Incidence Of Parkinsons Disease
Its estimated that approximately four people per 1,000 in Australia have Parkinsons disease, with the incidence increasing to one in 100 over the age of 60. In Australia, there are approximately 80,000 people living with Parkinsons disease, with one in five of these people being diagnosed before the age of 50. In Victoria, more than 2,225 people are newly diagnosed with Parkinsons every year.
Original Explanation From July 2017
It is useful to consider the Fajardo Method of Biomechanics to help us understand what’s going on inside the body in terms of internal pressures . In particular, this framework for understanding teaches us about the physiological changes in the pressures throughout the body, and the outcomes of these changes, under different degrees/types of stress. Indeed, I wrote an article based on this myself and noted the very direct correlations with these physiological changes and the advancing symptoms of PD:
Medications For People With Parkinsons Disease
Symptoms of Parkinsons disease result from the progressive degeneration of nerve cells in the brain and other organs such as the gut, which produce a neurotransmitter called dopamine. This causes a deficiency in the availability of dopamine, which is necessary for smooth and controlled movements. Medication therapy focuses on maximising the availability of dopamine in the brain. Medication regimes are individually tailored to your specific need. Parkinsons medications fit into one of the following broad categories:
- levodopa dopamine replacement therapy
- dopamine agonists mimic the action of dopamine
- COMT inhibitors used along with levodopa. This medication blocks an enzyme known as COMT to prevent levodopa breaking down in the intestine, allowing more of it to reach the brain
- anticholinergics block the effect of another brain chemical to rebalance its levels with dopamine
- amantadine has anticholinergic properties and improves dopamine transmission
- MAO type B inhibitors prevent the metabolism of dopamine within the brain.
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S You Can Take To Reduce Fatigue
If you are feeling fatigued and exhausted all the time, what can you do about it?
First and most importantly, speak to your healthcare provider about how much the fatigue disturbs you. Does it undermine your daily activities? Does it make it more difficult to attend clinic visits or rehabilitation appointments? Does it feed into your emotional life? Does it undermine your coping ability? Once you speak to your practitioner about your fatigue, your medical professional might also recommend the following steps:
- Engage in regular physical exercise, including the use of weights to increase muscle strength. Studies show that physical exercise combats both physical and mental fatigue.
- Consider taking anti-depressant medication. Although fatigue is not caused by depression, depression can worsen fatigue . Treating depression if it is present might allow you to overcome fatigue with exercise or some other treatment.
- Consider trying stimulants like Ritalin , normally prescribed for attention deficit-hyperactivity disorder or Provigil , prescribed for sleep apnea, as an adjunct for depression and as a palliative treatment in end of life care. Some healthcare providers have reported that these drugs may help certain Parkinson’s patients.
How Can Caregivers Support Their Loved Ones
Caring for someone who sees, hears, or believes things that arent real can be very difficult. Try to be as patient and calm as you can.
Avoid arguing with the person. If they still have insight, gently explain that what theyre seeing isnt real. Tell anyone who cares for or visits your loved one what to expect, and how to respond.
Stay in close contact with the persons doctor. If their symptoms dont improve, ask whether they need a medication adjustment.
Check whether the person needs hearing aids or glasses. Poor hearing or vision can sometimes lead to hallucinations. It can also help to turn on bright lights at night, to prevent the shadows that may trigger visual illusions.
Secure any dangerous objects, and keep pathways in the home clear to prevent falls and injuries. If you ever feel like the person is a risk to themselves or others, call their doctor.
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Which Body Parts Do Parkinsons Tremors Affect
There are five main places youâll have Parkinsonâs tremors:
1. Hands. Parkinsonâs disease tremors often start in the fingers or hands with whatâs called a pill-rolling motion. Imagine holding a pill between your thumb and index finger and rolling it back and forth.
2. Foot. A Parkinsonâs foot tremor is more likely to happen while youâre sitting or lying down with your feet at rest. If the tremor moves into your thigh muscles. It could look like your whole leg is shaking.
Foot tremors disappear when you stand or walk because those are active movements. A foot or leg tremor while youâre standing may be another condition.
3. Jaw. This is common in people with Parkinsonâs. It may look like youâre shivering. It can become bothersome if the tremor makes your teeth chatter. If you wear dentures, it could make them shift or fall out.
Chewing eases the tremor, so gum might help.
4. Tongue. Itâs rare, but a tongue tremor can cause your entire head to shake.
5. Internal. Some people with Parkinsonâs say they can feel a shaking sensation in their chest or abdomen. But canât be seen from the outside.
Support For People With Parkinsons Disease
Early access to a multidisciplinary support team is important. These teams may include doctors, physiotherapists, occupational therapists, speech therapists, dietitians, social workers and specialist nurses. Members of the team assess the person with Parkinsons disease and identify potential difficulties and possible solutions.There are a limited number of multidisciplinary teams in Victoria that specialise in Parkinsons disease management. But generalist teams are becoming more aware of how to help people with Parkinsons disease.
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How Do Symptoms Progress And What Is The Outlook
The symptoms of PD tend to become gradually worse over time. However, the speed of progression varies greatly from person to person. When symptoms first begin, you may not need treatment when symptoms are relatively mild.
Most people with PD can expect to have some time of relatively mild symptoms. Then, when the symptoms become worse, they can expect several years of good or reasonable control of the symptoms with medication. But everyone is different and it is difficult to predict for an individual how quickly the disease will progress. Some people may only be slightly disabled 20 years after PD first begins, whereas others may be very disabled after 10 years.
Research into PD is active. For example, one main aim of research is to find medicines that prevent the damage to the affected cells, rather than just treating the symptoms, which is the main value of treatment at present. Further research on these chemicals continues. Research is underway using stem cell therapy to help treat PD. Other researchers are looking at alpha synuclein, a protein that gathers around the junction between nerve cells and is thought to affect the way messages are conducted between the brain and the nerves controlling movement.
Fascia And Parkinson’s Disease
for a detailed explanation and the potential ramifications for PD. In particular, it is the fascia which gives the body the ability to stand up against gravity. Together with the bones, the fascia gives the body a very special structural property called Tensegrity, flexible, yet able to withstand tremendous forces, and able to maintain shape. Indeed, in her book
Deanna Hansen writes
“… the degeneration of our bodys tissue resulting in pain and disease. The ultimate driver of this is gravity… as we go through time, we decrease in our internal space we get shorter and wider as we age we compress. The constant force of gravity is relentless at pulling down on the body. We dont even recognize this force and how it acts on the cells because it is always present”
perhaps until it becomes more apparent when we develop conditions like PD.
Deanna describes fascia as
and I believe everyone who has experienced PD could attest to this statement.
Deanna goes on to explain that diaphragmatic breathing is the key driver to maintaining the anti-gravity tensegrity properties of fascia, and hence for our bodies to be able stand up against such forces. Again, this is a vital new understanding for anyone affected by PD, since our ability to breathe from the diaphragm tends to be well and truly shot. Unfortunately, the link between posture and diaphragmatic breathing seems to be yet another one of those vicious circles which people with PD suffer from,
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How Is Parkinsons Disease Diagnosed
Diagnosing Parkinsons disease is sometimes difficult, since early symptoms can mimic other disorders and there are no specific blood or other laboratory tests to diagnose the disease. Imaging tests, such as CT or MRI scans, may be used to rule out other disorders that cause similar symptoms.
To diagnose Parkinsons disease, you will be asked about your medical history and family history of neurologic disorders as well as your current symptoms, medications and possible exposure to toxins. Your doctor will look for signs of tremor and muscle rigidity, watch you walk, check your posture and coordination and look for slowness of movement.
If you think you may have Parkinsons disease, you should probably see a neurologist, preferably a movement disorders-trained neurologist. The treatment decisions made early in the illness can affect the long-term success of the treatment.
How Are Hallucinations And Psychosis In Parkinsons Treated
Treatment for Parkinsons-related psychosis can involve adding antipsychotic medication or reducing the dose of dopaminergic drugs. Regardless, people experiencing these symptoms need careful attention and support from their loved ones and health care providers to prevent them from harming themselves.
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What Causes Parkinson’s Disease
Parkinsons disease occurs when nerve cells in the basal ganglia, an area of the brain that controls movement, become impaired and/or die. Normally, these nerve cells, or neurons, produce an important brain chemical known as dopamine. When the neurons die or become impaired, they produce less dopamine, which causes the movement problems of Parkinson’s. Scientists still do not know what causes cells that produce dopamine to die.
People with Parkinson’s also lose the nerve endings that produce norepinephrine, the main chemical messenger of the sympathetic nervous system, which controls many functions of the body, such as heart rate and blood pressure. The loss of norepinephrine might help explain some of the non-movement features of Parkinson’s, such as fatigue, irregular blood pressure, decreased movement of food through the digestive tract, and sudden drop in blood pressure when a person stands up from a sitting or lying-down position.
Many brain cells of people with Parkinson’s contain Lewy bodies, unusual clumps of the protein alpha-synuclein. Scientists are trying to better understand the normal and abnormal functions of alpha-synuclein and its relationship to genetic mutations that impact Parkinsons disease and Lewy body dementia.
Can Parkinsons Disease Be Prevented
Unfortunately, no. Parkinsons disease is long-term disease that worsens over time. Although there is no way to prevent or cure the disease , medications may significantly relieve your symptoms. In some patients especially those with later-stage disease, surgery to improve symptoms may be an option.
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How Are Parkinsons Tremors Treated
Tremor can be unpredictable. Some experts say itâs the toughest symptom to treat with medication. Your doctor may prescribe medication for your tremors:
- Levodopa/carbidopa combination medicines . This treatment is a type of medication called a dopamine agonist. Itâs usually the first treatment for Parkinsonâs.
What Is The Best Treatment For Parkinson Disease
Levodopa, the most effective Parkinson’s disease medication, is a natural chemical that passes into your brain and is converted to dopamine. Levodopa is combined with carbidopa , which protects levodopa from early conversion to dopamine outside your brain. This prevents or lessens side effects such as nausea.
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Understanding Why Some Days Are Good Or Bad Is Still A Mystery
I understand the fluctuations that Parkinsons Disease patients experience during the day as reflecting their medication levels, their activities, their sleep, their social interactions and a number of other social and physical stresses and strains that I dont know about. But I have little idea of why the average Parkinsons Disease patient will tell me that theyve had a good few days or a bad few days, without any noticeable change in their medications or in their environment. Although I dont understand these variations, I try to teach my patients that after we make a change in their treatment regiment, to give the change a week or so, if possible, to see what changes occur. When they report that the change resulted in a decline the first day, I ask for patience, since many a patient will have such a decline without a change in anything. We need to see a pattern emerge, and that may take a week or so.
If any patients have figured out what makes a good or a bad day, Id love to hear from you.
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Who Gets Parkinsons Disease
Parkinsonâs disease, documented in 1817 by physician James Parkinson, is the second most common neurodegenerative disease after Alzheimerâs disease. Estimates regarding the number of people in the United States with Parkinsonâs range from 500,000 to 1,500,000, with 50,000 to 60,000 new cases reported annually. No objective test for Parkinsonâs disease exists, so the misdiagnosis rate can be high, especially when a professional who doesnât regularly work with the disease makes the diagnosis.
What Are The Treatment Options For Parkinsons Psychosis
Because Parkinsons drugs can cause psychosis, your doctor will likely start by taking you off your medications, one at a time, or adjusting the dose. Changing your medication may make your movement symptoms worse.
Your doctor will keep adjusting your medication. The goal is to get you to a dose that improves your movement without causing hallucinations and delusions.
If changing your medication doesnt work, the next step is to go on an antipsychotic medication. These drugs prevent psychosis symptoms by altering levels of chemicals in your brain.
Older antipsychotic drugs can make Parkinsons movement symptoms worse. Newer drugs, called atypical antipsychotics, are less likely to affect your movement. These drugs are off-label, meaning theyre not approved to treat Parkinsons specifically. They include:
- clozapine
- quetiapine
In 2016, the Food and Drug Administration approved pimavanserin . Its the first drug designed specifically to treat Parkinsons disease psychosis. Nuplazid reduces the number of hallucinations and delusions without affecting movement.
Nuplazid and other newer antipsychotic drugs do carry a black box warning. They can increase the risk of death in older people who have psychosis related to dementia. Your doctor will consider this and other risks before prescribing one of these drugs.
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Confusion With Essential Tremor
The tremor of Parkinsons disease is often confused with the tremor of a condition called Essential Tremor, or Benign Familial Tremor . Katherine Hepburn had Essential Tremor, and was originally misdiagnosed with Parkinsons. Ronald Reagan also had Essential Tremor. Both had a head tremor and a vocal tremor. In Essential Tremor, the hands are most commonly involved, followed by the head and then the voice. Essential Tremor can also cause the jaw to tremor, and it may be difficult to figure out if a jaw tremor is from Essential Tremor or Parkinsons. Unfortunately, some people may have both disorders. Some authorities believe that there is, in fact, an increased association between the two conditions, so that more people with Parkinsons disease have Essential Tremor than would be expected by chance alone, but this has not been established.
Why Might Dance Help Creativity And Flexibility
Creativity is the trait that underlies the act of creation and is historically defined as the creation of something new through a dynamic process of growth and development . Self-efficacy is a concept developed by Albert Bandura in 1995, defined as the individuals belief in his abilities to achieve a particular goal or task . Creative self-efficacy is defined as the individuals perception of his ability to utilize creative thinking and execute these thoughts . In other words, because a person feels creative, he will be more likely to be creative . Higher levels of creative self-efficacy increase the tendency to invest effort in performing the task even in the face of difficulties and obstacles. Creative self-efficacy is related to motivation and creative performance in students , as well as efficiency, achievement, and interpersonal skills in the workplace .
Psychological flexibility is defined as the ability to adapt to different situations by redefining and shifting mental resources. Psychological flexibility is dependent on ones awareness, ability to recognize shifting situations and being open to adapt to different situations. Individuals who have lower levels of psychological flexibility as measured by the Acceptance and Action Questionnaire have higher anxiety and depression, as well as lower levels of daily functioning . An intervention designed to increase psychological flexibility improved the emotional and psychological well-being of participants .
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What To Avoid As A Caregiver For Parkinsons Disease
These are some things to avoid while caring for someone with Parkinsons disease:
- Avoid changing their day-to-day schedule: Stick to a daily routine as far as possible, so the person knows what to expect at each time of day. They may struggle to cope with changes to their routine.
- Avoid distracting stimuli: Try to keep the persons environment free of distractions, such as loud noises or brightly-patterned decor, as it can be confusing and disorienting.
- Avoid changing their environment: Try not to make any changes to the persons surroundings, such as changes to the layout of the house. Keeping it the same can help prevent falls caused by disorientation.
- Avoid confusing them: When you communicate with the person, use simple sentences and ask only yes or no questions. Avoid interrupting them or finishing their sentences. Though it may take them time to complete a sentence, interjecting in between can confuse and frustrate them.
- Avoid losing your patience with them: Parkinsons disease can cause the person to speak and move slowly. Be patient with them and try to match their pace to make them more comfortable.
- Avoid shouting at them: There may be times when you get angry or frustrated with your loved one. However, try to refrain from shouting at them or speaking to them sharply. The dementia that may accompany Parkinsons disease can cause them to respond aggressively. Stay calm and be still while you talk to them.