Monday, August 8, 2022

Does Parkinson’s Affect The Brain

How Does Parkinsons Disease Affect The Body

Dr. James Beck – How does Parkinson’s disease affect the brain?

Recognising the signs

A combination of signs can help a doctor make an early diagnosis. If Parkinsons 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 Parkinsons disease. Some signs such as loss of smell could be caused by an infectious illness, or joint stiffness by conditions like arthritis.

Parkinsons is most commonly diagnosed with a very physical examination and assessment of a persons medical history. There are very specific markers for diagnosis which doctors use to assess for possible Parkinsons 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

2. Secondary motor symptoms

Other motor symptoms include:

Some individuals may also experience the following:

  • Hunched over / stooped posture – 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
  • Cramping
  • Production of excess saliva and drooling
  • Sexual dysfunction
  • Dystonia
  • Akathisia

3. Non-motor symptoms

Symptoms that do not involve physical movement or coordination, and often precede motor problems, can include:

Symptoms are initially mild, even if they develop suddenly, and typically affect one side of the body at first.

What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms

Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinsons disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didnt exercise or didnt start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.

Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinsons, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.

Preventing falls and maintaining balance: Falls are a frequent complication of Parkinsons. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments whether medicines or deep brain stimulation are optimal and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.

How Will My Doctor Test For It

There’s no one test for Parkinson’s. A lot of it’s based on your symptoms and health history, but it could take some time to figure it out. Part of the process is ruling out other conditions that look like Parkinson’s. The docotor may do a DaT scan, which looks for dopamine in the brain. This can aid in a diagnosis.

Because there is no single test, it’s very important to go to a doctor who knows a lot about it, early on. It’s easy to miss.

If you do have it, your doctor might use what’s called the Hoehn and Yahr scale to tell you what stage of the disease you’re in. It ranks how severe your symptoms are from 1 to 5, where 5 is the most serious.

The stage can help you get a better feel for where your symptoms fall and what to expect as the disease gets worse. But keep in mind, some people could take up to 20 years to move from mild to more serious symptoms. For others, the change is much faster.

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How Is Parkinson’s Disease Managed

Your doctors will tailor your treatment based on your individual circumstances. You will manage your condition best if you have the support of a team, which may include a general practitioner, neurologist, physiotherapist, occupational therapist, psychologist, specialist nurse and dietitian.

While there is no cure for Parkinson’s disease, symptoms can be treated with a combination of the following.

When People Talk About Parkinsons They May Mention The Effects It Has On The Substantia Nigra But Did You Know That There Are Other Areas Of The Brain That Are Affected By The Condition

Study reveals roots of Parkinson

Parkinsons is a condition that causes the gradual loss of the dopamine-producing brain cells of the substantia nigra an area of the brain located just above where the spinal cord meets the midbrain. It is these cells that produce and release the neurotransmitter dopamine, which has a key role in turning thought about movement into action.

While this definition of the condition is useful to briefly explain Parkinsons, the whole story is somewhat more complex. Over the last 30 years, it has become accepted that Parkinsons also causes a number of non-motor symptoms, such as changes in sleep, smell and even the way we think, which likely involve other areas of the brain.

Now scientists are looking at the broader effects of the condition on the brain in an attempt to better understand why people experience different symptoms. The finding could lead us to new treatments that tackle more than just the motor symptoms of the condition.

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Other Reasons For Cognitive Symptoms

Besides PD, there are other important causes of cognitive dysfunction to keep in mind. Medical illnesses such as thyroid disease or vitamin B12 deficiency can cause cognitive symptoms. Urinary tract infections or pneumonia can acutely cause confusion or hallucinations. In these settings, the cognitive symptoms are generally reversible after the infection or medical condition is treated. One should be aware that some medications for pain or bladder problems may cause sedation/sleepiness or confusion, and, thereby, impair cognitive function.

How Is Parkinson’s Disease Treated

If a doctor thinks a person has Parkinson’s disease, there’s reason for hope. Medicine can be used to eliminate or improve the symptoms, like the body tremors. And some experts think that a cure may be found soon.

For now, a medicine called levodopa is often given to people who have Parkinson’s disease. Called “L-dopa,” this medicine increases the amount of dopamine in the body and has been shown to improve a person’s ability to walk and move around. Other drugs also help decrease and manage the symptoms by affecting dopamine levels. In some cases, surgery may be needed to treat it. The person would get anesthesia, a special kind of medicine to prevent pain during the operation.

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Parkinsons Doesnt Always Cause Dementia

While cognitive decline is common in both Alzheimers and Parkinsons, it is less likely to occur in Parkinsons patients. According to studies, only half of those with Parkinsons develop cognitive difficulties. This can range from mild forgetfulness to full-blown dementia.

When dementia does manifest itself with Parkinson, it occurs in the subcortical area of the brain. Alzheimers dementia occurs in the cortical area of the brain. As a result of this, the clinical symptoms of these two dementias can be somewhat different.

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Parkinson’s Disease: How is the brain affected?

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Foster A Good Relationship

Lastly, maintaining your relationship and communication with the person with Parkinsonâs can be the most challenging and rewarding aspect of caregiving. As Parkinsonâs disease progresses, the roles change and the person with Parkinsonâs may go from being an independent head of the household to a very dependent person requiring a significant level of care. However, research shows that despite high levels of strain, caregivers with good quality relationships have reduced depression and better physical health. Remember, as a caregiver your service to your loved one is beyond measure in terms of love, depth of care, and concern.

So What Do We Know So Far

Location of the substantia nigra. FrozenManCC BY-SA 4.0

The substantia nigra is an area of the mid brain located at the top of the spinal cord, which has been the focus of much work into how Parkinsons affects the brain.

There are a right and a left substantia nigra, and often one side is affected before the other. Because of this, people with Parkinsons often experience symptoms primarily on one side of their body, particularly in the early stages. Indeed, this common feature of the condition often helps to distinguish Parkinsons from other similar conditions.

When it comes to confirming a diagnosis, it is the substantia nigra where pathologists look for changes at the end of life in brain tissue that has been donated to research. And the loss of the dopamine-producing cells in this area of the brain, accompanied by the presence of clumps of alpha-synuclein protein , has been the hallmark of Parkinsons for decades.

You can read more about the alpha-synuclein protein, and how it plays a role in the spread of Parkinsons, in a previous blog post:

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Living With Parkinson’s Disease

Coming to terms with a diagnosis of Parkinson’s and living with the disease is challenging and will take a lot of adjustment. There are still things you can do that can help you to feel more in control of your situation and to stay positive. Some things that might help could include:

  • choosing to lead a healthy lifestyle
  • making informed decisions related to your treatment
  • keeping a diary of your symptoms in preparation for meetings with health and social care professionals
  • attending a self-management course

Sedation And Regional Anesthesia For Deep Brain Stimulation In Parkinsons Disease

Parkinsons Disease  Medical

Dilek Yazicioglu

1Ankara Diskapi Yildirim Beyazit Teaching and Research Hospital, Irfan Bastug Caddesi, Dskap, 06330 Ankara, Turkey

Academic Editor:

Abstract

Objective. To present the conscious sedation and the regional anesthesia technique, consisting of scalp block and superficial cervical plexus block, used in our institution for patients undergoing deep brain stimulation for the treatment of Parkinsons disease . Methods. The study included 26 consecutive patients. A standardized anesthesia protocol was used and clinical data were collected prospectively. Results. Conscious sedation and regional anesthesia were used in all cases. The dexmedetomidine loading dose was 1gkg1 and mean infusion rate was 0.26gkg1h1 . Propofol was used to facilitate regional anesthesia. Mean propofol dose was 1.68mgkg . Scalp block and superficial cervical plexus block were used for regional anesthesia. Anesthesia related complications were minor. Postoperative pain was evaluated mean visual analog scale pain scores were 0 at the postoperative 1st and 6th hours and 4 at the 12th and 24th hours. Values are mean . . Dexmedetomidine sedation along with scalp block and SCPB provides good surgical conditions and pain relief and does not interfere with neurophysiologic testing during DBS for PD. During DBS the SCPB may be beneficial for patients with osteoarthritic cervical pain. This trial is registered with Clinical Trials Identifier .

1. Introduction

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The Nervous System & Dopamine

To understand Parkinson’s, it is helpful to understand how neurons work and how PD affects the brain .

Nerve cells, or neurons, are responsible for sending and receiving nerve impulses or messages between the body and the brain. Try to picture electrical wiring in your home. An electrical circuit is made up of numerous wires connected in such a way that when a light switch is turned on, a light bulb will beam. Similarly, a neuron that is excited will transmit its energy to neurons that are next to it.

Neurons have a cell body with branching arms, called dendrites, which act like antennae and pick up messages. Axons carry messages away from the cell body. Impulses travel from neuron to neuron, from the axon of one cell to the dendrites of another, by crossing over a tiny gap between the two nerve cells called a synapse. Chemical messengers called neurotransmitters allow the electrical impulse to cross the gap.

Neurons talk to each other in the following manner :

Faulty Metabolism Of Parkinson’s Medication In The Brain Linked To Severe Side Effects

by Uppsala University

Until now, the reason why the drug levodopa , which reduces the motor symptoms of Parkinson’s disease, declines in efficacy after a few years’ use has been unknown. A side effect that then often occur is involuntary movements. A SwedishFrench collaboration, led from Uppsala University, has now been able to connect the problems with defective metabolism of L-Dopa in the brain. The study is published in Science Advances.

“The findings may lead to new strategies for treating advanced Parkinson’s,” says Professor Per Andrén of the Department of Pharmaceutical Biosciences at Uppsala University. He and Dr. Erwan Bézard of the University of Bordeaux, France, headed the study jointly.

Parkinson’s disease is caused by the slow death of nerve cells that produce the key neurotransmitter dopamine. This results in the typical symptoms, such as rigidity and tremor. Treatment with L-Dopa, a precursor to dopamine, initially works very well as a rule but after a few years, the effect of each dose becomes progressively more short-lived. Adverse side effects, such as rapid alternation between rigidity and uncontrolled movements that become increasingly severe over time, are very common. Finally, the benefits of L-Dopa treatment are jeopardized and the symptoms can become debilitating. Which neurochemical mechanisms cause these side effects is unknown. The involuntary movements are collectively known as “L-Dopa-induced dyskinesia.”

Explore further

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Seeking Help For Cognitive Changes

Cognitive change is a sensitive issue. In fact, the doctor is often as hesitant to address this subject as the person with PD is to ask about it. Sometimes, the doctor will delay discussing cognitive impairment out of concern for the person who is still coping with the shock of a new PD diagnosis or struggling with motor symptoms.

For this reason, the person with PD often needs to be the one to initiate the conversation. Tell your doctor if you or your loved one is experiencing problems that upset the family or cause interruptions at work.

Cognitive issues are never too mild to address with your care team. A doctor can provide ways to help, often, referring psychiatrist, neuropsychologist, speech or occupational therapist for further evaluation and assistance. The neuropsychological evaluation can be particularly useful, especially in the early stages of a cognitive problem. Having this baseline test can help the doctor determine whether future changes are related to medications, the progression of the PD itself or to other factors such as depression.

When reporting symptoms of mild cognitive impairment, the doctor will first want to rule out causes other than PD, such as Vitamin B-12 deficiency, depression, fatigue or sleep disturbances. It should be noted that PD does not cause sudden changes in mental functioning. If a sudden change occurs, the cause is likely to be something else, such as a medication side-effect.

Medicines For Parkinsons Disease

Impact of Falls and Parkinson’s Disease

Medicines prescribed for Parkinsons include:

  • Drugs that increase the level of dopamine in the brain
  • Drugs that affect other brain chemicals in the body
  • Drugs that help control nonmotor symptoms

The main therapy for Parkinsons is levodopa, also called L-dopa. Nerve cells use levodopa to make dopamine to replenish the brains dwindling supply. Usually, people take levodopa along with another medication called carbidopa. Carbidopa prevents or reduces some of the side effects of levodopa therapysuch as nausea, vomiting, low blood pressure, and restlessnessand reduces the amount of levodopa needed to improve symptoms.

People with Parkinsons should never stop taking levodopa without telling their doctor. Suddenly stopping the drug may have serious side effects, such as being unable to move or having difficulty breathing.

Other medicines used to treat Parkinsons symptoms include:

  • Dopamine agonists to mimic the role of dopamine in the brain
  • MAO-B inhibitors to slow down an enzyme that breaks down dopamine in the brain
  • COMT inhibitors to help break down dopamine
  • Amantadine, an old antiviral drug, to reduce involuntary movements
  • Anticholinergic drugs to reduce tremors and muscle rigidity

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How Does Parkinson’s Affect The Body

The telltale symptoms all have to do with the way you move. You usually notice problems like:

Rigid muscles. It can happen on just about any part of your body. Doctors sometimes mistake early Parkinson’s for arthritis.

Slow movements. You may find that even simple acts, like buttoning a shirt, take much longer than usual.

Tremors. Your hands, arms, legs, lips, jaw, or tongue are shaky when you’re not using them.

Walking and balance problems. You may notice your arms aren’t swinging as freely when you walk. Or you can’t take long steps, so you have to shuffle instead.

Parkinson’s can also cause a range of other issues, from depression to bladder problems to acting out dreams. It may be a while before abnormal movements start.

Language Dysfunction In Parkinsons

There are several functions within language, including naming objects, generating words, comprehension, and verbal concepts. PD most often affects a persons ability to find a word, although as PD progresses, additional language difficulties may develop, including difficulty naming, difficulty comprehending information, and the use of more simplified and less spontaneous speech.3,4

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Causes Of Parkinsons Disease

At present, we do not know the cause of Parkinsons disease. In most people there is no family history of Parkinsons Researchers worldwide are investigating possible causes, including:

  • environmental triggers, pesticides, toxins, chemicals
  • genetic factors
  • combinations of environment and genetic factors
  • head trauma.

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