Wednesday, September 21, 2022

Parkinson’s Disease And Chronic Diarrhea

Exercise For Constipation In Parkinsons Disease

Managing hidden Parkinson’s symptoms

Be guided by your doctor, but general suggestions include:

  • Talk with your doctor, physiotherapist, exercise physiologist or healthcare professional when planning your exercise program.
  • Aim for at least 30 minutes of exercise every day.
  • Spend a few minutes warming up and cooling down. This could include marching in place or stretching.
  • Start with the easiest exercises first. Slowly introduce the more difficult exercises as your fitness increases.
  • Only exercise when other people are at home who can help if necessary.
  • Remember: too little exercise and fluid intake with an increase in dietary fibre can worsen constipation for some people.

How Might Parkinson’s Affect The Bowels

Bowel problems can occur in anyone, but some problems, especially reduced bowel movement or constipation, are particularly common in Parkinsons. This tends to be as a result of slowness of movement and muscle rigidity, both of which are visible symptoms of the condition. But Parkinson’s also muscles we cannot see including the bowel muscles – which in turn causes a reduction or slowness of bowel movements.

Poor bowel function may be exacerbated if chewing and swallowing food is difficult, which is quite common in Parkinsons. This may make it harder to eat a diet that is rich in fibre – for example fruit, vegetables and whole grains which helps form soft, bulky stools and aids bowel function.

Exercise is also thought to play a role in efficient bowel function, but if Parkinson’s makes activities more difficult, the bowel may be less stimulated and the intestines can become sluggish.

Constipation is thought to affect up to 65% of people with Parkinson’s the bowel symptoms may predate the neurological ones . Tremor and a fear of spilling drinks can mean some people unintentionally reduce their fluid intake which can make stools hard and more difficult to pass. When stools remain unpassed for a long time, they become harder as the body absorbs more water from them. If stools build up in the rectum they can become impacted and block the rectum. They may also overflow as lumps of stool or watery mucus.

How Can I Avoid Getting Constipated

  • Eat a well-balanced diet with plenty of fiber. Good sources of fiber are fruits, vegetables, legumes, and whole grain bread and cereal. Most of the fiber in fruits is found in the skins. Fruits with edible seeds, such as strawberries, have the most fiber. Eat bran cereal or add bran cereal to other foods, such as soup.
  • Drink 1½ to 2 quarts of water and other fluids a day. Liquids that contain caffeine, such as coffee and soft drinks, seem to have a dehydrating effect and may need to be avoided until your bowel habits return to normal.
  • Move your bowels when you feel the urge.

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Hospice Eligibility For Parkinsons Disease

Due to the progressive nature of Parkinsons disease, it can be challenging for families to know when their loved one is eligible for the support of hospice care. If a loved one has been diagnosed with six months or less to live or if they have experienced a decline in their ability to move, speak, or participate in the activities of daily living without caregiver assistance, it is time to speak with a hospice professional about next steps.

Aspect : Weight/malnutrition Status In Pd

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Weight loss and malnutrition are not benign phenomena during the course of PD. PD patients in low BMI group showed lower scores of the K-MMSE and 3MS compared to stable BMI group, implying the potential relation between weight loss and cognitive decline in PD patients . Low BMI and malnutrition is one such risk factor for osteoporosis in PD patients, which deserves more attention for the concomitant risk of fractures . In addition, a growing body of evidence suggested weight loss and malnutrition in PD was associated with worsening life qualities . With respect to survival, only one study explored the association between changes in BMI and survival among persons with PD . According to this study, changes in BMI was not associated with survival after adjusting for covariates although there was inverse correlation between BMI changes and UPDRS score variations. One thing to note is the low number of death in the study limits the results. Moreover, low body weight patients tend to receive significantly higher daily dose of levodopa per kilogram body weight, which may contribute to developing dyskinesias .

Table 1. Summary of literature on weight change in PD patients.

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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 Parkinson’s 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.

Aspect : Relationship Between Weight Loss/malnutrition And Pd

It has long been recognized that there is a relationship between weight loss and PD. Amounting evidence support weight loss may begin at the early stage of PD, even several years before the diagnosis, and may be more pronounced in patients with greater disease severity . A prospective cohort study involving 10,812 men reported that subjects who lost 0.5 units of body mass index per decade during the follow-up time had more than a 2-fold risk for developing PD when compared with men having stable BMI . Given this considerable list of association between weight loss and PD, one is left asking: whether it is a chicken or egg problem?

Given the lengthy latency period of PD, it cannot be excluded that the observed weight loss before the diagnosis of PD may stem from subclinical effects of PD rather than an independent pathogenesis. That is to say, weight loss is the consequence of PD. There are ample evidences supporting the effect of PD on weight loss for this time being .

Figure 1. Postulated determinants of weight loss in PD. NPY, NeuropeptideY LC, locus coreruleus.

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What Research Is Being Done

The mission of the National Institute of Neurological Disorders and Stroke is to seek fundamental knowledge about the brain and nervous system and to use the knowledge to reduce the burden of neurological disease. NINDS is a component of the National Institutes of Health , the leading supporter of biomedical research in the world. NINDS conducts and supports three types of research: basicscientific discoveries in the lab, clinicaldeveloping and studying therapeutic approaches to Parkinsons disease, and translationalfocused on tools and resources that speed the development of therapeutics into practice. The goals of NINDS-supported research on Parkinsons disease are to better understand and diagnose PD, develop new treatments, and ultimately, prevent PD. NINDS also supports training for the next generation of PD researchers and clinicians and serves as an important source of information for people with PD and their families.

Parkinsons Disease Is A Neurodegenerative Condition

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Parkinsons disease is a chronic condition in which neurons within a region of the brain responsible for the control of movement break down and die. These neuronal cells use a chemical called dopamine to communicate with each other. It is this complex dopamine-based communication between neurons that is responsible for control of movement. Death of these neurons is referred to as dopaminergic neurodegeneration, and directly leads to the movement-related symptoms of the condition . These include tremors, changes in posture, stiffness, and a slowness of movement, also referred to as bradykinesia.1,2

Importantly, and often little appreciated, is the fact that Parkinsons disease can also affect neurons outside of the brain. Neuronal connections are made throughout the body, and connect all parts of the body to the brain and spinal cord, including to the GI tract. In particular, Parkinsons interferes with normal communication between the central nervous system, and the esophagus and stomach.3 Parkinsons can also affect the enteric nervous system, a network of neurons that functions with a considerable level of independence from the brain and central nervous system, and that is highly involved in controlling the intestinal tract and digestion.3,4 By affecting both the central and enteric nervous systems, Parkinsons disease may give rise to an array of GI symptoms.

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What Examinations May I Need To Have

Your GP or specialist will probably ask a series of questions to find out what the problem is. These may include:

  • When did the trouble start?
  • How often does it happen?
  • Can you feel when your bladder or bowel is full?
  • Are you having difficulty emptying your bladder or bowel?
  • How often are you using the toilet?

Parkinson’s symptoms, such as slowness of movement and rigid muscles, affect the muscles in the bowel wall. This can make it harder to push stools out of the body. You may be asked to keep a chart for several days of how often you use the toilet and how much you drink.

You may also be asked for a urine sample to test for infection and they will normally carry out a physical examination.

Bladder or bowel problems can be complex in Parkinson’s, so sometimes specialist tests or X-rays may be needed. All of these can usually be done in an outpatient department or clinic.

What Is Parkinson’s Disease

Parkinson’s disease is the second most common neurodegenerative disorder and the most common movement disorder. Characteristics of Parkinsons disease are progressive loss of muscle control, which leads to trembling of the limbs and head while at rest, stiffness, slowness, and impaired balance. As symptoms worsen, it may become difficult to walk, talk, and complete simple tasks.

The progression of Parkinson’s disease and the degree of impairment vary from person to person. Many people with Parkinson’s disease live long productive lives, whereas others become disabled much more quickly. Complications of Parkinsons such as falling-related injuries or pneumonia. However, studies of patent populations with and without Parkinsons Disease suggest the life expectancy for people with the disease is about the same as the general population.

Most people who develop Parkinson’s disease are 60 years of age or older. Since overall life expectancy is rising, the number of individuals with Parkinson’s disease will increase in the future. Adult-onset Parkinson’s disease is most common, but early-onset Parkinson’s disease , and juvenile-onset Parkinson’s disease can occur.

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What Are The Symptoms Of The Disease

The four primary symptoms of PD are:

  • Tremor. Tremor often begins in a hand, although sometimes a foot or the jaw is affected first. The tremor associated with PD has a characteristic rhythmic back-and-forth motion that may involve the thumb and forefinger and appear as a pill rolling. It is most obvious when the hand is at rest or when a person is under stress. This tremor usually disappears during sleep or improves with a purposeful, intended movement.
  • Rigidity. Rigidity , or a resistance to movement, affects most people with PD. The muscles remain constantly tense and contracted so that the person aches or feels stiff. The rigidity becomes obvious when another person tries to move the individuals arm, which will move only in ratchet-like or short, jerky movements known as cogwheel rigidity.
  • Bradykinesia. This slowing down of spontaneous and automatic movement is particularly frustrating because it may make simple tasks difficult. The person cannot rapidly perform routine movements. Activities once performed quickly and easilysuch as washing or dressingmay take much longer. There is often a decrease in facial expressions.
  • Postural instability. Impaired balance and changes in posture can increase the risk of falls.

Addressing Practical Aspects Of Eating And Drinking

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Some people with Parkinsons have problems chewing and swallowing. This can make it difficult to eat a diet with plenty of fibre. A speech and language therapist can give advice about this. Ask your GP, specialist or Parkinsons nurse for a referral. If it takes a long time to eat and your meal goes cold, eat smaller portions and go back for seconds that have been kept warm. You can also get special plates that keep your meals hot the Disabled Living Foundation has more information.

An occupational therapist will also be able to give you some tips and practical advice.

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Fluids For Constipation In Parkinsons Disease

Be guided by your doctor, but general suggestions include:

  • Try to drink six to eight glasses of fluid every day. Water is best, but you can also include fluid in the form of soup, juice, tea and coffee.
  • Limit drinks that cause dehydration such as alcohol, tea and coffee.
  • Spread your drinks throughout the day.

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, it’s 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. It’s also much more common in men than in women.

Parkinson disease is a chronic and progressive disease. It doesn’t go away and continues to get worse over time.

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Dehydration A Common Risk Of Disease And Aging

Dehydration in Parkinsons disease is a major concern because the risks associated with becoming dehydrated can significantly worsen already compromised neurological function. Complicating matters even more, it is very easy to misread symptoms of dehydration for symptoms common to PD.

Dehydration is always a risk of disease and aging. As we age, the bodys mechanism for signaling thirst and distributing water to the cells becomes compromised. In the United States, dehydration is responsible for 1.8 million days of hospital care each year and costs more than $1 billion annually.

The body is made up of over 70% water, and it moves throughout the membranes from the blood to the lymph system, to the organs, and to the brain. Its needed to transport vital nutrients like minerals, vitamins and amino acids to cells and extract waste from every cell. Water also affects the efficiency of the nervous system and plays a role in cerebral blood flow.

The choices you make about food and nutrition impact your health and well-being. This article will outline the health risks of dehydration, why people with PD are more at risk, signs of dehydration and tips for incorporating more water into your diet.

Who is at Risk for Dehydration?

Knowing the risk factors for dehydration can help you manage the issue, whether youre a caretaker or someone with Parkinsons.

Those at an increased risk for dehydration include:

Dehydration in Parkinsons

Dehydration Health Risks

Signs of Dehydration

More About Carbidopa / Entacapone / Levodopa

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1. “Product Information. Stalevo 150 .” Novartis Pharmaceuticals, East Hanover, NJ.

2. “Product Information. Stalevo 50 .” Novartis Pharmaceuticals, East Hanover, NJ.

3. Hauser RA “Levodopa/carbidopa/entacapone .” Neurology 62 : S64-71

4. “Product Information. Stalevo 100 .” Novartis Pharmaceuticals, East Hanover, NJ.

5. Giner V, Rueda D, Salvador A, Hernandez JC, Esteban MJ, Redon J “Comments, opinions, and brief case reports: thrombocytopenia associated with levodopa treatment.” Arch Intern Med 163 : 735-6

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How Is Parkinson Disease Treated

Parkinson disease can’t be cured. But there are different therapies that can help control symptoms. Many of the medicines used to treat Parkinson disease help to offset the loss of the chemical dopamine in the brain. Most of these medicines help manage symptoms quite successfully.

A procedure called deep brain stimulation may also be used to treat Parkinson disease. It sends electrical impulses into the brain to help control tremors and twitching movements. Some people may need surgery to manage Parkinson disease symptoms. Surgery may involve destroying small areas of brain tissue responsible for the symptoms. However, these surgeries are rarely done since deep brain stimulation is now available.

Parkinsons Disease And The Gut

In Part 1 of this 3-part blog I cover questions or concerns that many of my patients with Parkinsons disease have that center around the gut.

  • Constipation/delayed gastric emptying
  • Dietary recommendations for PD in general
  • Protein interactions with levodopa
  • Dietary interactions with MAO-B inhibitors
  • Connection of PD and the gut
  • Antibiotic impact on gut bacteria
  • The outlook for prevention or prevention progression for PD
  • 1. Gastrointestinal symptoms of Parkinsons disease

    Up to 70% of patients with PD have gastrointestinal symptoms, often beginning years prior to the onset of motor symptoms, along the entire length of the gastrointestinal tract. I will describe the issues that can arise from top to bottom, so to speak.

    Symptoms of the mouth and throat include the slowing down and reduction of the swallow response, resulting in drooling or repeated swallows being required in early stages of PD. As the disease progresses, swallowing difficulty may worsen, resulting in aspiration , which can be silent or associated with coughing, choking, or pneumonia. Dysphagia and aspiration should be evaluated by a swallow study, performed by a speech therapist. Treatment recommendations include chewing more slowly, clearing ones throat before taking another bite, eating while sitting up with the chin tucked, and changing the texture of the solids and liquids to be easier and safer to swallow.

    For more on management of constipation, please see Part 2 of this blog.

    • Green leafy vegetables

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