Parkinson's disease

2021-08-26 10:43 PM

There is no cure for Parkinson's disease, but many medications can treat the symptoms. In some cases, your doctor may recommend surgery.

Define

Parkinson's disease is a progressive nervous system disorder that affects movement. It develops gradually, often starting with a barely noticeable tremor in just one hand. But while tremors may be the most prominent sign of Parkinson's disease, the disorder also often causes slow or stopped movement.

Others may notice little or no facial expressions and no arm swings when walking. Speech often becomes soft and mumbling. Parkinson's symptoms tend to worsen as the disease progresses.

There is no cure for Parkinson's disease, but many medications can treat the symptoms. In some cases, your doctor may recommend surgery.

Symptoms

Symptoms of Parkinson's disease can vary from person to person. The signs may be faint and may go unnoticed. Symptoms usually start on one side of the body and are often worse even after symptoms begin to affect both sides. Signs and symptoms of Parkinson's may include:

Tremors

The tremors associated with Parkinson's disease usually begin in one hand. Prolapse of the thumb and index finger is common and can occur when the hand is at rest. However, not everyone experiences shaking.

Slowed movement

Over time, Parkinson's disease can reduce the ability to initiate voluntary movement. This can make simple tasks difficult and time-consuming. When walking, the steps can become short and chaotic. Or the foot may stay longer to the floor, making it difficult to take the first step.

Muscle stiffness

Muscle stiffness can occur in any part of the body. Sometimes the stiffness can be so severe it limits the range of motion and causes pain. This can be first noticed when no longer swinging the arm while walking.

Impaired posture and balance

Posture can become stooped as a result of Parkinson's disease. Balance problems can also occur, although this is usually in the later stages of the disease.

Loss of automatic movement

Blinking, smiling, and swinging your arms while walking, all unconscious behaviors that are a normal part of being human. In Parkinson's disease, these behaviors tend to be diminished and even lost. Some people may develop fixed expressions and unblinking eyes. Others may take longer or appear to be motionless when they speak.

Change the voice

Many people with Parkinson's disease have problems with speaking. May speak more softly, quickly, or monotonically, sometimes repeat words, or hesitate before speaking.

Dementia

In the late stages of Parkinson's disease, some people develop problems with memory and mental clarity. Alzheimer's drugs can relieve some mild symptoms.

See your doctor if you have any symptoms associated with Parkinson's disease - not only to diagnose the disease but also to rule out other causes for symptoms.

Causes

The exact cause of Parkinson's disease is unknown, but several factors appear to play a role, including:

Gene. Researchers have found specific mutated genes that may play a role in Parkinson's disease. Additionally, scientists suspect changes in even more genes - whether inherited or due to environmental exposures - could be the cause of Parkinson's disease.

Environment. Exposure to certain toxins or viruses can trigger Parkinson's signs and symptoms.

In addition, changes were found in the brains of people with Parkinson's disease. The role of these factors in the development of the disease, however, if any is unclear. These changes include:

Lack of dopamine. Many symptoms of Parkinson's disease result from a lack of a chemical called dopamine in the brain. This happens when brain cells that produce dopamine die or become impaired. Why and exactly how this happens is unknown.

Low norepinephrine levels. People with Parkinson's disease also have nerve damage from norepinephrine. Norepinephrine plays a role in regulating the autonomic nervous system, which controls automatic functions, such as blood pressure regulation.

Lewy body dementia. An abnormal protein called Lewy is found in the brains of many people with Parkinson's disease. The occurrence and abnormalities of Lewy disease are unknown.

Risk factors

The age. Young adults rarely get Parkinson's disease. It usually begins in mid or late life, and the risk continues to increase with age.

Genetic. Having a close relative with Parkinson's disease increases the chance of developing the disease, although the risk is no more than 4 to 6 percent.

Sex. Men are more likely to develop Parkinson's disease than women.

Exposure to toxins. Exposure to herbicides and pesticides slightly increases the risk of Parkinson's disease.

Complications

Parkinson's disease is often accompanied by the following problems:

Depression

Depression is common in people with Parkinson's disease. Treating depression can make dealing with Parkinson's disease easier.

Sleep problems

People with Parkinson's disease often have trouble falling asleep and may wake up frequently at night. They may also experience a sudden onset of sleep, naps during the day.

Difficulty in chewing and swallowing

The muscles used to swallow may be affected in the later stages of the disease, making eating more difficult.

Urinary problems

Parkinson's disease can cause urinary incontinence or urinary retention. Some medications used to treat Parkinson's can also make urination difficult.

Constipation

Many people with Parkinson's disease develop constipation because the digestive tract works more slowly. Constipation can also be a side effect of medication.

Sexual dysfunction

Some people with Parkinson's disease may notice a decrease in sex drive. This may stem from a combination of psychological and physical factors or maybe the result of physical factors.

Medicines for Parkinson's disease can also cause a number of complications, including involuntary seizures or jerky movements of the arms or legs, hallucinations, drowsiness, and low blood pressure when standing up.

Tests and diagnostics

There is no definitive test for diagnosing Parkinson's disease, so it can be difficult to diagnose, especially in the early stages. Symptoms of Parkinson's disease can be caused by many other problems. For example, other neurological disorders, toxins, head trauma, and even certain medications - such as chlorpromazine (THORAZINE), prochlorperazine (Compazine) or metoclopramide (REGLAN), can cause Parkinson's.

Diagnosis of Parkinson's disease is based on medical history and neurological examination:

Medical history. Your doctor wants to know about any medications you're taking and look at your family history of Parkinson's.

Neurological examination. Testing includes assessing walking coordination, as well as some simple handwork.

A diagnosis of Parkinson's disease is most likely to be:

Have at least two of the three signs and symptoms of Parkinson's - tremors, slowness of movement, and muscle stiffness

The onset of the above symptoms on only one side of the body.

Shaking is more pronounced at rest, for example, when the hand is at rest.

Significant improvement with the drug levodopa.

Treatments and drugs

There is no cure for Parkinson's disease, but medication can help control some of its symptoms, and in some cases, surgery can be helpful. Your doctor may recommend lifestyle changes, such as physical therapy, a healthy diet, and exercise.

Medicine

Medications can help manage problems with movement, walking, and tremors by increasing the brain's supply of dopamine. However, dopamine by itself is not helpful, as it cannot enter the brain.

The initial response to Parkinson's treatment can be dramatic. Over time, however, the benefits of the medications diminish or become less relevant, although symptoms can often still be fairly well controlled.

Medications your doctor prescribes may include:

Levodopa. Levodopa is the most effective, it is a natural substance in the body. When taken in pill form, it enters the brain and is converted to dopamine. Levodopa is combined with carbidopa to create combination drugs. Carbidopa protects levodopa from premature conversion to dopamine outside the brain, it also prevents nausea. In Europe, levodopa is combined with a benserazide, eg Madopar.

As the disease progresses, the benefits from levodopa may become less stable. This then requires medication adjustments. Levodopa side effects include involuntary movements, dyskinesia. Resolved by dose reduction. Like other Parkinson's drugs, it can also lower blood pressure with standing.

Dopamine agonist. Unlike levodopa, these drugs are not converted to dopamine. Instead, it mimics the effects of dopamine in brain neurons and induces a dopamine-like response. It is not nearly as effective in treating the symptoms of Parkinson's disease. However, it lasts longer and is often used to soften the effects of levodopa. This category includes pills, such as pramipexole (Mirapex) and ropinirole (Requip). The short-acting derivative, apomorphine (Apokyn), is used for quick relief of symptoms.

Side effects of dopamine agonists include hallucinations, drowsiness, fluid retention, and hypotension on standing. These drugs can also increase the risk of compulsive behaviors such as lust, gambling, and overeating. If you are taking these medications and start behaving that way, talk to your doctor.

MAO B inhibitors. These drugs include selegiline (ELDEPRYL) and rasagiline (Azilect), which help prevent the natural breakdown of both the dopamine and dopamine formed from levodopa. It inhibits the activity of monoamine oxidase B enzyme - an enzyme that metabolizes dopamine in the brain. Side effects are rare but can include confusion, headache, hallucinations, and dizziness. These medicines may not be used in combination with other antidepressants, the antibiotic ciprofloxacin (Cipro), the herb St John's wort, or certain narcotics. Check before taking any supplements with an MAO inhibitor.

Catechol O-methyltransferase (COMT) inhibitors. These drugs prolong the effects of levodopa-carbidopa, by blocking the enzyme that breaks down levodopa. Tolcapone (Tasmar) has been linked to liver damage and liver failure, so it's usually only used in people who don't respond to other therapy. Entacapone (Comtan) does not cause liver problems and is currently combined with carbidopa and levodopa in medicine called Stalevo. However, it can cause other effects of levodopa, such as involuntary movements (dyskinesias), nausea, confusion, or hallucinations. It can cause urine discoloration.

Anticholinergic drugs. These drugs have been used for many years to help control the tremors associated with Parkinson's disease. Several anticholinergic drugs, such as benztropine (Cogentin) and trihexyphenidyl are available. However, the benefits are modest because of side effects such as memory loss, constipation, dry mouth, and vision disturbances, and difficulty urinating.

Glutamate blocking drugs (NMDA). Doctors may prescribe Amantadine (Symmetrel) alone to provide short-term relief of mild, early stages of Parkinson's disease. It may also be added to levodopa-carbidopa therapy in later stages of Parkinson's disease, especially if there is a problem with voluntary movements (dyskinesia) caused by levodopa-carbidopa. Side effects include purple skin mottling and sometimes hallucinations.

Physical therapy

Exercise is important for general health, but especially for maintaining function in Parkinson's disease. Physical therapy may be recommended and can help improve mobility, range of motion, and muscle tone. While specific exercises cannot stop the progression of the disease, maintaining muscle strength and agility can help with the progression of the disease and also allow one to feel more confident and capable. Physical therapy can also help improve gait. Speech therapy or speech pathology can improve speech and swallowing problems.

Surgery

Deep brain stimulation, conducting surgery is used to treat Parkinson's disease. It involves implanting an electrode deep in the part of the brain that controls movement. Delivered by electrode stimulation controlled by a pacemaker-like device placed under the skin in the upper chest. A wire that goes under the skin connects the devices, called a pulse generator to the electrodes.

Deep brain stimulation is often given to people with severe Parkinson's disease, and levodopa doesn't work. It can stabilize oscillation and reduce or eliminate voluntary movements (dyskinesia). Tremor is particularly responsive to this treatment.

Serious risks of this measure are common, including brain hemorrhage or stroke. Infection is also a risk and sometimes requires equipment parts to be replaced. Deep brain stimulation is not beneficial for people who do not respond to levodopa-carbidopa.

Lifestyle and remedy

If you receive a diagnosis of Parkinson's disease, it's important to work closely with your doctor to find a treatment plan that provides the greatest relief from symptoms with the fewest side effects. Certain lifestyle changes can also help make living with Parkinson's disease easier.

Healthy eating

Eat a nutritionally balanced diet that contains plenty of fruits, vegetables, and whole grains. Foods that are high in fiber are important to help prevent constipation that is common in Parkinson's disease. A balanced diet that also provides nutrients, such as omega-3 fatty acids, may be beneficial for people with Parkinson's disease.

If you have a fiber supplement, like psyllium powder, Metamucil or Citrucel, take it gradually and drink plenty of water daily. Otherwise, constipation may get worse. If you find fiber helps symptoms, use it on a regular basis for best results.

Walking with care

Parkinson's can disturb your sense of balance, making walking difficult with a normal gait. These suggestions can help:

Try not to move too fast.

Aim for the first heel touch when walking.

If the disturbance is noticed, stop and check posture. It is best to stand upright.

Avoid falls:

In the late stages of this disease, it may be easier to fall. The following suggestions may help:

Do not rest your body axis on your feet while spinning.

Do not lean or approach. Keep the center of gravity on your feet.

Do not perform controls while walking.

Avoid turning back when leaving.

Wearing clothes:

Wearing clothes can be difficult with Parkinson's disease. The loss of control makes it difficult to button clothes. An occupational therapist can point to techniques that make everyday activities easier. These suggestions may also help:

Allow plenty of time to not feel rushed.

Get clothes nearby.

Choose clothes that can be put on easily, such as simple tops or pants with elastic.

Use fabric buckles, such as Velcro, instead of buttons.

Alternative medicine

Forms of alternative medicine that can help people with Parkinson's include:

Coenzyme Q10. People with Parkinson's disease tend to have low levels of coenzyme Q10, and some studies have suggested it may help. However, subsequent research did not confirm this. Coenzyme Q10 can be purchased without a prescription at drugstores and natural foods stores. Discuss with your doctor before taking this supplement to ensure that it will not interfere with any medications being taken.

Massage. Therapeutic massage can relieve muscle tension and promote relaxation, which may be especially helpful for people experiencing the muscle stiffness associated with Parkinson's disease. These services, however, are rarely covered by health insurance.

Tai chi. An ancient form of Chinese exercise, tai chi uses slow motion to help improve flexibility and balance.

Yoga. Yoga is also a type of exercise that increases flexibility and balance. Most poses can be done, depending on physical ability.

Coping and supporting

Living with any chronic illness can be difficult, and it's common to feel angry, depressed, and frustrated. Parkinson's is particularly problematic because it can cause chemical changes in the brain that make you feel anxious or depressed. And Parkinson's disease can be deeply frustrating, as walking, talking, and even eating becomes more difficult and time-consuming.

While friends and family can be your best allies, understanding what you're going through can be especially helpful. Support groups aren't for everyone, but for many, they can be a good resource for factual information about Parkinson's disease, as well as a place to learn from people who are going through similar things.

To learn about support groups in your community, talk to your doctor, Parkinson's disease patient, or public health worker.

Prevention

Since the cause of Parkinson's disease is unknown, the definitive way to prevent the disease also remains a mystery. However, some studies have shown that caffeine, found in tea, coffee, and cola, may reduce the risk of developing Parkinson's disease.

Related articles:

- Disease and Parkinson's syndrome

- Practice diagnosis and treatment of Parkinson's

- Parkinsonian gait - signs of symptoms and causes

- Wolff Parkinson White Syndrome (WPW)

- Hand tremor, shock tremor