Caregiving For People Living With Parkinsons
Caring for a loved one with PD can be a challenging job, especially as the disease progresses. Former caregivers of a loved one with PD suggest doing the following : Get prepared, Take care of yourself, Get help , Work to maintain a good relationship with your loved one, and Encourage the person with PD for whom you care, to stay active.
Preparing for caregiving starts with education. Reading this fact sheet is a good start. More resources are available to you in theResources section of this fact sheet. Early Parkinsonâs disease usually requires more emotional support and less hands-on care. It is a good time for family members/caregivers to educate themselves about the disease.
What Medications Are Used To Treat Parkinsons Disease
Medications are the main treatment method for patients with Parkinsons disease. Your doctor will work closely with you to develop a treatment plan best suited for you based on the severity of your disease at the time of diagnosis, side effects of the drug class and success or failure of symptom control of the medications you try.
Medications combat Parkinsons disease by:
- Helping nerve cells in the brain make dopamine.
- Mimicking the effects of dopamine in the brain.
- Blocking an enzyme that breaks down dopamine in the brain.
- Reducing some specific symptoms of Parkinsons disease.
Levodopa: Levodopa is a main treatment for the slowness of movement, tremor, and stiffness symptoms of Parkinsons disease. Nerve cells use levodopa to make dopamine, which replenishes the low amount found in the brain of persons with Parkinsons disease. Levodopa is usually taken with carbidopa to allow more levodopa to reach the brain and to prevent or reduce the nausea and vomiting, low blood pressure and other side effects of levodopa. Sinemet® is available in an immediate release formula and a long-acting, controlled release formula. Rytary® is a newer version of levodopa/carbidopa that is a longer-acting capsule. The newest addition is Inbrija®, which is inhaled levodopa. It is used by people already taking regular carbidopa/levodopa for when they have off episodes .
Nicotine And Its Neuroprotective Mechanisms
Nicotine may have a potential to protect against PD, and pharmaceuticals that target nicotine receptors have been searched for. In particular, the nicotinic alpha-7 receptor, implicated in long-term memory function, has been in the focus of interest .
Nicotine acts as an agonist to most nicotinic acetylcholine receptors , and can be used to improve cognition and alertness . A meta-analysis of 41 placebo-controlled studies concluded that nicotine had a positive effect on motor abilities, orienting attention, and working memory .
Using rat embryo tissue, Toulorge et al. prepared brain cell cultures demonstrating conditions that favored progressive loss of dopaminergic neurons, which also showed distinctive features otherwise characterizing PD, and this group also reported a protective effect of nicotine. In normal mice, nicotine has been found potentially able to rescue dopaminergic neurons, but apparently not in mice without the nicotine receptor .
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General Approach To Management
The primary goal in the management of PD is to treat the symptomatic motor and nonmotor features of the disorder, with the objective of improving the patients overall quality of life. Appropriate management requires an initial evaluation and diagnosis by a multidisciplinary team consisting of neurologists, primary care practitioners, nurses, physical therapists, social workers, and pharmacists., It is also important that the patient and his or her family have input into management decisions.
Effective management should include a combination of nonpharmacological and pharmacological strategies to maximize clinical outcomes. To date, therapies that slow the progression of PD or provide a neuroprotective effect have not been identified., Current research has focused on identifying biomarkers that may be useful in the diagnosis of early disease and on developing future disease-modifying interventions.,
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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Caffeine: Maybe Another Iron Chelator
Postuma et al. found that patients with PD improved by taking caffeine pills for 2 months. For the study, 61 PD patients with a mean age of 60 years were selected. In six weeks, 30 of the participants received caffeine pills in an amount equivalent to two cups of coffee a day and the remaining 31 subjects got placebo capsules. At the end of the study, the patients who had ingested caffeine reported, in addition to less drowsiness, a general improvement in motor symptoms such as muscle stiffness and movement difficulties . A larger multicenter follow up study was however unable to reproduce these findings .
What Causes Parkinsons
Although its well-known that lack of dopamine causes the motor symptoms of Parkinsons disease, its not clear why the involved brain cells deteriorate. Genetic and pathological studies have revealed that various dysfunctional cellular processes, inflammation, and stress can all contribute to cell damage.
- Age is the largest risk factor for the development and progression of Parkinsons disease. Most people who develop Parkinsons disease are older than 60 years of age.
- Men are affected about 2 times more often than women.
- A small number of individuals are at increased risk because of a family history.
- Head trauma, illness, or exposure to environmental toxins such as pesticides and herbicides may be a risk factor.
In Preventing Parkinsons: How to Cut Your Risk by Strengthening Your Multiple Shields, Ben Weinstock PT, DPT, writes:
It appears that aging combined with certain genetic vulnerabilities and environmental exposures leads to PD in susceptible individuals. The combination of unhealthy vulnerabilities and exposures is referred to as multiple hits. These multiple hits may be: poor diet poor sleep head trauma lack of exercise stress exposures to toxins and other unhealthy factors.
Recommended Reading: Iowa Parkinson’s Disease Association
Take Care Of Yourself
Probably one of the most important, and sometimes difficult, things caregivers can do is to take care of themselves. This includes maintaining mental and physical health by making and keeping your own medical and dental appointments. As a caregiver, it is important to keep your job whenever possible as it provides not only financial help and possibly insurance coverage, but also a sense of self-esteem. Join a support group for caregivers if possible. Support groups help you meet people who are going through what you are going though, vent frustrations, give and receive mutual support, and exchange resource information and coping strategies. Whenever possible get your sleep, take breaks, make and keep social activities, and try to keep your sense of humor.
What Is The Prognosis
The average life expectancy of a person with PD is generally the same as for people who do not have the disease. Fortunately, there are many treatment options available for people with PD. However, in the late stages, PD may no longer respond to medications and can become associated with serious complications such as choking, pneumonia, and falls.
PD is a slowly progressive disorder. It is not possible to predict what course the disease will take for an individual person.
One commonly used scale neurologists use for describing how the symptoms of PD have progressed in a patient is the Hoehn and Yahr scale.
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Effects Of Parkinson’s Disease On The Body Include:
- Continue regular daily activities to help maintain mobility.
- Lead as normal a life as possible, not restricting activities that are still possible.
- Establish a regular exercise program consisting of stretching and weight bearing.
- Walking 30 minutes each day can be a realistic goal.
- Seek advice from a rehabilitation specialist as soon as possible for help determining an exercise level, overcoming problems with balance and safety, difficulties with speech, or for fatigue and stress management.
- Adaptive training and use of quad-canes or straight canes, and other mechanical aids help with balance problems.
- Try to avoid unnecessary stress in your life. Leading a healthy life, eating regularly, sleeping regularly, and exercising will help keep you fit both mentally and physically.
- All symptoms of Parkinson’s disease get worse under stress.
- Ask the doctor about regulating treatments so that treatments are more effective during peak work conditions.
Adopt A Regular Sleep Rhythm
Optimizing your circadian rhythm and improving your sleep promotes brain health and may reduce your risk of developing Parkinsons disease. To optimize your rhythm, create a regular sleepwake schedule and sleep in a room that is completely dark and free of light pollution from electronic devices. Avoid using blue light-emitting devices, such as computers and cell phones, several hours before bed. If you must use these devices, wear a pair of blue light-blocking glasses while doing so the glasses prevent blue light from disrupting your sleep rhythm.
Read Also: Why Does Parkinson’s Affect Speech
Physical Exercise Can Reduce The Accumulation Of The
The -syn protein is the main pathogenic protein of PD, which is acidic synaptophysin expressed in the vertebrate presynaptic. In the central nervous system , many neurodegenerative diseases are associated with the exiting of the -syn protein in the cytoplasm and nucleus . Aggregation of -syn is a crucial risk factor for PD, multiple system atrophy , and Lewy body dementia . In previous studies, physical exercise was found to have a positive effect on neurodegenerative diseases such as Huntington’s disease, Alzheimer’s disease, and PD . Physical exercise could reduce the loss of dopaminergic neurons, increase synaptic connections, and upregulate neurotrophic factor levels to improve PD dyskinesia . Physical exercise could downregulate -Syn protein levels and neuronal apoptosis , which could reduce inflammation and mitochondrial dysfunction to restore the motor function in PD patients. Overexpression of -synuclein also resulted in significant impairment on hippocampal neurogenesis-dependent pattern separation . Voluntary running exercise could prevent deterioration and improve cognition through the decrease of -Syn protein overexpression. This can be further substantiated by an effect of running on neurogenesis levels in the dorsal dentate gyrus, suggesting that the functional effects of running on pattern separation were mediated via increased neurogenesis . However, the exact molecular mechanisms of exercise-induced -syn protein level decrease are unrevealed.
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Do Symptoms Get Worse
PD does not affect everyone the same way. The rate of progression and the particular symptoms differ among individuals.
PD symptoms typically begin on one side of the body. However, the disease eventually affects both sides, although symptoms are often less severe on one side than on the other.
Early symptoms of PD may be subtle and occur gradually. Affected people may feel mild tremors or have difficulty getting out of a chair. Activities may take longer to complete than in the past. Muscles stiffen and movement may be slower. The persons face may lack expression and animation . People may notice that they speak too softly or with hesitation, or that their handwriting is slow and looks cramped or small. This very early period may last a long time before the more classical and obvious motor symptoms appear.
As the disease progresses, symptoms may begin to interfere with daily activities. Affected individuals may not be able to hold utensils steady or they may find that the shaking makes reading a newspaper difficult.
People with PD often develop a so-called parkinsonian gait that includes a tendency to lean forward, taking small quick steps as if hurrying , and reduced swinging in one or both arms. They may have trouble initiating movement , and they may stop suddenly as they walk .
Diet And Exercise May Play Key Roles
Parkinson’s disease results from the death of dopamine-producing nerve cells within an area of the brain called the substantia nigra.
Since dopamine regulates movement, depletion of it results in motor symptoms like shaking, stiffness, and walking problems. Non-motor symptoms, like depression, sleep problems, and loss of smell, also commonly occur.
While there is no definitive way yet to prevent Parkinson’s disease, eating a “brain-healthy” diet and incorporating physical activity into your daily routine might help reduce the risk or delay symptom onset. This article reviews the potential roles of diet and exercise in PD prevention.
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What Are The Different Stages Of Parkinsons Disease
Each person with Parkinsons disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinsons disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset.
In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:
Early symptoms of Parkinsons disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing.
Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.
Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.
So What Does Nutrition Have To Do With Parkinsons
1. The neurotransmitter dopamine is made in the body from amino acids which are the building blocks of protein. Every time we eat a protein rich food we take in protein, which the body breaks down into its component amino acids. Two amino acids are converted in the body into L-Dopa, which is then converted into dopamine in the brain.
2. Nutrient co-factors are required for each stage of this conversion process, so deficiencies of these may reduce dopamine production.
3. L-dopa medication competes for absorption with dietary amino acids, therefore the timing of taking L-dopa and the eating of protein needs to be managed for optimal absorption and effectiveness of the drug and the reduction of side-effects.
Therefore, the nutritional therapy approach to Parkinsons includes:
1. Supporting dopamine production by ensuring adequate precursors and co-factors
2. Considering drug-nutrient interactions to enhance effectiveness and reduce side-effects
3. Optimising nutritional status and addressing co-morbidities . These co-morbidities include constipation, depression, fatigue, and insomnia.
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Dural Lymphatic Vasculature: A New Player In The Pathophysiology Of Parkinsons Disease
Many researchers are drawn to studying the brain because theyre still making basic discoveries about how this mysterious organ works. One of those recent discoveries may be key to deciphering the causes of Parkinsons disease.
Most organs in the body have a lymphatic system to drain toxins, waste and other unwanted materials. After long believing it did not exist, researchers have realized the brain, too, has a lymphatic system to do this cleansing work.
At Toronto Western Hospital, Scientific Associate Naomi Visanji, a neuroscientist, immediately saw the implications of this discovery. Shes investigating the lymph vessels in the brain to see if they door coulddrain alpha-synuclein, a protein that accumulates in the brain cells critical to Parkinsons disease. That accumulation kills the brain cells producing dopamine, the chemical that signals other cells to initiate movement.
Because lymph vessels are involved in drainage of fluid, waste and other unwanted material, its a natural idea that the vessels might be involved in the drainage of excess toxic proteins in the brain, says Visanji.
Using imaging equipment, Visanji will compare the brains of two mouse models. One has been genetically engineered to remove its lymphatic vessels in the brain the other is a normal mouse.
The next questionrequiring a further studyis whether these vessels are damaged in people with Parkinsons disease.
Recommended Reading: Parkinson’s Life Center Of Southern New Jersey
Who Gets Parkinsons Disease
Risk factors for PD include:
- Age. The average age of onset is about 70 years, and the incidence rises significantly with advancing age. However, a small percent of people with PD have early-onset disease that begins before the age of 50.
- Sex. PD affects more men than women.
- Heredity. People with one or more close relatives who have PD have an increased risk of developing the disease themselves. An estimated 15 to 25 percent of people with PD have a known relative with the disease. Some cases of the disease can be traced to specific genetic mutations.
- Exposure to pesticides. Studies show an increased risk of PD in people who live in rural areas with increased pesticide use.