Treatment Of Parkinson’s Disease In Elderly

Conditions That Mimic Parkinsons

Certain diseases can obscure early diagnosis of PD, which is another significant reason why a neurology appointment should be scheduled early in the diagnosis process. According to the Parkinsons Foundation, conditions that are most similar to Parkinsons display a wide range of familiar symptoms:

Essential tremor disorder

Many elderly people experience essential tremor disorder. These tremors are different from Parkinsons tremors in that they affect both hands and result in shaking of the head and voice.

Progressive supranuclear palsy

Progressive supranuclear palsy typically affects people after the age of 50, usually worsens more rapidly than Parkinsons, and results in imbalance, falling, stiffening of the midsection, and difficulty with eye movement.

Corticobasal degenerationis

Corticobasal degenerationis is an uncommon condition that affects speech, balance, and posture and also leads to slowness of movement. Affected limbs often become severely or completely disabled as this condition progresses.

Multiple system atrophy

Possibly the most difficult disease to distinguish from Parkinsons, multiple system atrophy has an earlier onset and rapid progression, which are two key characteristics of this neurodegenerative disease. As this condition intensifies, more symptoms arise and may indicate that other systems of the body are compromised.

Vascular parkinsonism

Lewy body dementia

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.

Treatment For Parkinsons Disease In The Elderly

Unfortunately, the disease is difficult to diagnose in many cases, and is incurable. The good news that older adults can live with Parkinsons disease comfortably with the proper types of treatment.

• Regular Medication. A treatment plan will most likely include at least one medicine for the patient. Fortunately, advances in medicine have given those with Parkinsons disease hope for a relatively normal life.
• Surgery. Treating Parkinsons disease in older adults with surgery is usually only an option when medication has become less effective and the symptoms have begun to get worse.
• Therapy. In addition to following a medication routine, several types of therapy may improve a patients overall health and help minimize Parkinsons toll on the persons lifestyle. Physical, occupational, and speech therapy have all been successful in helping Parkinsons disease patients maintain a high quality of life for longer. Psychological therapy is also helpful in working through the emotions that such a debilitating disease brings on.
• Exercise. By exercising several times a week, an older adult battling Parkinsons disease can help improve their balance, keep their muscles strong, and release some stress. Water exercises are good choices, along with simple walking. Pilates is another good option.

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• J. Eric Ahlskog, PhD, MD *Author Footnotes* Dr Ahlskog has no conflicts of interest to disclose, apart from citation of 2 books he authored on Parkinson disease.J. Eric AhlskogCorrespondenceIndividual reprints of this article are not available. Address correspondence to J. Eric Ahlskog, PhD, MD, Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 ContactFootnotes* Dr Ahlskog has no conflicts of interest to disclose, apart from citation of 2 books he authored on Parkinson disease.Affiliations
• Show footnotesHide footnotesAuthor Footnotes* Dr Ahlskog has no conflicts of interest to disclose, apart from citation of 2 books he authored on Parkinson disease.

What Tests Will Be Done To Diagnose This Condition

When healthcare providers suspect Parkinsons disease or need to rule out other conditions, various imaging and diagnostic tests are possible. These include:

• Blood tests .
• Positron emission tomography scan.

New lab tests are possible

Researchers have found possible ways to test for possible indicators or Parkinsons disease. Both of these new tests involve the alpha-synuclein protein but test for it in new, unusual ways. While these tests cant tell you what conditions you have because of misfolded alpha-synuclein proteins, that information can still help your provider make a diagnosis.

The two tests use the following methods.

• Spinal tap. One of these tests looks for misfolded alpha-synuclein proteins in cerebrospinal fluid, which is the fluid that surrounds your brain and spinal cord. This test involves a spinal tap , where a healthcare provider inserts a needle into your spinal canal to collect some cerebrospinal fluid for testing.
• Skin biopsy. Another possible test involves a biopsy of surface nerve tissue. A biopsy includes collecting a small sample of your skin, including the nerves in the skin. The samples come from a spot on your back and two spots on your leg. Analyzing the samples can help determine if your alpha-synuclein has a certain kind of malfunction that could increase the risk of developing Parkinsons disease.

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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 Are The Signs And Symptoms Of Parkinsons Disease

The presenting symptoms in Parkinsons disease along with the rate of cognitive decline varies widely from individual to individual. Most commonly observed symptoms of Parkinsons disease include:

Various other symptoms of Parkinsons disease may include

• a) Decrease in facial expressions: One may not be able to smile or blink as worsening of this disease takes place, patients may have expressions less face

• b) Changes in ones speech or vocal alterations: A persons speech might become quick-paced, undergo slurring, or may even become softer. One might also undergo hesitation before starting to speak and the voice pitch may exhibit no changes or become monotonous

• c) One can observe changes in handwriting: A person suffering from Parkinsons disease might show a reduction in the size of their handwriting that might become difficult to be read

• d) Depression as well as anxiety

• e) Problems in chewing as well as swallowing

• f) drooling of saliva

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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.

What Are The Five Stages Of Parkinson’s Disease

Researchers may disagree on the number of stages of Parkinsons disease . However, they all agree the disease is a progressive disease with symptoms that usually occur in one stage and may overlap or occur in another stage. The stage increase in number value for all stage naming systems reflects the increasing severity of the disease. The five stages used by the Parkinsons Foundation are:

• Stage 1: mild symptoms do not interfere with daily activities and occur on one side of the body.
• Stage 2: Symptoms worsen with walking problems and both sides of the body are affected.
• Stage 3: Main symptoms worsen with loss of balance and slowness of movement.
• Stage 4: Severity of symptoms require help usually a person cannot live alone.
• Stage 5:Caregiver needed for all activities a patient may not be able to stand or walk and maybe bedridden and may also experience hallucinations and delusions.

A neurologist who specializes in movement disorders will be able to make the most accurate diagnosis. An initial assessment is made based on medical history, a neurological exam, and the symptoms present. For the medical history, it is important to know whether other family members have Parkinson’s disease, what types of medication have been or are being taken, and whether there was exposure to toxins or repeated head trauma previously. A neurological exam may include an evaluation of coordination, walking, and fine motor tasks involving the hands.

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Causes Of Parkinsons Disease

Parkinsons disease is caused by a lack of dopamine, a neurotransmitter in the brain that plays a critical role in the nervous system. Dopamine, which essentially serves as a messenger in the brain to produce the controlled, smooth movements most of us enjoy, is lacking in the brain of those suffering from Parkinsons disease the greater the loss of dopamine, the more uncontrolled the symptoms. Further, it is also believed that Parkinsons may also cause other cells in the brain to deteriorate, as well.

Although it is clear that a lack of dopamine causes the symptoms of Parkinsons disease, why these dopamine cells deteriorate is unclear. What is clear is that a number of irregular cellular processes are to blame, although stress has also been attributed to cell damage in Parkinsons disease patients. In other words, it appears as if dopamine loss occurs because of both genetic and environmental factors.

What Causes Parkinson Disease

Parkinson disease arises from decreased dopamine production in the brain. The absence of dopamine makes it hard for the brain to coordinate muscle movements. Low dopamine also contributes to mood and cognitive problems later in the course of the disease. Experts don’t know what triggers the development of Parkinson disease most of the time. Early onset Parkinson disease is often inherited and is the result of certain gene defects.

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Parkinsons Disease In The Elderly: Symptoms And Treatment

Older adults must face many health challenges as they age, and one that rears its ugly head is Parkinsons disease. Around 60,000 people are diagnosed with the disease each year, and there are around 1 million people currently living with and battling it.

Understanding Parkinsons disease is the first step toward formulating a game plan for you or your loved one. Watching for symptoms of Parkinsons disease in your elderly loved ones, and being aware of the treatment, can help decrease worry and stress, and make the situation a bit more comfortable.

Symptoms of Parkinsons Disease in Older Adults

• Rigid Muscles. Stiffness in the persons extremities and neck may be a symptom of Parkinsons. If these muscles are aching for seemingly no reason for more than a few days, its time to visit the doctor.
• Balance Issues. Feeling unsure on your feet when you have been sure-footed before, is a sign. Being unbalanced so you lean forward or backward to stay upright may signal Parkinsons disease.
• Tremors. This is perhaps the most well-known of symptoms of Parkinsons disease in the elderly. You may notice uncontrollable hand tremors that may start small and gain power. They might even move up through the arms. If you notice even small tremors, schedule a doctors appointment immediately.
• Slow Movements. Many of us slow down as we get older, so this symptom is more difficult to pinpoint. If there is a quick progression, however, it may be more than a simple by-product of aging.

Drug Therapy And Research

If the disease progresses beyond minor symptoms, drug treatment may be indicated. Drug therapy for Parkinsonâs typically provides relief for 10â15 years or more. The most commonly prescribed medication is L-dopa , and this helps replenish some of the depleted dopamine in the brain. Sinemet, a combination of levodopa and carbidopa, is the drug most doctors use to treat Parkinsonâs disease. Recent clinical studies have suggested, in the younger person, the class of drugs called âdopamine agonistsâ should be used prior to levodopa-carpidopa except in patients with cognitive problems or hallucinations. In those older than 75, dopamine agonists should be used cautiously because of an added risk of hallucinations.

Other drugs are also used, and new drugs are continually being tested. It is common for multiple drugs to be prescribed because many of them work well together to control symptoms and reduce side effects. Contrary to past beliefs, starting Sinemet in newly diagnosed people does not lead to early symptoms of dyskinesia . Current knowledge is that the disease progression causes dyskinesias, not a âresistanceâ to the drug.

Quality of life studies show that early treatment with dopaminergic medications improves daily functioning, prevents falls, and improves a personâs sense of well-being.

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What Causes Parkinson’s Disease

A substance called dopamine acts as a messenger between two brain areas – the substantia nigra and the corpus striatum – to produce smooth, controlled movements. Most of the movement-related symptoms of Parkinson’s disease are caused by a lack of dopamine due to the loss of dopamine-producing cells in the substantia nigra. When the amount of dopamine is too low, communication between the substantia nigra and corpus striatum becomes ineffective, and movement becomes impaired the greater the loss of dopamine, the worse the movement-related symptoms. Other cells in the brain also degenerate to some degree and may contribute to non-movement-related symptoms of Parkinson’s disease.

Although it is well known that lack of dopamine causes the motor symptoms of Parkinson’s disease, it is not clear why the dopamine-producing brain cells deteriorate.

• Genetic and pathological studies have revealed that various dysfunctional cellular processes, inflammation, and stress can all contribute to cell damage.
• In addition, abnormal clumps called Lewy bodies, which contain the protein alpha-synuclein, are found in many brain cells of individuals with Parkinson’s disease. The function of these clumps in regard to Parkinson’s disease is not understood.

In general, scientists suspect that dopamine loss is due to a combination of genetic and environmental factors.

What Are The Later Secondary Signs And Symptoms Of Parkinson’s Disease

While the main symptoms of Parkinson’s disease are movement-related, progressive loss of muscle control and continued damage to the brain can lead to secondary symptoms. These secondary symptoms vary in severity, and not everyone with Parkinson’s will experience all of them, and may include:

• Normal Blood Pressure By Age

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Where To Go For Help

Several national PD outreach groups exist and provide education, community support, research funding, patient and caregiver programs. Clinical trials of experimental therapies for PD are listed at www.clinicaltrials.gov. The organizations in Table 2 have many patient booklets available for download, educational DVDs, physician information, local support groups, dance and exercise classes, caregiver respite care, fundraising opportunities, and movement disorder specialist referral lists.

Diagnosis Of Parkinsons Disease

There are currently no blood or laboratory tests to diagnose non-genetic cases of Parkinsons. Doctors usually diagnose the disease by taking a persons medical history and performing a neurological examination. If symptoms improve after starting to take medication, its another indicator that the person has Parkinsons.

A number of disorders can cause symptoms similar to those of Parkinsons disease. People with Parkinsons-like symptoms that result from other causes, such as multiple system atrophy and dementia with Lewy bodies, are sometimes said to have parkinsonism. While these disorders initially may be misdiagnosed as Parkinsons, certain medical tests, as well as response to drug treatment, may help to better evaluate the cause. Many other diseases have similar features but require different treatments, so it is important to get an accurate diagnosis as soon as possible.

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What Are The Symptoms

PD symptoms do not predictably differ according to age. However, everyone experiences PD slightly differently. Different people develop different symptoms at different times.3

The most common motor symptoms of PD include:3

• Tremor at rest, such as a tremor in a finger, hand, or foot
• Rigidity of limbs, neck, or shoulder
• Impaired balance when standing up , which can lead to falls
• Slowness of movement or gradual loss of movement , such as slower walking, decreased blinking, or slower facial expressions

• Difficulty swallowing
• Speech issues, such as slurred speech, abnormally long pauses, or hoarseness
• Sleep issues, such as difficulty falling or staying asleep , restless legs syndrome, or acting out dreams

Important Points About The New Medications

With multiple new medications available for the treatment of PD, there is more hope than ever that Parkinsons symptoms can be successfully managed for many years. A few things to consider:

• For people whose symptoms are difficult to control, these new treatments are welcome additions to what was previously available and many people with PD have been using these new medications with significant benefit.
• On the other hand, many of the newly-approved medications have the same mechanisms of action as older medications so they are not breaking new ground in treating symptoms.
• In addition, for some people, the effect on symptoms may be mild or not substantial.

These caveats may mean that your physician has not suggested a medication change for you. It is also important to note that despite all the new medications, carbidopa/levodopa remains the most potent medication to treat the motor symptoms of PD.

If your doctor does choose to try one of the new options, there may be multiple paths that your doctor can take when contemplating a medication adjustment. Often trial and error is the only way to determine the best medication regimen for you, so you may need to practice some patience as you work together with your doctor to determine what works or doesnt work.

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