Parkinson's Disease



Definition:

A disorder of the brain that leads to tremors (shaking), and difficulty with walking, movement and coordination. It is a chronic and progressive movement disorder, which means that symptoms will contiue and eventually worsen over time.

Cause

The true cause of PD is unknown. Parkinson's involves progressive malfunction and death of nerve cells particularly in the substantia nigra portion of the brain. Many of the malfunctioning and dying neurons are ones that produce dopamine. Dopamine is an important neurotransmitter that helps with coordinating muscle movement. Without dopamine the nerve cells are unable to send proper messages to the body which leads to loss of muscle function.
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Risk Factors

  • People over 50. Young adults generally do not experience this disease. It usually begins in middle to late life and the risk continues to increase with age.
  • Family history
  • Sex. Men are more likely than women to develop PD.
  • Exposure to toxins. Chronic exposure to hebicides and pesticides increases one's risk for PD.

Symptoms

Symptoms may be mild at first and may also affect one or both sides of the body.

Symptoms include:
  • Blinking
  • Constipation
  • Difficulty swallowing
  • Drooling
  • Problems with balance and walking
  • No facial expression
  • Muscle aches and pains
  • Movement problems, which include:
      • Difficulty starting movement (ex. starting to walk or getting out of a chair)
      • Difficulty continuing to move
      • Slowed movements
      • Loss of small or fine hand movements (ex. writing may become small and difficult to read or eating becomes difficult)
  • Rigid or stiff muscles, often beginning in the legs
  • Shaking called tremors, which usually:
      • Occurs in the limbs at rest or when the arm or leg is held out
      • Goes away when you move
      • Eventually may be seen in the head, lips, tongue, and feet
      • May be worse when tired, excited, or stressed
      • Finger-thumb rubbing may be present
  • Slowed quieter speech and monotone voice
  • Stooped position
  • Low blood pressure when getting up
  • Sweating
  • Drooling
  • Lack of temperature control

Other symptoms may include:
  • Anxiety, stress, and tension
  • Confusion
  • Dementia
  • Depression
  • Fainting
  • Hallucinations
  • Memory loss

Tests and Diagnosis

There are no standard diagnostic tests for Parkinson's disease. A diagnosis is based on medical history and neurological exam. It can be difficult to diagnose especially in the early stages and in the elderly. Tests may be needed to rule out other disorders that cause similar symptoms.

Treatment

There is no known cure. The goal of treatment is to control the symptoms.

Treatments include:
  • Medications
    • Levodopa (L-dopa), levodopa and carbidopa (Atamet, Sinemet)
    • Dopamine agonists - Pramipexole (Mirapex), ropinirole (Requip), bromocriptine (Parlodel), apomorphine (Apokyn)
    • MAO B inhibitors - Selegiline (Eldepryl, Deprenyl), rasagiline (Azilect)
    • Catechol O-methyltransferase (COMT) inhibitors - Tolcapone (Tasmar), Entacapone (Comtan)
    • Amantadine or anticholinergic medications to reduce early or mild tremors
    • Glutamate (NMDA) blocking drugs - Amantadine (Symmetrel)
    • Memantine, rivastigmine, galantamine for cognitive difficulties
    • Antidepressants for mood disorders
    • Gabapentin, duloxetine for pain
    • Fludrocortisone, midodrine, botox, sidenafil for autonomic dysfunction
    • Armodafinil, clonazepam, zolpidem for sleep disorders
  • Physical therapy
  • Surgery




Complications

  • Depression
  • Sleep problems
  • Difficulty chewing and swallowing
  • Urinary problems
  • Constipation
  • Sexual dysfunction
  • Difficulty in performing daily activities
  • Disability
  • Injuries from falls
  • Pneumonia from breathing (aspirating) saliva
  • Side effects of medications

Dietary Treatment

A normal balanced diet is important in people with Parkinson's disease. People with Parkinson's disease tend to lose weight due to loss of appetite and inadequate food intake.
  • Eat a balanced diet with all nutritional requirements
  • Maintain bone growth
  • Maintain bowel regularity
  • Balance medications and food
  • Adjust nutritional proirities according to stage of disease
  • Extra fruits and vegetables provide more fiber
  • Take medications before meal time on an empty stomach
  • Drink plenty of fluids during the day to prevent dehydration

Exercise


Exercise is important because it helps to keep the muscles strong and improve flexibility and mobility. Exercise will not stop the progression of PD but it will help to improve balance and prevent joint stiffening. The type of exercise one should perform will depend on individual symptoms, fitness levels, and overall health. Exercises that work on flexibility by taking a joint through its full range of motion are generally best. It is recommended that patients speak with a physical therapist or other professional in planning an exercise regimen.

Tips for Exercise
  • Always warm up before beginning exercise and implement a cool down at the end.
  • When beginning exercise start out with smaller increments of time (10 minutes) and gradually increase until goal is obtained.
  • Exercise facial muscles, jaw and voice whenever possible. This can be done by reading or singing out loud, chewing vigorously, an making faces.
  • Exercises performed in water are recommended due to less stress on the joints and it requires less balance.
  • Ensure that the workout environment is appropriate so it will not result in any unnecessary injury. If there are balane issues try exercising near a hand rail or other sturdy object that can be used to maintain balance.
  • Choose a hobby or activity that you enjoy and incorporate exercise into it. This helps to increase the likelihood of adhering to your exercise plan.






Resources:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001762/
http://www.mayoclinic.com/health/parkinsons-disease/DS00295
http://www.pdf.org/en/diet_nutrition
http://medicalcenter.osu.edu/patientcare/healthcare_services/parkinsons_disease/Pages/index.aspx