Monday, March 4, 2024

Tell Me About Parkinson’s

How Do I Prevent Falls From Common Hazards

Telling friends and family about my Parkinson’s
  • Floors: Remove all loose wires, cords, and throw rugs. Minimize clutter. Make sure rugs are anchored and smooth. Keep furniture in its usual place.
  • Bathroom: Install grab bars and non-skid tape in the tub or shower. Use non-skid bath mats on the floor or install wall-to-wall carpeting.
  • Lighting: Make sure halls, stairways, and entrances are well-lit. Install a night light in your bathroom or hallway and staircase. Turn lights on if you get up in the middle of the night. Make sure lamps or light switches are within reach of the bed if you have to get up during the night.
  • Kitchen: Install non-skid rubber mats near the sink and stove. Clean spills immediately.
  • Stairs: Make sure treads, rails, and rugs are secure. Install a rail on both sides of the stairs. If stairs are a threat, it might be helpful to arrange most of your activities on the lower level to reduce the number of times you must climb the stairs.
  • Entrances and doorways: Install metal handles on the walls adjacent to the doorknobs of all doors to make it more secure as you travel through the doorway.

How Parkinsons Disease Affects The Brain

What makes Parkinsons disease distinctive from other movement disorders is that cell loss occurs in a very specific region of the brain called the substantia nigra . The nerve cells, or neurons, in this region actually appear dark under a microscope .

Those dark neurons produce a specific type of neurotransmitter called dopamine. The neurotransmitter dopamine helps to regulate movement. This loss of dopamine is the reason that many treatments for Parkinsons Disease are intended to increase dopamine levels in the brain. Future research will hopefully tell us more about alpha-synuclein. Learn more about APDA research initiatives here.

In addition to decreases in dopamine and the cells that make dopamine, you might also read or hear about alpha-synuclein . We do not yet know what this protein does in the healthy brain, but in Parkinsons disease it clumps up in what are called Lewy bodies. Researchers believe that alphasynuclein build-up contributes to the cause of Parkinsons disease and that it may be possible to develop new treatments based on this idea.

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.

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What Are The Symptoms Of Parkinson Disease

Parkinson disease symptoms usually start out mild, and then progressively get much worse. The first signs are often so subtle that many people don’t seek medical attention at first. These are common symptoms of Parkinson disease:

  • Tremors that affect the face and jaw, legs, arms, and hands
  • Slow, stiff walking

Clinical History And Testing

Can I Tell You About Parkinson

Diagnostic tests can be used to establish some features of the condition and distinguish them from symptoms of other conditions. Diagnosis may include taking the person’s , a physical exam, assessment of neurological function, testing to rule out conditions that may cause similar symptoms, brain imaging, to assess cognitive function,, or myocardial scintigraphy. Laboratory testing can rule out other conditions that can cause similar symptoms, such as abnormal , , , or vitamin deficiencies that may cause symptoms similar to dementia.

Dementia screening tests are the and the . For tests of attention, , , and can be used for simple screening, and the Revised Digit Symbol Subtest of the may show defects in attention that are characteristic of DLB. The , and are used for evaluation of executive function, and there are many other screening instruments available.

If DLB is suspected when parkinsonism and dementia are the only presenting features, PET or SPECT imaging may show reduced dopamine transporter activity. A DLB diagnosis may be warranted if other conditions with reduced dopamine transporter uptake can be ruled out.

Since 2001, – has been used diagnostically in East Asia , but not in the United States. MIBG is taken up by nerve endings, such as those that innervate the heart, and is for scintigraphy with radioactive 123iodine. Autonomic dysfunction resulting from damage to nerves in the heart in patients with DLB is associated with lower cardiac uptake of 123I-MIBG.

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How Is Parkinson’s Disease Treated

If a doctor thinks a person has Parkinson’s disease, there’s reason for hope. Medicine can be used to eliminate or improve the symptoms, like the body tremors. And some experts think that a cure may be found soon.

For now, a medicine called levodopa is often given to people who have Parkinson’s disease. Called “L-dopa,” this medicine increases the amount of dopamine in the body and has been shown to improve a person’s ability to walk and move around. Other drugs also help decrease and manage the symptoms by affecting dopamine levels. In some cases, surgery may be needed to treat it. The person would get anesthesia, a special kind of medicine to prevent pain during the operation.

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.

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How Is Parkinsons Disease Treated

There is no cure for Parkinsons disease. However, medications and other treatments can help relieve some of your symptoms. Exercise can help your Parkinsons symptoms significantly. In addition, physical therapy, occupational therapy and speech-language therapy can help with walking and balance problems, eating and swallowing challenges and speech problems. Surgery is an option for some patients.

Causes Of Parkinson’s Disease

Faces of Parkinson’s

Parkinson’s disease is caused by a loss of nerve cells in part of the brain called the substantia nigra. This leads to a reduction in a chemical called dopamine in the brain.

Dopamine plays a vital role in regulating the movement of the body. A reduction in dopamine is responsible for many of the symptoms of Parkinson’s disease.

Exactly what causes the loss of nerve cells is unclear. Most experts think that a combination of genetic and environmental factors is responsible.

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Why Is Parkinsons Disease More Common In Men Than Women

Researchers arent yet sure why there is a difference in the rate of PD between men and women. Some suggested explanations are the protective effect of estrogen in women, the higher rate of minor head trauma and exposure to occupational toxins in men, and genetic susceptibility genes on the sex chromosomes.1

What Are The Surgical Treatments For Parkinsons Disease

Most patients with Parkinsons disease can maintain a good quality of life with medications. However, as the disease worsens, medications may no longer be effective in some patients. In these patients, the effectiveness of medications becomes unpredictable reducing symptoms during on periods and no longer controlling symptoms during off periods, which usually occur when the medication is wearing off and just before the next dose is to be taken. Sometimes these variations can be managed with changes in medications. However, sometimes they cant. Based on the type and severity of your symptoms, the failure of adjustments in your medications, the decline in your quality of life and your overall health, your doctor may discuss some of the available surgical options.

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An Interview With Jon Palfreman

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Jon Palfreman, author of Brain Storms and a person living with Parkinsons.

Jon Palfreman, author of Brain Storms, My Fight Against Parkinsons and the Race to Unlock the Secrets of One of the Brains Most Mysterious Diseases

The following is an edited and condensed version of our telephone interview with Jon Palfreman on November 11, 2015.

ePP: First, thank you for writing such an informative and readable book about Parkinsons disease. Brain Storms portrays the long journey full of the disappointments and the excitement of scientific discovery in the search for a cure and better treatments. The book interweaves this research story with the very human experiences of individuals, including you, who are living with Parkinsons.

ePP: When did you decide to write Brain Storms? How did you determine your approach blending research and personal stories even personal stories about the researchers?JP: It was about finding the right voice. It had to be based in journalism, not a memoir. But I am there staging the story, in the same way as a correspondent in a documentary not dominating the conversation, but guiding the reader. I wanted to tell an actual story, including patient stories, with hope for the future. I wanted to balance truth and hope.

My wife power walks with me most days, challenging me to keep up with her. There is a story in my book about how vigorous, challenging, exercise can be beneficial to people with Parkinsons.

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How Does Parkinsons Progress

Off and On: The Alaska Parkinson

Parkinsons is a chronic and slowly progressive disorder. This means that symptoms normally appear slowly and develop gradually over time. The stage at which symptoms appear, speed at which they progress and the severity of those symptoms will vary from person to person. The most important point is that Parkinsons affects everyone differently.

There are a wide range of symptoms, but it is highly unlikely that you will experience every possible symptom. Some of the early symptoms of Parkinsons include handwriting changes, reduced sense of smell, tiredness and constipation. As Parkinsons progresses symptoms will change over time, and new symptoms will emerge. It can take many years for symptoms to progress to a point where they cause problems.

Ultimately symptoms will begin to impact on your day to day life. Many symptoms are related to physical movement, so you may find that walking becomes difficult. You may also experience non-movement symptoms such as mood changes, disrupted sleep or difficulty communicating. As these symptoms worsen it may become difficult to manage all of your daily activities.

Currently, there is no known way to slow the progression of Parkinsons. However, medications and other treatments can help to effectively manage your symptoms. To ensure the effectiveness of medications, they will need to be reviewed regularly by your specialist or doctor.

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Signs Of Parkinsons Disease

In 1817, Dr. James Parkinson published An Essay on the Shaking Palsy describing non-motor, as well as, motor symptoms of the illness that bears his name. Parkinsons is not just a movement disorder, explained Dr. Shprecher. Constipation, impaired sense of smell, and dream enactment can occur years before motor symptoms of Parkinsons. The latter, caused by a condition called REM sleep behavior disorder, is a very strong risk factor for both Parkinsons and dementia . This has prompted us to join a consortium of centers studying REM sleep behavior disorder.

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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What Are The Complications Of Parkinson Disease

Parkinson disease causes physical symptoms at first. Problems with cognitive function, including forgetfulness and trouble with concentration, may arise later. As the disease gets worse with time, many people develop dementia. This can cause profound memory loss and makes it hard to maintain relationships.

Parkinson disease dementia can cause problems with:

  • Speaking and communicating with others
  • Problem solving
  • Forgetfulness
  • Paying attention

If you have Parkinson disease and dementia, in time, you likely won’t be able to live by yourself. Dementia affects your ability to care of yourself, even if you can still physically do daily tasks.

Experts don’t understand how or why dementia often occurs with Parkinson disease. Its clear, though, that dementia and problems with cognitive function are linked to changes in the brain that cause problems with movement. As with Parkinson disease, dementia occurs when nerve cells degenerate, leading to chemical changes in the brain. Parkinson disease dementia may be treated with medicines also used to treat Alzheimer’s disease, another type of dementia.

Speak Out About What You’re Experiencing

Our Dad and Parkinson’s

If any or all of the statements below apply to you, tell your Parkinson’s specialist at your next appointment. To read additional questions, a full discussion guide.

  • People tell me what I am hearing, seeing, or sensing are not actually there .
  • I have beliefs or fears that a loved one is stealing from me or being unfaithful .

If any or all of the statements below apply to you, tell your Parkinson’s specialist at your next appointment. To read additional questions, a full discussion guide.

  • I have noticed my loved one interacting with things, seeing things, or sensing things that are not there .
  • My loved one has had false beliefs toward me or others, such as believing someone is stealing from them or being unfaithful .
  • These experiences have affected our daily lives and/or our relationships.

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Drugs And Medication Used To Treat Parkinsons Disease

A number of different drugs can be used to treat Parkinsons.

Levodopa

Levodopa is the most common treatment for Parkinsons. It helps to replenish dopamine.

About 75 percent of cases respond to levodopa, but not all symptoms are improved. Levodopa is generally given with carbidopa.

Carbidopa delays the breakdown of levodopa which in turn increases the availability of levodopa at the blood-brain barrier.

Dopamine agonists

Dopamine agonists can imitate the action of dopamine in the brain. Theyre less effective than levodopa, but they can be useful as bridge medications when levodopa is less effective.

Drugs in this class include bromocriptine, pramipexole, and ropinirole.

Anticholinergics

Anticholinergics are used to block the parasympathetic nervous system. They can help with rigidity.

Benztropine and trihexyphenidyl are anticholinergics used to treat Parkinsons.

Amantadine

Amantadine can be used along with carbidopa-levodopa. Its a glutamate-blocking drug . It offers short-term relief for the involuntary movements that can be a side effect of levodopa.

COMT inhibitors

Catechol O-methyltransferase inhibitors prolong the effect of levodopa. Entacapone and tolcapone are examples of COMT inhibitors.

Tolcapone can cause liver damage. Its usually saved for people who do not respond to other therapies.

Ectacapone does not cause liver damage.

Stalevo is a drug that combines ectacapone and carbidopa-levodopa in one pill.

MAO-B inhibitors

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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