occurs).
- Finding support where it is needed, including groups which assist those with a debilitating illness, as well as their close family members and caregivers in coping with the emotionally straining effects of it all.
- Caregiving during the latter stages of Parkinson’s disease can become more difficult and demanding. It is best to enlist the help of professionals (palliative care) to help best manage symptoms and side-effects, especially if a person with Parkinson’s disease has severe depression or dementia. Options include home health nurses or a nursing home environment.
What is the outlook for someone with Parkinson’s disease?
Parkinson’s Disease is not yet preventable or curable, but a diagnosis is not a death sentence. Parkinson’s Disease itself does not cause death. Related symptoms causing other medical complications, however (such as choking due to swallowing difficulties or falling) can be fatal if not effectively treated or managed by a medical professional.
Not all diagnosed individuals will experience the most advanced or severe stages of the disease. Most will experience mild to moderate levels of disability. Not every individual will experience the full range of expected symptoms either. A small percentage of diagnosed individuals will not respond well to treatment options and will eventually develop severe disability during the advanced stages.
It is also not entirely possible to predict how slowly or quickly the disease will progress. In general, it has been noted that the average life-expectancy is similar to that of others in generally good health.
It is critical to be able to recognise the major symptoms characteristic of the disease early enough in order to implement treatment as soon as possible. This provides a person with the best possible outlook and chance of a much-improved quality of life or as near to normal as can be achieved.
Are there other conditions that can resemble Parkinson’s disease?
Conditions with similar sets of major symptoms are collectively known as Parkinsonism. Conditions that involve multiple system atrophy, corticobasal degeneration, progressive supranuclear palsy, Lewy body dementia, head trauma, inflammation of the brain or stroke fall into the same classification.
Other conditions such as lateral sclerosis, dystonic tremor, essential tremor, vascular Parkinsonism, drug-induced Parkinsonism and Alzheimer’s Disease can also be misdiagnosed as Parkinson’s disease. Parkinsonism is not, however the same as Parkinson’s disease.
What is Parkinsonism?
Parkinson’s Disease is a form of Parkinsonism, which is medically a general term used to define a set of symptoms commonly associated, but not necessarily as a result of the same cause.
To make a distinctive diagnosis, a doctor will need to rule out possible causes such as brain tumours, thyroid disorders, adverse reactions to medications and excess fluid on the brain which could cause a similar set of symptoms. To date, Parkinson’s disease does not have a known cause.
Does Parkinson’s disease affect men and women differently?
It is known that more men are prone to Parkinson’s disease than women, almost twice as much. It has also been determined that there are physiological differences in how Parkinson’s disease affects men and women.
- Major symptoms: Onset of Parkinson’s disease appears to develop approximately two years later in women than it does men. Women typically notice tremor as the dominant major symptom, whereas men usually notice symptoms of bradykinesia (slow movement and rigidity). When it comes to cognitive function, mental faculties and muscle control, men appear to understand spatial orientation better than women (depending on the side of the brain that is most deficient in dopamine). Women typically have less trouble with verbal fluency than do men (also dependant on the side of the brain affected). Studies have shown that a higher percentage of men have difficulty interpreting fearful facial expressions. Both men and women have difficulties with interpreting surprise and anger. Women appear to feel more distress with being unable to correctly interpret facial expression.
- Sleep disturbances: More men than women tend to develop rapid eye movement behaviour disorder.
- Treatment: It has been noted that women don’t generally progress to the point of needing surgical treatment as often as men do, but when symptoms cannot be otherwise managed, they are typically more severe. Surgical results may not be as effective in women as men. Women are also prescribed higher doses of medication than men which increases risk of adverse side-effects (this is often influenced by lower body weight in women).
- Living with Parkinson’s disease: It has been noted that more women suffer from depression as a result of their condition than men do, and as a result are often put on antidepressant medication. Men typically appear to struggle more with behavioural problems, such as aggression which can lead to abusive or inappropriate actions and outbursts.
Is it known why there are distinctive differences between the sexes when it comes to Parkinson’s disease?
Research has indicated that oestrogen exposure influences the way a women experiences Parkinson’s symptoms, possibly protecting the fairer sex from disease progression to some degree.
Oestrogen may serve as a neuroprotectant of dopamine levels in the brain. Delayed menopause (influenced by hormones) could potentially be one reason why onset of Parkinson’s disease symptoms occurs later in women than it does men. It is not yet fully understood as to why this may influence the condition.