Parkinson's Disease

Neurological Disorders

What is Parkinson's disease

Parkinson's disease is the second most common neurodegenerative disorder and the most common movement disorder. It is characterized by progressive loss of muscle control, which leads to trembling of the limbs and head while at rest, stiffness, slowness, and impaired balance. As symptoms worsen, it may become difficult to walk, talk, and complete simple tasks.

Symptoms

The primary symptoms of Parkinson's disease are all related to voluntary and involuntary motor function and usually start on one side of the body. Symptoms are mild at first and will progress over time. Some individuals are more affected than others. Characteristic motor symptoms include the following:

• Tremors: Trembling in fingers, hands, arms, feet, legs, jaw, or head.
• Rigidity: Stiffness of the limbs and trunk, which may increase during movement. Rigidity may produce muscle aches and pain.
• Bradykinesia: Slowness of voluntary movement.
• Postural instability: Impaired or lost reflexes can make it difficult to adjust posture to maintain balance.
• Parkinsonian gait: Individuals with more progressive Parkinson's disease develop a distinctive shuffling walk with a stooped position and a diminished or absent arm swing.

Secondary symptoms of Parkinson's disease

• Anxiety, insecurity, and stress
• Confusion
• Memory loss
• Dementia
• Constipation
• Depression
• Male erectile dysfunction

Treatment

There is currently no treatment to cure Parkinson's disease. Several therapies are available to delay the onset of motor symptoms and to ameliorate motor symptoms. All of these therapies are designed to increase the amount of dopamine in the brain either by replacing dopamine, mimicking dopamine, or prolonging the effect of dopamine by inhibiting its breakdown.

Coping up with the disease

Coping with a chronic (ongoing) medical condition is challenging for all persons including the patient, spouse, children, extended family, and friends. Everyone involved has their own emotions, finances, stresses, worries, and frustrations. The caregiver's health is just as important as the person with Parkinson's.

Regular exercise increases the power of neurotransmitters in the brain to enhance mood and positive thinking and can help relieve the muscle tension that builds up in the body. Exercise can improve self-image and thus help deal with life's daily stresses. Regular exercise helps patients with PD experience a milder and less-progressive disease process. It also helps keep bones strong, maintain balance and prevent falls. Stretching exercises enhance flexibility. Strengthening programs can improve the muscles for maintaining balance and good posture

Although Parkinson's disease progresses slowly, it will eventually affect every aspect of life-from social engagements, work, to basic routines. Accepting the gradual loss of independence can be difficult. Being well informed about the disease can reduce anxiety about what lies ahead.

Activities of daily living

The following tips are meant to be helpful and raise awareness of adjusting to some of the difficulties with PD.

Falling

• Remove throw rugs and low-lying obstacles from pathways inside and outside your home.
• Use a cane when necessary.
• Avoid using stepladders or stools to reach high objects.
• Stop walking or sit down if you feel dizzy.
• Install handrails, especially along stairways.
• Slow down when you feel yourself in a hurry.
• Before rising from your bed pause for a moment in a sitting position.

Sensory complaints

• Warm baths and regular massage will help relax tired muscles.
• When your hands or feet get cold, wear gloves or warm socks.
• Don't overdo physical activities; know your limits and stay within them.

Turning in bed

• Install night lights.
• Install light switches where you can reach them easily while in bed.
• When turning to one side, first turn your head, then push off with the opposite foot and rotate your hips. As soon as your hips start to move, reach with your uppermost arm in the same direction.
• When you want to sit up, lie on your side facing out, near the edge of the bed. Place both hands flat on the bed in front of your chest. Push down with your hands, and swing your legs over the edge.
• To get out of bed, first sit up on the edge of the bed, put both feet on the floor, place your hands next to your hips, and push off slowly.
• Satin bed sheets or satin pajamas reduce friction and make movement easier.

Sleep problems

• Depression can cause insomnia. Tell your doctor about it.
• Watch for breathing difficulty during sleep.
• Restless leg syndrome can be the cause sleep problems.
• Excessive daytime sleepiness can be caused by dopamine agonists medications.
• Avoid alcohol, caffeine and fluid intake at night.
• Avoid daytime naps and try to re-establish a normal sleep-wake cycle.
• Tell your doctor about motor activity during dreams (striking out, yelling).

Dressing

• Replace clothes that have complicated fasteners with ones you can slip on easily, such as sweatpants, sweatshirts, or pants with elastic waistbands.
• Avoid clothes that fasten in the back.
• Look for clothes and shoes that have Velcro fasteners, or have the buttons and zippers on your clothes replaced with Velcro.
• Make your dressing area "user friendly." Install clothes rods and drawers that make your clothing easy to reach.
• Dress sitting down on a bed or a chair. Place the clothes you plan to wear next to you on the bed or on a table within easy reach.
• Always wear shoes or slippers.
• Put clothes on and take clothes off from your stiffer side first.

Hygiene

• "Accident-proof" your bathroom. Replace glass partitions and slippery bath mats, and use paper cups.
• Tile flooring in the bathroom can become slippery and dangerous when wet. Consider replacing it with wall-to-wall carpeting.
• Install sturdy grab bars next to the bath, toilet, and wherever else you need balance and support. Never use towel racks for support.
• Avoid standing up in the bathtub. If you like to take showers, consider sitting down in the shower or place rubber mats on the floor of the tub.
• Instead of drying with a towel after you bathe, put on a terry-cloth robe.
• Use an electric toothbrush.

Walking

• If you notice yourself shuffling, slow down or stop walking and check your posture.
• Keep your feet a comfortable distance apart, eight to ten inches.
• Stand up straight with your head over your hips.
• Buy a good pair of walking shoes with a low heel and good arch support.
• Exaggerate lifting your feet and swinging your arms. With each step, pretend you are stepping over a log.
• Practice taking long steps.
• When you need to turn around, don't pivot on one foot. Instead, walk around in a circle until you're facing the direction you want to go.

Swallowing

• Take extra-small bites of food, chew thoroughly, and swallow carefully.
• Chop up your food in a food processor, so that it's easier to chew and swallow.
• Always swallow your food completely before taking more food into your mouth.
• Use an electric warming tray to keep your food hot so that you won't feel the need to rush.
• Swallow excess saliva before you put food into your mouth.
• Keep a beverage at hand during meals and take frequent sips.

Freezing

• When you freeze, stop trying to walk; instead, press your heels to the floor.
• Look straight ahead, not down.
• Pick a target and walk towards it, especially when walking through doorways.
• If you're walking with someone, have the person hold your arm or elbow.
• Stand up straight, with your head over your hips, but don't lean backwards.

Tremor

• Perform difficult tasks when you feel well and when your medication is working effectively.
• Relax. Sit down from time to time, relax your arms and shoulders, and take deep breaths.
• Get a regular massage.
• Avoid caffeine and alcohol.
• Get plenty of rest.

Salivation

• To control saliva accumulation, you must swallow. Swallowing may no longer be an automatic reflex. You may have to force yourself to remember to swallow.
• Chew gum or suck on a piece of hard candy.
• Try sleeping on your side, so that you won't wake up choking during the night.
• Swallow excess saliva before you put food into your mouth.
• Keep a beverage near you during the day. Get in the habit of frequently taking small sips.

Cutting food

• Use "non-skid" or rubber place mats that will help you keep your plates and serving dishes from sliding.
• Eat foods that do not require cutting with a knife.
• Use a food processor to chop or shred your food after it is cooked.
• Ask someone to cut your food for you.
• Use large-handled utensils that are easy to grip.
• Use flexible straws to prevent spills.

Speech

• Take a breath before you start to speak, and pause between every few words or even between each word.
• Exaggerate your pronunciation. Pretend that your listener is hard of hearing and needs to read your lips.
• Face your listener directly when speaking.
• Finish saying the final consonant of a word before starting to say the next word.
• Express your ideas in short, concise phrases or sentences.
• Exaggerate facial motions as you practice reciting the alphabet, counting numbers, or reading a magazine or newspaper out loud.
• Encourage your family and friends to ask you to speak louder or repeat yourself if they can't understand what you're saying.
• Speak for yourself, and speak often. Don't get in the habit of letting others speak for you.

Handwriting

• Try using a large-body pen or pencil or one with a build-up handle.
• Experiment with different types of pens. Felt-tip pens, for example, have a "slippery" feel that offers less resistance.
• Lift your arm up from time to time, straighten your elbow, and move your fingers.
• Instead of writing by hand, use a typewriter or word processor. If you don't have keyboard skills, practice a little every day. The exercise will help improve your dexterity.