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This article was written at the request of a Parkinsons patient who wanted to know how patients die from PD.
Most patients die with Parkinsons Disease and not from it. The illnesses that kill most people are the same as those that kill people with PD. These are heart conditions, stroke and cancer. As we age we become increasingly aware that more than one bad thing can happen to our bodies.
What Are Lewy Bodies
The affected neurons of people with Parkinsons disease have been found to contain clumped proteins called Lewy bodies, but researchers arent yet sure why Lewy bodies form or what role they play in the disease.
Lewy bodies are clumps of a protein called alpha-synuclein . Neurons cant break down these protein clumps, which may lead to the death of these cells.
Some other theories about what causes the death of brain cells in people with Parkinsons disease include free radical damage, inflammation, or toxins.
Should I Get The Covid
For most people with Parkinsons disease, the answer is yes, get the vaccine. However, you should speak with your healthcare provider first.
Currently any risk the vaccine poses does not seem to be worse when given to those with Parkinsons disease. The vaccines were not studied specifically in people with Parkinsons, but there is likely enough benefit in reducing the risk of severe illness to suggest getting the vaccine.
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Emergencies And Complications Of Device
Device-aided therapies include deep-brain stimulation, levodopa-carbidopa intestinal gel, and apomorphine subcutaneous injections and infusion. These are indicated to treat response fluctuations, such as recurrent disabling offs and dyskinesias refractory to standard therapy. Deep-brain stimulation is also used for drug-refractory tremor. Emergencies and complications related to device-aided therapies are not uncommon, and require prompt medical attention since they are generally associated with significant aggravation of Parkinsons disease symptoms .
An algorithm approach for DBS efficacy loss. DBS, deep-brain stimulation LD, levodopa.
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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Drastic Changes In Blood Pressure
PD can cause drastic changes in blood pressure because it affects the autonomic nervous system, which controls blood flow and blood pressure. Unlike other parts of the body, we do not have control over our nervous system. When PD occurs, it takes over the nervous system creating changes in blood pressure throughout the day, says Medical News Today.
These drastic changes in blood pressure can lead to orthostatic hypertension, a drop in blood pressure that causes a person to feel dizzy or faint when they stand up, writes the source. It can also lead to falls and fainting. Another common problem is low blood pressure, also known as hypotension. High blood pressure can also be a problem for some people. Any type of wild fluctuation between the two can lead to heart problems. To help treat this complication and avoid any drastic changes, doctors can sometimes prescribe medications that will help stabilize blood pressure. Patients can also invest in a pair of compression stockings which may also be helpful.
What Are Motor Complications Of Parkinsons Disease
The motor complications of Parkinsons disease are the side effects related to the motor activities of the patient that are caused due to the prolonged use of medication for treatment purposes. The motor complications may be essentially grouped into two main categories, namely-
Fluctuations- These include the symptoms like wearing off along with the on and off phase of Parkinsons disease.
Dyskinesia- These are characterized by involuntary muscular movements like twitches and shaking of limbs and other body parts usually brought about by levodopa therapy.
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What Are The Symptoms Of Parkinson’s Disease
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
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.
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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Two Areas In Which Parkinsons Disease May Bring About Death
PD patients are at an increased risk of falling and bad falls can lead to death. This usually occurs as a complication of a fall that requires hospitalization, particularly if it involves surgery. While most people do not fracture their hips when they fall, some do, and hip surgery, while routine, is still major surgery. It carries the risk of infection, delirium related to pain medications and anesthesia, heart failure, pneumonia, blood clots in the legs that then go to the lungs, and general weakness from immobility. Hip fractures are probably the main cause for death for those who fall, but people can fracture other bones and require surgery. They may fracture their ribs, which leads to reduced coughing, because of the pain, and an increased risk of lung infections . It is surprisingly uncommon for Parkinsons Disease patients to die from brain injuries related to falls, but it still may occur.
PD patients also may develop pneumonias completely unrelated to difficulties with swallowing, just like their non-PD friends and relatives.
Reduced Sense Of Smell
According to research published in the Parkinsons Disease journal, over 95-percent of people with this chronic condition will lose their sense of smell to some degree. Part of this loss of smell may be an inability to identify certain odors or differentiate between odors. This is due to Parkinsons impact on the nervous system, says Medical News Today.
This reduced sense of smell can be interpreted as a warning sign of PD because it can begin to happen years before any other symptoms appear. Oftentimes its overlooked. The source notes that doctors can sometimes use a reduced sense of smell as a predictor for PD. Its also considered one of the top five most common symptoms.
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Causes And Risk Factors Of Parkinsons Disease
Most cases of Parkinsons disease are idiopathic, meaning the cause is unclear.
Its widely believed that a person with Parkinsons may have been genetically vulnerable to the disease, and that one or more unknown factors in the environment eventually triggered the disease.
Normally, the neurons in this part of the brain make the chemical messenger dopamine, which allows communication with another area of the brain, the corpus striatum.
This communication helps produce smooth, purposeful movement. When the neurons in the substantia nigra die, the resulting loss of communication leads to the motor symptoms of Parkinsons.
Although the cause of this cell death is unknown, many researchers believe that the cells are killed by clumped proteins called Lewy bodies.
Complications Of Parkinsons And Covid
It has been found that motor and non-motor symptoms of Parkinsons disease may become worse due to COVID-19 infection.
Other studies showed an increase in symptoms from Parkinsons disease during the pandemic, even without COVID-19 infection, due to a lack of physical activity and the need for people with Parkinsons to isolate themselves from others to reduce the risk of infection. Worsening symptoms included:
- Psychologic distress
Long COVID-19 symptoms may continue well after the initial infection has resolved. COVID-19 infection has been associated with long-term effects on the following body systems:
- Heart: Heart muscle damage has been found in patients with COVID-19. This could lead to a weakened heart muscle or heart failure.
- Lungs: Damage to the air sacs in the lungs by pneumonia from the virus can cause difficulty breathing after the infection has resolved.
- Brain: Some people who had COVID-19 developed strokes, and many report difficulty thinking or concentrating.
One article estimated that at least 10% of people diagnosed with COVID-19 will be considered a long-hauler currently it is unknown which patients are at a higher risk for developing long COVID-19 symptoms.
Many long-haulers initially had mild symptoms, did not require hospitalization, and did not have other comorbidities.
At this time, it is not known if having Parkinsons disease increases the risk of being a long-hauler. Research is ongoing to help answer these questions.
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Managing Motor Complications Of Parkinsons
The motor complications discussed so farfrom tremor to balance problemsmay all be managed with different Parkinsons medications, says Jennifer S. Hui, M.D., a neurologist with Keck Medicine of University of Southern California in Los Angeles. The gold standard medication is levodopa, which is a medication that basically gets converted to dopamine, which is the missing neurotransmitter in the brain in Parkinsons, she explains. Its very effective at treating the motor symptoms. Other medications may be used as well, such as dopamine agonists or different delivery methods , she says.
Living With Parkinsons Disease
Patients living with PD can take steps to ensure they get quality care from their healthcare team, as well as take good care of themselves.
Staying as active as possible with help from an occupational therapist who can show you how to modify daily activities, eating a healthy and well-balanced diet, and taking medications as prescribed can all help optimize your health and promote well-being. Talking with the doctor about any challenges or concerns can also help you brainstorm solutions to problems or help create a plan to address issues.
Don’t neglect emotional health, as well. Depression and anxiety affect up to half of those living with PD.5
Mood disorders and changes like these can actually worsen symptoms and affect overall health, so proper treatment is crucial. Tell the doctor if youre noticing changes in mood at all, so this can be addressed with treatment, whether its medication, counseling, or both. Spending time with other people friends, family members, activity groups can also help decrease feelings of isolation or loneliness.
Eating And Weight Issues
Because Parkinsons can affect muscles used for chewing and swallowing, you may experience choking on food or drink, slow eating, or drooling, and, as a result, unintentional weight loss, according to Michigan Medicine. Patients may lose their appetite due to a variety of issues, adds Dr. Hui. Number one, they tend to lose their sense of smell, which makes food not taste as good. They might also have difficulty swallowing because of difficulty with coordination of swallowing muscles, so its just harder and slower for them to eat. Working with a speech therapist and dietitian can be helpful.
Who Is Prone To Parkinson’s Disease
Some people are more to Parkinsons disease than others. They include:
- People who are of advanced age
- Males are more likely to get Parkinsons disease than females
- People with a family history of Parkinsons disease
- Postmenopausal women who have very low levels of oestrogen
- Women who have undergone hysterectomies
- People who suffer from vitamin B deficiency
- People who have suffered from head trauma
- People who are frequently exposed to environmental toxins such as a pesticide or herbicide
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How Is Parkinson’s Disease Managed
Your doctors will tailor your treatment based on your individual circumstances. You will manage your condition best if you have the support of a team, which may include a general practitioner, neurologist, physiotherapist, occupational therapist, psychologist, specialist nurse and dietitian.
While there is no cure for Parkinson’s disease, symptoms can be treated with a combination of the following.
Causes Of Parkinson’s Disease
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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Complications Of Parkinsons Disease
Cognitive problems can occur in the later stages of Parkinsons disease, such as thinking difficulties and impaired reasoning. Emotional changes are also common, namely depression and anxiety. In fact, nearly half of sufferers experience clinical depression at some point in their lives, and its quite common for people living with chronic conditions to feel anxious. Dementia is another complication of Parkinsons disease, due to abnormal protein deposits in the brain known as Lewy bodies. This causes memory loss, trouble concentrating, poor judgement, hallucinations, delusions, irritability, sleep disturbances, and anxiety. Some of these symptoms can be treated with the same medications that treat Alzheimers disease and other forms of dementia.
Sleep problems and disorders are a common complication of Parkinsons disease. These issues range from trouble falling asleep and confusion at night, to acting out dreams and restless legs syndrome, to sleep apnea and frequent need to urinate. Additional bladder and bowel problems include stool leakage, diarrhea and constipation, constant urge to urinate, weak urine stream, and leaking with laughter, exercise, or sneezing. Most of these bladder and bowel issues can be resolved through lifestyle changes, like taking stool softeners, increasing intake of fiber and fluid, and going to the bathroom at regular times throughout the day.
Defining Features Of Parkinsons Disease
The defining features of Parkinsons disease are a variable combination of slowness of movement, muscle rigidity and resting tremor. Sometimes the onset of Parkinsons disease is characterised by vague, non-specific symptoms such as fatigue or localised muscle pain making early diagnosis very difficult. People should be aware that other complications can also develop with this disease. Other early symptoms of Parkinsons disease can include mild depression, restlessness or a softer voice. No two people will experience the disease in exactly the same way. The nature, severity and impact of symptoms can vary markedly.
The resting tremor associated with Parkinsons disease usually affects one side of the body first and is typically more evident when the muscles are relaxed. This is in contrast to other types of tremor, which usually affect both sides of the body, improve with rest and become worse with activity. Tremor usually affects the hands and arms and less frequently the legs, jaw or head. Stress or fatigue exacerbate tremor.
SLOWNESS OF MOVEMENT – BRADYKINESIA
Increased muscle tone can cause stiffness, pain and cramps. People with Parkinsons disease typically become stooped and may walk with a shuffle or a limp. Their arms cease to swing when they walk and they can have difficulty turning around.
ANXIETY & DEPRESSION
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Depression Anxiety And Apathy
Mental health and emotional changes may also be complications of Parkinsons disease, according to the NIH. Depression and anxiety can actually precede the motor symptoms before diagnosis, says Dr. Hui. In fact, up to half of people with Parkinsons may deal with depression or anxiety at some point during their disease, says the Michael J. Fox Foundation for Parkinsons Research. Antidepressants can help, Dr. Hui says. Apathya lack of motivation and interestmay also occur, affecting up to 40% of people with Parkinsons, per the Foundation. Exercise and a regular sleep/wake schedule can be helpful here too, they say.
Black Americans And Parkinsons Disease
Most research suggests that Parkinsons disease is more likely to affect whites and Hispanics.
But, some studies have shown that Black patients may be less likely to receive proper care for the disease.
A review published in 2018 in Neurology found there are racial disparities when it comes to managing Parkinsons disease.
Researchers identified one study that showed Black patients were 4 times less likely than whites to be started on treatment for Parkinsons.
Another study found an average seven-year delay in diagnosis among Black patients.
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What Are The Symptoms Of Parkinson’s Disease How Is Parkinson’s Disease Diagnosed
People with Parkinsons disease suffer from motor symptoms as well as non-motor symptoms.
Motor symptoms include intermittent tremors, slow and rigid movements. Non-motor symptoms include loss of smell, pain and even dementia.
In the initial stages of Parkinsons disease a person may experience symptoms such as:
- Slight rigidity in the arms and legs
- unable to change facial expressions according to emotions spontaneously
- Slight back pain due to which the posture of the person may be slightly stooped
- Sudden stiffness in the body at times
- Tremor on one arm on one side of the body
- The symptoms may be experienced only on one side of the body
- Handwriting may get messier and smaller
In the intermediate stage of Parkinsons disease a person may experience symptoms such as:
- Slower movements and therefore takes longer to do the daily work such as combing, dressing etc
- Loss of balance
- Sudden falls due to frequent loss of balance
- Slurring of speech
- Inability to speak loudly and clearly
- Erratic footwork, as the person is unable to start walking immediately after getting up as if the feet are stuck to the ground, or change direction quickly while walking
- Taking smaller steps than normal while walking
- Trouble swallowing food
- May require aids while walking such as a walker
In the advanced stage of Parkinsons disease the symptoms include: