Care Partners: Burden Assessment And Support
Care partners or caregivers are an invaluable healthcare resource. When caregivers are present, patients are less likely to move to nursing homes. Caregivers also improve participation rates and retention of people with PD in research studies, which helps advance the path towards finding more effective therapeutics. Furthermore, many clinical trials for PDD require a caregiver in the study inclusion criteria.
Informal caregivers are providers who supervise or assist with instrumental and/or basic activities of daily living without pay to someone who cannot do these activities independently due to cognitive, physical, or psychological impairment. However, caregivers provide much more than this formal definition states. They often provide medical care including administration of medications, emotional and social support, and advice on medical decision-making. About 90% of men and 80% of women with PD have caregivers during their physician visits, and most caregivers are spouses.
Despite existing therapeutic support and resources for caregivers, there are several challenges to overcome. These include sex disparities in caregiving and the substantial financial strain that can be associated with caregiving. Caregivers are frequently at the forefront of providing medical history and administering complicated medication regimens without formalized education or support.
Memory Difficulties In Parkinsons
The most common difficulty for people with PD is remembering information that has previously been learned. Memory has several different processes and types, and people with PD have trouble recalling information but their long-term memory function generally remains intact. Memory cues or choices can help people with PD to retrieve information from the brains long-term storage.3,4
The Substantia Nigra And Movement
The reason that Parkinsons causes movement symptoms is that the substantia nigra makes up part of the circuitry, called the basal ganglia, that the brain uses to turn thought about movement into action.
The structures of the basal ganglia.
The substantia nigra is the master regulator of the circuit, it mainly communicates using the chemical dopamine, but other chemical transmitters are also used to communicate between other areas of the basal ganglia.
The balance of signals being sent between these structures allows us to control movement. But as Parkinsons progresses, and the dopamine-producing brain cells in the substantia nigra are lost, movement symptoms appear. Without enough dopamine, it becomes harder to start and maintain movements, which leads to symptoms such as slowness of movement, rigidity and freezing. And an imbalance of signals in the basal ganglia means people with Parkinsons can experience what is known as a resting tremor.
But while this is the description of Parkinsons you may find in most textbooks, it is now recognised that changes are not limited to the substantia nigra and basal ganglia.
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What Is Parkinson’s Disease
Parkinsons disease is a degenerative, progressive disorder that affects nerve cells in deep parts of the brain called the basal ganglia and the substantia nigra. Nerve cells in the substantia nigra produce the neurotransmitter dopamine and are responsible for relaying messages that plan and control body movement. For reasons not yet understood, the dopamine-producing nerve cells of the substantia nigra begin to die off in some individuals. When 80 percent of dopamine is lost, PD symptoms such as tremor, slowness of movement, stiffness, and balance problems occur.
Body movement is controlled by a complex chain of decisions involving inter-connected groups of nerve cells called ganglia. Information comes to a central area of the brain called the striatum, which works with the substantia nigra to send impulses back and forth from the spinal cord to the brain. The basal ganglia and cerebellum are responsible for ensuring that movement is carried out in a smooth, fluid manner .
The action of dopamine is opposed by another neurotransmitter called acetylcholine. In PD the nerve cells that produce dopamine are dying. The PD symptoms of tremor and stiffness occur when the nerve cells fire and there isn’t enough dopamine to transmit messages. High levels of glutamate, another neurotransmitter, also appear in PD as the body tries to compensate for the lack of dopamine.
Symptoms Of Parkinsons Disease
Parkinson’s disease has four main symptoms:
- Tremor in hands, arms, legs, jaw, or head
- Stiffness of the limbs and trunk
- Slowness of movement
- Impaired balance and coordination, sometimes leading to falls
Other symptoms may include depression and other emotional changes difficulty swallowing, chewing, and speaking urinary problems or constipation skin problems and sleep disruptions.
Symptoms of Parkinsons and the rate of progression differ among individuals. Sometimes people dismiss early symptoms of Parkinson’s as the effects of normal aging. In most cases, there are no medical tests to definitively detect the disease, so it can be difficult to diagnose accurately.
Early symptoms of Parkinson’s disease are subtle and occur gradually. For example, affected people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly, or that their handwriting is slow and looks cramped or small. Friends or family members may be the first to notice changes in someone with early Parkinson’s. They may see that the person’s face lacks expression and animation, or that the person does not move an arm or leg normally.
People with Parkinson’s often develop a parkinsonian gait that includes a tendency to lean forward, small quick steps as if hurrying forward, and reduced swinging of the arms. They also may have trouble initiating or continuing movement.
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How Parkinsons Disease Affects The Brain
The Parkinson’s disease brain stops producing dopamine cells, which in turn causes problems with movement and coordination known as motor symptoms. We all have a basic understanding of how Parkinson’s disease affects the brain, but what really happens when someone has Parkinson’s disease? Let’s explore the facts surrounding the Parkinson’s disease brain and how it differs from a normal, “healthy” brain.
How To Deal With Low Pressure In Parkinsons Disease
If you are a Parkinsons patient, it is very important to keep your eyes open on your blood pressure. Monitor and measure your blood pressure on regular bases, even if you dont feel any obvious signs. When taking blood pressure, do it in both seated and standing positions. It is good to take it 2-3 times a day. If you observed that your blood pressure is constantly low, talk to your caregiver immediately.
Here are some of the ways that can help you to maintain your blood pressure at a normal range.
- Drink a lot of water and avoid too much eating at once.
- If you have no issue with heart and kidney, increase the intake of salt in your food as it has been shown to elevate the blood pressure.
- Stop or reduce the consumption of alcohol and hot drinks. They widen the blood vessels and drop the blood pressure abruptly.
- Try to avoid excessive exercise as it can exacerbate the condition.
- Avoid changing your position suddenly. Take time to move from lying to sitting or from sitting to standing.
- Avoid standing for a long time.
- Consider the use of assistive devices like compression hose and an abdominal binder.
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Researchers Trace Clues To The Disease’s Effects On Patients’ Mental Ability
Patients with Parkinson’s disease are known to exhibit slowed movements and tremors, but one aspect of their condition is often overlooked: cognitive impairment.
Unlike with Alzheimer’s and other dementias, patients with Parkinson’s don’t lose their memory. Instead, they may develop trouble with planning, making decisions and controlling their emotions, and often exhibit changes in personality as a result. About one-third to one-half of Parkinson’s sufferers exhibit some signs of cognitive impairment at the time they are diagnosed, but over time virtually all patients will experience substantial cognitive decline.
Cognitive Problems And Parkinsons
Many people with Parkinsons experience some mild memory loss and thinking problems. Symptoms vary widely and may fluctuate through the day. Research has shown that cognitive problems tend to be more severe in people with Parkinsons with more pronounced bradykinesia and rigidity, and less severe in those with more pronounced tremor.
If you are experiencing changes in your thinking and mental abilities, its natural to be concerned. You may worry you could go on to develop dementia however, this happens to comparatively few people. One study found that after ten years with Parkinsons, 80% of people with the condition experienced some cognitive difficulties, but less than 20% had developed dementia – known as Parkinsons disease dementia . The symptoms of PDD are very different from those of Alzheimers disease.
Some Parkinsons symptoms can make speech and facial communication difficult, and slowed thinking will often make things even harder. As the ability to remember words is affected, your vocabulary can become limited and humour may be less understood. It can also get harder to follow conversations, and this can result in you not making sense, or forgetting what you have said and repeating things.
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What Are The Causes And Symptoms Of Parkinsons Disease
As a neurodegenerative disorder, Parkinsons Disease leads to the progressive deterioration of motor function due to loss of dopamine-producing brain cells. While the cause of Parkinsons Disease is unknown, researchers speculate that both genetic and environmental factors are involved. Studies also show that men are 50% more likely to develop the disorder than women.
Primary symptoms of Parkinsons Disease:
- tremor
- dementia
How Can I Help Myself
Keeping physically active and mentally stimulated is very important when living with both Parkinsons and cognitive problems.
Avoiding stress is also important. Anything that puts you under pressure is likely to worsen memory problems, so try to take each day at a steady pace. Allow time for rest and relaxation, and make time to do the things you enjoy. Relaxing effectively can help to improve your concentration, attention span and ability to plan. Complementary therapies such as yoga and Tai Chi, together with exercise such as swimming may help with this.
We can all be forgetful and while this is often frustrating, a good quality of life can still be enjoyed if you make some adaptations.
You could begin by adapting your home and work environments to accommodate your needs. For example, removing clutter will reduce the number of visual distractions and make it easier for you to find your way around. Keeping furniture in the same place and having a regular daily routine may be helpful. At night, you may find it useful to keep a low-level night light on to minimise possible disorientation if you wake.
As time passes, carrying out more complex tasks is likely to become harder. Try writing down the various steps you have to go through in order to complete specific tasks, and follow these steps one by one.
The following tips may also help maintain brain function and improve quality of life:
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Attention Difficulties In Parkinsons
Attention involves filtering information, and people with PD who experience attention difficulties have trouble maintaining focus, especially as the complexity of a situation increases. Attention difficulties can affect both intellectual pursuits and everyday activities, such as walking and holding a conversation at the same time.1,3
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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Is Parkinson’s Diagnosed In The Brain
Parkinson’s disease is one of the most challenging neurological disorders to diagnose and treat. If your doctor suspects you have Parkinson’s disease, you will usually be referred to a neurologist for further tests. These tests will involve certain movements and exercises to check your symptoms.
A neurologist will look for motor symptoms such as:
- A tremor that occurs at rest
- Slowed movement
- Muscle stiffness
If you have two or more of these symptoms and your doctor has taken blood tests to rule out other causes, it’s likely you will be diagnosed with Parkinson’s disease. Your symptoms will be closely monitored to see any progression of Parkinson’s disease, which can take years.
What Are The Warning Signs
There are several warning signs that an individual with Parkinsons and depression can display. However, it is important to remember that each individual will handle his or her emotions respectively and may display different warning signs. Some things to look out for are:
- Lack of motivation to carry out daily tasks such as cleaning the house, preparing meals, etc.
- Loss of interest in hobbies that once were a priority.
- Loss of interest in socialization.
- Lack of motivation to leave the house or get out of bed.
- Loss of interest in taking his or her medication or attending routine doctors appointments.
If you or your loved one is experiencing depression, anxiety or mood changes due to their Parkinsons Disease diagnosis, it is important to seek out resources to improve their overall wellbeing. It is imperative to seek out treatment through medical professionals, support groups from the community or support through family and friends. An in-home caregiver can also help the individual affected with his or her daily tasks such as light housekeeping, medication reminders, meal preparation or simple companionship. A caregiver can be the support system that a Parkinsons patient needs in order to continue with heir prescribed medical plan and avoid regression. With the proper medication, support and professional supervision, an individual with Parkinsons can improve his or her mental state and live a happy, healthy and prosperous life.
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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.
What Are The Symptoms Of Parkinsons Disease
Symptoms of Parkinsons disease and the rate of decline vary widely from person to person. The most common symptoms include:
Other symptoms include:
- Speech/vocal changes: Speech may be quick, become slurred or be soft in tone. You may hesitate before speaking. The pitch of your voice may become unchanged .
- Handwriting changes: You handwriting may become smaller and more difficult to read.
- Depression and anxiety.
- Sleeping disturbances including disrupted sleep, acting out your dreams, and restless leg syndrome.
- Pain, lack of interest , fatigue, change in weight, vision changes.
- Low blood pressure.
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How Are Cognitive Problems Treated
Much remains to be learned about the basic biology that underlies cognitive changes in PD. Researchers work towards the development of diagnostic tests to identify people who seem to be at greatest risk for cognitive changes and to differentiate cognitive problems in people with PD from those that occur in another disorder related but different known as dementia with Lewy bodies.
Causes Of Cognitive Impairment In Pd
The exact causes of cognitive impairment or dementia in Parkinsons disease are not fully understood. There may be changes in the neurochemical signals that the brain uses to pass along information to different regions of the brain. Besides dopamine, the neurochemical signals acetylcholine, serotonin, and norepinephrine are especially important for cognition, memory, attention, and mood. In autopsy studies, Lewy bodies, abnormal protein accumulations, have been found in neurons in brain regions responsible for cognitive processes. Other causes include co-existing strokes or mini-strokes or Alzheimers disease pathology.
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Nutritional Interventions: Can They Help Cognition In Pd
Good nutrition is essential for living well in general and with PD, not only playing a role in optimizing general health and motor strength but also potentially cognitive function. The relationship between nutrition and cognition is an area of growing interest to the PD community. In a large cross-sectional survey conducted by the Parkinson Alliance , 93% of participants reported that they believed that diet/nutrition was important in managing their PD symptoms. Yet, only 11% of participants reported that a healthcare professional offered specific dietary recommendations to them. The majority of participants who followed a specific diet designed their meal plans based on information obtained from self-help resources , family, and friends. Moreover, while 63% of respondents perceived themselves as eating a healthy diet most of the time, there is a lack of consensus as to what comprises a healthy diet for people with PD. Discussions regarding nutrition in PD have typically focused on topics such as protein and medication absorption, weight loss, dysphagia, and gastrointestinal issues. However, there are growing investigations of nutrients that may be associated with increased or decreased risk of PD. Increased consumption of dairy products and lower serum urate levels may be risk factors for PD, whereas high intake of fruits, vegetables, and fish or use of nicotine and caffeine may confer a lower risk of PD.,
The Parkinson’s Disease Brain: What We Know
Parkinson’s disease is a degenerative disorder of the nervous system, which most scientists agree originates in the brain. We know that Parkinson’s disease causes damage to the nerves in the brain, which in turn reduces dopamine cells, but did you also know that this leads to an accumulation of alpha-synuclein, known more commonly as Lewy bodies? This damage is thought to be what causes the motor symptoms of Parkinson’s disease, though scientists still have many questions as to how this works.
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