Research Is Underway To Further Understand The Cardiac Effects Of Parkinsons
It is possible to image the sympathetic nervous system of the human heart by injecting a radioactive tracer, meta-iodo-benzyl-guanidine, . Development of this technique, known as MIBG cardiac imaging, holds much promise as a test to confirm the diagnosis of PD , to identify those who are at risk of developing PD in the future, and to distinguish PD from related disorders. MIBG cardiac imaging is still considered an experimental procedure for detection of PD and is not yet in use as a clinical tool for this purpose.
A recent research was conducted in monkeys in which the destruction of the sympathetic nerves of the heart was chemically induced to mimic the changes that are seen in PD. The cardiac system was then imaged using a number of new-generation radioactive tracers, which bind to markers of inflammation and oxidative stress. This model system may help to shed light on the molecular changes that accompany the loss of the sympathetic nerves of the heart and can also be used to track the response of the cardiac system to therapeutic agents.
How Are Swallowing Problems Treated
The first step to addressing swallowing issues is to speak to a neurologist about getting an evaluation performed by a SLP. This professional will take a medical history and interview the person with PD about eating and swallowing.
This is typically followed by either a video X-ray or an endoscopic examination, so the medical specialist can observe the swallowing process as an individual sips liquid and eats food, as these substances flow from the mouth, down the throat and esophagus, to the stomach. With these tests it is possible to see where the trouble is occurring and to recommend therapies.
Follow the recommendations of the swallowing specialist, which may include the following:
- Exercise and Swallow Hard. Just as exercise can ease other PD-related movement difficulties, it can also help with swallowing. The Lee Silverman Voice Technique® helps a person exaggerate speaking and swallowing. Working with an SLP on an individualized program helps the person to swallow hard and move food from the mouth down the throat.
- Expiratory Muscle Strength Training. This therapy strengthens respiratory muscles, improves cough and swallowing and reduces aspiration.
- Change in food. Modifying liquids and solids can help. For people who find liquids get into the airway, liquids may need thickening. Taking bigger or smaller bites or sips or pureeing solid foods may help. First get an evaluation, so the SLP can recommend how to modify food and liquid.
Surgery For Parkinsons Disease
Some people with Parkinsons disease benefit from surgery. At UW Health, we offer deep brain stimulation for Parkinsons disease.
During DBS, surgeons place an electrode in your brain. The electrode is connected to a device implanted in your chest. The device in your chest sends electrical stimulation to areas of your brain affected by movement disorders.
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Neurologic Voice Disorders Risk Factors And Causes
Neurologic voice disorders include a broad spectrum of diagnoses that can affect the voice. These could include local laryngeal conditions such as spasmodic dysphonia, conditions that involve the head and neck region such as essential tremor or segmental dystonia, or conditions that involve the entire body, such as Parkinsons disease, ALS, or stroke. Neurologic voice disorders can be the first sign that a person has a neurological condition. Slurred speech can also be a sign of the onset of a stroke.
If you are already diagnosed with a neurological condition, neurologic voice disorders can be part of disease progression. Having had a stroke can also impact your neurological functions such as your voice.
V Management Of Dysphagia
Because lack of awareness of swallowing difficulty as well as silent aspiration are not uncommon in PD, it is critical to monitor weight and provide counseling regarding signs and symptoms of swallowing difficulty even to individuals who report no swallowing difficulties. For patients with documented swallowing difficulty, regular evaluation should help to anticipate problems and put strategies in place to reduce the likelihood of malnutrition, dehydration, and pulmonary problems.
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Other Symptoms Of Parkinsons
The primary motor symptoms of PD are tremor, rigidity, postural instability , and bradykinesia .
PD also causes many secondary motor symptoms, including micrographia , changes in gait , stooped posture, dystonia , cramping, difficulty swallowing, sexual dysfunction, impaired fine motor dexterity, and akathisia .
In addition to these motor symptoms, PD can cause non-motor symptoms such as depression, difficulty swallowing or chewing, urinary problems, constipation, skin problems, sleep problems, pain, and cognitive problems, such as memory problems or slow thinking.1,7
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How Can I Improve My Speech With Parkinson’s Disease
Speech-language pathologists can help people with Parkinson’s disease maintain as many communication skills as possible. They also teach techniques that conserve energy, including non-verbal communication skills. Speech-language pathologists are also available to:
- Recommend appropriate communication technologies that will help with daily activities.
- Treat all types of speech, language, and communication problems.
- Evaluate swallowing function and recommend changes as necessary.
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How Is Parkinson Disease Diagnosed
Parkinson disease can be hard to diagnose. No single test can identify it. Parkinson can be easily mistaken for another health condition. A healthcare provider will usually take a medical history, including a family history to find out if anyone else in your family has Parkinsons disease. He or she will also do a neurological exam. Sometimes, an MRI or CT scan, or some other imaging scan of the brain can identify other problems or rule out other diseases.
A Swallowing And Medication
As previously mentioned, levadopa treatment tends to have the most predictable effects on limb symptoms in PD. Nonetheless, certain aspects of eating and swallowing may be enhanced by medication. It therefore is recommended that patients time their meals and medication in such a way that they receive maximum medication effect during meals so as to facilitate upper extremity control and possibly oral and pharyngeal function. Similarly, some patients may show improvement in swallowing when medication is changed. Thus, in patients who have changed medication, the clinician may opt to wait several weeks to begin swallow therapy especially in the form of active range of motion exercises to determine whether the medication benefits the patients swallow. Some patients experience xerostomia as a side effect of pharmacologic treatment for PD. Depending on the existence of other swallowing and eating difficulties, taking frequent sips of water, throat lozenges or lemon drops, as well as synthetic saliva may prove helpful.
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Speech Problems Of Parkinsons Disease
The most common speech problems experienced by people with PD involve reduced volume , reduced pitch range , and difficulty with the articulation of sounds or syllables . In essence, you cant speak as loudly as others, you find it more difficult to convey emotion when you do speak, and you find it difficult to form the words you are trying to pronounce.
You dont need me to tell you that this combination of factors makes speaking extremely frustrating. When you couple all of these voicing problems with the so-called masked faces of PD, the difficulty in expressing emotions via facial expression, it’s no wonder that people occasionally find it challenging to understand what you are trying to say.
It may be tempting to withdraw from conversations with others altogether, but that would be a mistake. You need to interact with others on a daily basis, no matter how frustrating it becomes this is critical for your mental health, and be assured that your loved ones want to interact with you. The good news is that there are treatments, such as voice exercises, that can dramatically improve the voicing problems associated with PD.
The Lee Silverman Voice Treatment
The Lee Silverman Voice Treatment is the first speech treatment for PD proven to significantly improve speech after one month of treatment.
- Exercises taught in the LSVT method are easy to learn and typically have an immediate impact on communication.
- Improvements have been shown to last up to two years following treatment.
- LSVT methods have also been used with some success in treating speech and voice problems in individuals with atypical PD syndromes such as multiple-system atrophy and progressive supranuclear palsy .
LSVT® Guidelines
- Must be administered four days a week for four consecutive weeks.
- On therapy days, perform LSVT exercises one other time during the day. On non-therapy days, perform LSVT exercises two times a day.
- Once you complete the four-week LSVT therapy, perform LSVT exercises daily to maintain your improved voice.
- Schedule six-month LSVT re-evaluations with your specialist to monitor your voice.
- If available in your area, participate in a speech group whose focus is on thinking loud.
- A Digital Sound Level Meter can help you monitor voice volume. Place the meter at arm distance to perform the measurement. Normal conversational volume ranges between 68-74dB.
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What Is Parkinson Disease
Parkinson disease is a movement disorder. It can cause the muscles to tighten and become rigid This makes it hard to walk and do other daily activities. People with Parkinsons disease also have tremors and may develop cognitive problems, including memory loss and dementia.
Parkinson disease is most common in people who are older than 50. The average age at which it occurs is 60. But some younger people may also get Parkinson disease. When it affects someone younger than age 50, its called early-onset Parkinson disease. You may be more likely to get early-onset Parkinson disease if someone in your family has it. The older you are, the greater your risk of developing Parkinson disease. Its also much more common in men than in women.
Parkinson disease is a chronic and progressive disease. It doesnt go away and continues to get worse over time.
Maintaining Your Normal Pd Medication Schedule
Maintaining your PD medication schedule is crucial for anyone with PD. The correct timing and dosage are essential to your comfort and well-being. However, oftentimes when undergoing surgery, there may be restrictions regarding when you can and cannot take medications. Here are a few tips to navigate this issue:
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What Does Parkinsons Do To The Brain
Deep down in your , theres an area called the substantia nigra, which is in the basal ganglia. Some of its cells make , a chemical that carries messages around your . When you need to scratch an or kick a ball, dopamine quickly carries a message to the nerve cell that controls that movement.
When that system is working well, your body moves smoothly and evenly. But when you have Parkinsons, the cells of your substantia nigra start to die. Theres no replacing them, so your dopamine levels drop and you cant fire off as many messages to control smooth body movements.
Early on, you wont notice anything different. But as more and more cells die, you reach a tipping point where you start to have symptoms.
That may not be until 80% of the cells are gone, which is why you can have Parkinsons for quite a while before you realize it.
How Do I Know If I Have A Speech Or Voice Problem
- My voice makes it difficult for people to hear me.
- People have difficulty understanding me in a noisy room.
- My voice issues limit my personal and social life.
- I feel left out of conversations because of my voice.
- My voice problem causes me to lose income.
- I have to strain to produce voice.
- My voice clarity is unpredictable.
- My voice problem upsets me.
- My voice makes me feel handicapped.
- People ask, “What’s wrong with your voice?”
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What Impact Do Neurologic Disorders Have On Voice And Swallowing Function
A number of different neurologic disorders can cause changes in voice and/or swallowing function. Often, patients already have a diagnosis from a neurologist and are referred to a laryngologist to be evaluated for interventions that can help with their voice or swallowing. Occasionally, a voice or swallowing problem can be the first or only symptom of a neurologic condition.
Common neurologic disorders affecting voice include:
Spasmodic dysphonia: This disorder primarily affects the voice and not swallowing function. It is caused by abnormal firing of different muscles that move the vocal cords during speech. It gives patients either a strained or breathy voice, depending on which vocal cord muscles are dominantly affected, and may greatly affect the patients ability to communicate with others. Patients often report that their voice is worse when speaking on the telephone or when they are anxious or nervous and more normal when laughing or singing.
Tremor: Tremor of the throat or vocal cords can cause changes that make the voice sound shaky or unsteady, and it may overlap with the diagnosis of spasmodic dysphonia. Tremor may occur in the muscles of the throat or vocal cords alone but often is part of a systemic tremor that affects the neck, hands, arms or legs.
Rarer neurologic disorders that can dramatically affect voice and swallowing include:
-
Multiple system atrophy
The Spread Of Parkinsons
Researchers have found that areas of the brain stem below the substantia nigra show cell loss in Parkinsons. And cells in these areas have been found to contain clumps of alpha-synuclein protein, which may form before those in the substantia nigra.
These findings have led some researchers to suggest that . Indeed, there is evidence that, for some, Parkinsons may start in the gut and travel up the vagus nerve, which connects the gut and the brain, to the substantia nigra.
The theory that Parkinsons may spread up the brain stem and progress throughout the brain is the basis of the Braak staging of Parkinsons.
The 6 stages in Braaks theory aim to describe the spread of Parkinsons through the brain:
While there is still some debate over the origin of Parkinsons, and even competing and more complex theories about the spread of Parkinsons, attempts to understand how and why different areas of the brain are involved in the motor and non-motor symptoms are helping in the development of better treatments.
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When Is The Parkinson’s Voice Clinic In Session
Treatment occurs on an individual and a group basis with individual treatment occurring first. You will attend individual therapy three days a week for about four weeks before transitioning to group therapy, which you will attend one day a week. Group therapy is ongoing and will only pause for schedule semester and holiday breaks.
At this time, individual therapy is scheduled at 10-10:50 a.m. Mondays, Wednesdays and Thursdays, and group therapy is scheduled at the same time on Mondays.
Please contact for more information.
What Is Parkinsons Disease
At the most basic level, Parkinsons Disease is a disorder of the nervous system. PD causes vital nerve cells in the brain to deteriorate, significantly decreasing the bodys stores of dopamine and other essential neuro-chemicals responsible for controlling movement.
This results in the tremors that are classically associated with PD.
Tremors, however, are only one of the varied and unpredictable symptoms of PD.
Persons with PD may also experience muscle rigidity or weakness. Movement may be slowed and problems with balance and coordination are common.
Additionally, PD can lead to challenges in thinking, concentrating, or remembering. Patients may even experience hallucinations, delusions, or paranoia as a result of changes in the brain.
Its estimated that more than 10 million people worldwide have PD, with more than 95% of patients diagnosed after the age of 50.
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How Does Parkinsons Disease Affect The Body
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.
Caring For Someone With Parkinsons
Practice patience and understanding when dealing with Parkinsons. You may be very frustrated and challenged as a caregiver, but those with Parkinsons are just as frustrated. Their physical and mental conditions can be debilitating, depressing, and humiliating.
Diet and nutrition can have a huge impact on the health and comfort of a Parkinson patient. Eating well, getting more rest, sleeping well, fresh air, and exercise can make a difference. Getting the right medication and complementary therapies is also important.
As Parkinsons impacts a patients motor skills, modifications to the living environment may have to be made to accommodate wheelchairs and limited mobility issues. Professional in-home assistance for Parkinsons can allow Parkinson patients to remain independent and can enhance quality of life.
Most importantly, seek help and support from family, friends, and caregiving support groups. Take advantage of the resources in your community. Shouldering all the burden can take a toll on a caregiver.
Take care of yourself or you wont be able to take care of your loved one. Follow the preventive advice provided above for yourself as well, and take deep breaths!
Resources
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