Sunday, August 7, 2022

Parkinson’s Disease In Older Adults

What Are The Symptoms Of Parkinson’s Disease

FALL PREVENTION: Older adult and Parkinson’s floor transfer after a fall

The main symptoms of Parkinson’s disease are:

  • tremor or shaking, often when resting or tired. It usually begins in one arm or hand
  • muscle rigidity or stiffness, which can limit movement and may be painful
  • slowing of movement, which may lead to periods of freezing and small shuffling steps
  • stooped posture and balance problems

The symptoms of Parkinson’s disease vary from person to person as well as over time. Some people also experience:

  • loss of unconscious movements, such as blinking and smiling
  • difficulties with handwriting
  • drop in blood pressure leading to dizziness
  • difficulty swallowing
  • sweating

Many of the symptoms of Parkinson’s disease could be caused by other conditions. For example, stooped posture could be caused by osteoporosis. But if you are worried by your symptoms, it is a good idea to see your doctor.

Causes Of Parkinsons Disease

At present, we do not know the cause of Parkinsons disease. In most people there is no family history of Parkinsons Researchers worldwide are investigating possible causes, including:

  • environmental triggers, pesticides, toxins, chemicals
  • genetic factors
  • combinations of environment and genetic factors
  • head trauma.

Study Population And Crude Incidence Rate Of Pd

The overall sample consisted of 1.72 million people, 1.63 million without gout and 94,133 with gout. Mean age was 75.3years , mean Charlson-Romano comorbidity index score was 1.6 , 58% were female, 86% were White and 37% had a Charlson-Romano comorbidity index score of 2 .

Table 1 Demographic and clinical characteristics of the study cohort with or without episodes of Incident Parkinsons Disease

In our study cohort, 22,636 developed incident PD during the study follow-up, 21,507 in people without gout and 1129 in people with gout. The mean time from diagnosis of gout to incident PD was 2.38 years . In unadjusted analyses, people who developed incident PD were older, and more likely to be male or white. Compared to persons without PD, individual Charlson-Romano comorbidities were more common in people with PD with few exceptions AIDS, metastatic cancer, and mild liver disease .

Crude incidence rate of PD was higher in people with gout compared to those without gout, 3.7 vs. 2.2 per 1000 person-years, respectively .

Table 2 Crude Incidence rate of Parkinsons Disease

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Treatment Of Dyskinesia And Dystonia

Troublesome peak-dose dyskinesia can be managed by reducing the dose of levodopa or adjunctive dopaminergic agents if possible. Dopamine agonists are less likely to cause dyskinesia, so in patients with brittle symptom control, adding or increasing the dopamine agonist may allow levodopa to be reduced. Amantadine, an NMDA antagonist, has been shown to reduce dyskinesia in some studies., However, its short-lasting efficacy and anticholinergic adverse effects, including delirium and hallucinations, limit its use in older people.

To manage dystonia, levodopa dosage and administration should be adjusted, as outlined for motor fluctuations. Anticholinergic agents such as benztropine and trihexyphenidyl may be useful, however, the risk of adverse effects such as delirium, hallucinations and falls in older people usually outweigh the benefits. In patients with cognitive impairment they should be avoided. Baclofen or botulinum toxin injections into dystonic muscles can occasionally help in intractable cases.

Stage Three: Symptoms Are More Pronounced But You Can Still Function Without Assistance

Benefits of dance for older adults with Parkinsons to be ...

The third stage is considered moderate Parkinsons disease. In this stage, youll experience obvious difficulty with walking, standing, and other physical movements. The symptoms can interfere with daily life. Youre more likely to fall, and your physical movements become much more difficult. However, most patients at this stage are still able to maintain independence and need little outside assistance.

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Diagnosis And Management Of Parkinsons Disease

There are no diagnostic tests for Parkinsons. X-rays, scans and blood tests may be used to rule out other conditions. For this reason, getting a diagnosis of Parkinsons may take some time.

No two people with Parkinsons disease will have exactly the same symptoms or treatment. Your doctor or neurologist can help you decide which treatments to use.

People can manage their Parkinsons disease symptoms through:

  • seeing a Doctor who specialises in Parkinsons
  • medication
  • multidisciplinary therapy provided for example, by nurses, allied health professionals and counsellors
  • deep brain stimulation surgery .

Surgery And Deep Brain Stimulation

Deep brain stimulation is a treatment for Parkinsonâs disease that uses an implantable pacemaker-like device to deliver electrical pulses to parts of the brain involved in movement. The DBS system consists of leads precisely inserted into a specific brain target, the neurostimulator implanted in the chest, and extension wires that connect the leads to the neurostimulator. Though implantation of the system requires a neurosurgical procedure, the treatment itself consists of long-term electrical stimulation. Advantages of DBS include its ability to reduce the high doses of medications , its adjustability , and its reversibility DBS was approved by the Food and Drug Administration as a treatment for PD in 2002 and according to Medtronic , more than 80,000 patients have undergone DBS surgery worldwide.

Typical candidates are those who have motor fluctuations or periods of âoffâ time with troublesome symptoms alternating with periods of âonâ time with good symptom control, and also with possible periods of excessive movement .

Not all patients with Parkinsonâs disease are good candidates for treatment with DBS. Approximately 10â20% of patients considered for possible treatment with DBS include those:

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Availability Of Data And Materials

These data can be obtained from the Centers for Medicare and Medicaid Services Chronic Condition Data Warehouse. Data requests can be made to the following e-mail address: . The DUA agreement with CMS does not allow us to share these data due to the inclusion of PHI and PII data and the rules of use of Medicare data. We are ready to share the data with colleagues, after obtaining appropriate permissions from the Centers for Medicare and Medicaid Services Chronic Condition Data Warehouse and the University of Alabama at Birmingham Ethics Committee, related to HIPAA and Privacy policies. Additional information about these data can be found at .

Clinical And Epidemiological Data On Parkinsons Disease In Older Adults: Experience Of A Single Italian Centre

Dr Christopher Lien – Parkinson’s Disease in the Elderly (Part 1)

T. Schirinzi, G. Di Lazzaro, M. Pierantozzi, A. Stefani, N. Mercuri, A. Pisani

Session Time: 1:15pm-2:45pm

Location: Les Muses, Level 3

Objective: To provide descriptive data on clinical features and therapy of older patients with PD from an Italian single centre.

Background: The incidence of neurodegenerative diseases, such as Parkinsons disease , is expected to increase significantly in the next future, with relevant socio-economic implications. OPD represent a category of extreme frailty, presenting higher burden of comorbidities, multiple therapies and different sensitivity to medications . Despite the relevance of this matter, clinical-epidemiological studies lack, although they are essential to drive public healths choices.

Method: This cross-sectional study retrospectively evaluated over a 7 years long period a group of OPD patients afferent to Tor Vergata University Hospital that at last visit was older than 75 years. Data on age, sex, disease duration, Hoehn and Yahr score, presence of depression, cognitive decline, hallucinations, levodopa induced dyskinesia and current therapy were collected. Descriptive statistics, parametric test and regression analysis were performed.

This study provides preliminary clinical-epidemiological data on Italian OPD. Of interest, they may constitute the background for future interventions aimed at improving the health status of a rapidly growing frail patient category.

To cite this abstract in AMA style:

Mov Disord.

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Living With Parkinson Disease

These measures can help you live well with Parkinson disease:

  • An exercise routine can help keep muscles flexible and mobile. Exercise also releases natural brain chemicals that can improve emotional well-being.
  • High protein meals can benefit your brain chemistry
  • Physical, occupational, and speech therapy can help your ability to care for yourself and communicate with others
  • If you or your family has questions about Parkinson disease, want information about treatment, or need to find support, you can contact the American Parkinson Disease Association.

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.

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Stage Four: Symptoms Are Severe And Disabling And You Often Need Assistance To Walk Stand And Move

Stage Four Parkinsons disease is often called advanced Parkinsons disease. People in this stage experience severe and debilitating symptoms. Motor symptoms, such as rigidity and bradykinesia, are visible and difficult to overcome. Most people in Stage Four arent able to live alone. They need the assistance of a caregiver or home health aide to perform normal tasks.

Stage One: Symptoms Affect Only One Side Of Your Body

Benefits of dance for older adults with Parkinsons to be ...

The initial phase of Parkinsons disease typically presents with mild symptoms. Some patients will not even detect their symptoms in the earliest phases of this stage. Typical motor symptoms experienced in Stage One include tremors and shaking limbs. Family members and friends may begin to notice other symptoms including tremor, poor posture, and mask face or loss of facial expression.

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What Is The Prognosis And Life Expectancy For Parkinson’s Disease

    The severity of Parkinson’s disease symptoms and signs vary greatly from person to person, and it is not possible to predict how quickly the disease will progress.

    • Parkinson’s disease itself is not a fatal disease, and the average life expectancy is similar to that of people without the disease.
    • Secondary complications, such as pneumonia, falling-related injuries, and choking can lead to death.
    • Many treatment options can reduce some of the symptoms and prolong the quality of life.

    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 .

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    Related Diagnosis: Lewy Body Dementia

    Current research is helping to differentiate dementia related conditions in relationship to Parkinsonâs disease. Doctorâs use a 12-month arbitrary rule to aid in diagnosis. When dementia is present before or within 1 year of Parkinsonâs motor symptoms developing, an individual is diagnosed with DLB. Those who have an existing diagnosis of Parkinsonâs for more than a year, and later develop dementia, are diagnosed with PDD.

    In the simplest terms, Lewy bodies are abnormal clumps of proteins that develop in nerve cells. Cholinesterase inhibitors, medications originally developed for Alzheimerâs disease, are the standard treatment today for cognitive DLB and PDD symptoms. Early diagnosis is important, as DLB patients may respond differently than Alzheimerâs disease patients to certain drug, behavioral, and dementia care treatments.

    This challenging, multi-system disorder involving movement, cognition, behavior, sleep, and autonomic function requires a comprehensive treatment approach to maximize the quality of life for both the care recipient and their caregiver. It is very important to pay attention to symptoms of dementia and to search for an expert clinician who can diagnose the condition accurately.

    What Is Parkinson’s Disease

    Parkinson’s disease in older adults | World Brain Day 2020

    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 varies 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 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 stage

      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.

      Mid stage

      Mid-late stage

      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.

      Advanced stage

      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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      What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms

      Exercise: Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinsons disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didnt exercise or didnt start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.

      Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinsons, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.

      Preventing falls and maintaining balance: Falls are a frequent complication of Parkinson’s. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments whether medicines or deep brain stimulation are optimal and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.

      Caregiving For People Living With Parkinsons

      Early Signs of Parkinsons Disease

      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.

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