Parkinson's disease overview

IGEA, Parkinson awareness

Parkinson's disease was first discovered in 1817 by James Parkinson. Although initially labeled a Palsy disorder, Parkinson's disease is a neurodegenerative disorder and has both motor and nonmotor components. It is a common disorder and affects around one million Americans. Typically Parkinson's disease affects elderly people, however, it can be young-onset and patients can begin to show symptoms as young as in their 30's and 40's. Factors that impact the development of the disease in patients include stress, environmental toxins, and free radicals. However, smokers and people that consume caffeine regularly have been shown to have a smaller chance of developing the disease. Gene mutations have also been linked to increased risk of developing Parkinson's diseases. Gender plays a role as well in the risk factors. Men are more likely to develop Parkinson's than women and although studies have suggested that estrogen plays a role in the lower instances of women with Parkinson's disease, it has not been conclusive. (Miller, 2010)

Slideshare, TRAP

There are four common symptoms of Parkinson's that can be described by the acronym TRAP. The first symptom in the acronym is tremors that occur while the patient is at rest. The most common tremors that occur in Parkinson's patients are hand tremors but Parkinson's patients can also display chin, lip, jaw and leg tremors as well. The second symptom is rigidity which promotes resistance against movements of the joints. This typically occurs in lower and upper joints and can be misdiagnosed as arthritis. Akinesia or bradykinesia is the term for slowing movements and is one of the biggest characteristics of Parkinson's disease. It usually begins as a slower reaction time when performing everyday tasks and develops into a loss of the ability to perform sudden movements and loss of facial movements. The last hallmark symptom of Parkinson's disease is postural deformities. These deformities occur because of the rigidity in the trunk and neck of the body. The rigidity can cause scoliosis along with other physical deformities. Parkinson's patients can also develop deformities in their hands and feet at a later stage of the disease. (Jankovic, 2008)

Manipalglobal, Healthy brain and Parkinson's brain 

Another risk for Parkinson's patients is the higher chance of developing dementia once Parkinson's disease is diagnosed. Research has shown that Parkinson's patients are four to six times more likely to develop dementia than their healthy counterparts. Parkinson's disease has been directly linked to the production of dopamine in the brain. Parkinson's disease starts to develop after the degeneration of dopaminergic neurons in the midbrain, these neurons are important because they are part of the nigrostriatal pathway which is a major dopamine pathway in the brain. This pathway facilitates movement by communicating from the midbrain to the corpus striatum with dopamine to allow smooth and controlled muscle movements. However, once these neurons begin to degenerate it negatively impacts the dopamine movement from one area to another which begins to adversely affect the motor movements in the body. These symptoms begin to occur after approximately 50% to 80% of dopaminergic neurons are lost in the brain. (DeMaagd, & Philip, 2015)


References:

DeMaagd, G., & Philip, A. (2015). Parkinson’s Disease and Its Management: Part 1: Disease Entity, Risk Factors, Pathophysiology, Clinical Presentation, and Diagnosis. Pharmacy and Therapeutics, 40(8), 504–532.

Harvey Checkoway, Karen Powers, Terri Smith-Weller, Gary M. Franklin, W. T. Longstreth, Jr., Phillip D. Swanson; Parkinson's Disease Risks Associated with Cigarette Smoking, Alcohol Consumption, and Caffeine Intake. Am J Epidemiol 2002; 155 (8): 732-738. doi: 10.1093/aje/155.8.732

Jankovic, J. (2008)Parkinson’s disease: clinical features and diagnosis

Journal of Neurology, Neurosurgery & Psychiatry,79:368-376.

Marie, L. (n.d.). James Parkinson | Parkinson's Disease. Retrieved April 04, 2017, from http://www.allaboutparkinsons.com/james-parkinson.html

Miller, I. N., & Cronin-Golomb, A. (2010). Gender differences in Parkinson's disease: Clinical characteristics and cognition. Movement Disorders, 25(16), 2695-2703. doi:10.1002/mds.23388

Mizuno, Y. (2016). Parkinson Symptoms in Dementia with Lewy Bodies. Dementia with Lewy Bodies, 93-109. doi:10.1007/978-4-431-55948-1_8

Pramod Krishnan, Consultant Neurologist, Epileptologist, Sleep Specialist at Manipal Institute of Neurological Disorders, Manipal Hospital, Bangalore, Karnataka, India Follow. (2015, May 13). BASICS IN NEUROIMAGING: CT, MRI AND PET. Retrieved April 04, 2017, from https://www.slideshare.net/drpramodkrishnan/basics-in-neuroimaging-ct-mri-and-pet

Susan Miller Follow. (2015, April 05). Parkinsons and exercise2. Retrieved April 04, 2017, from https://www.slideshare.net/SusanMiller28/parkinsons-and-exercise2

Understanding Parkinson's Disease. (2017, March 15). Retrieved April 04, 2017, from http://www.igeaneuro.com/understanding-parkinsons-disease/

Treatment for Parkinson's disease

Since Parkinson's disease has been discovered and named, there have been many developments in treatment and there continues to be groundbreaking research done on the disease. At this stage, Parkinson's disease doesn't have a cure but it can be treated with medication and therapy. After Parkinson's disease is diagnosed, the patient must be evaluated to determine how advanced the disease is. Once the patient's physicians have a clear idea of where the patient is at physically they can individualize and start a treatment plan. 

Medicalrealm, Levodopa

Levodopa, a dopamine replacement therapy is one of the most popular and effective treatment drugs on the market for Parkinson's disease. It is especially effective in treating bradykinesia and is frequently combined with carbidopa to combat feelings of nausea and vomiting. However, there are disadvantages to taking Levodopa for prolonged periods of time. Many patients have reported feeling fluctuations in their symptoms after approximately five years of being treated with Ledova. These symptoms are sometimes referred to as Levodopa-induced dyskinesias and fortunately, are treatable. Usually, the three approaches that are taken to treat Levodopa-induced dyskinesias are, reducing the dosage of Levodopa, using medications to counter the effects of Levodopa and surgery.(Jankovic, & Aguilar, 2008)

While Levodopa and carbidopa continue to be some of the most popular Parkinson medications, there are many others that can be used in combination or by themselves to treat motor symptoms. Dopamine agonists, which mimic the effects of dopamine can be used to treat progressing symptoms of Parkinson's disease. Another drug treatment for Parkinson's is the use of Monoamine Oxidase B Inhibitors which protect the dopamine that remains in the brain and keeps it from being broken down after it is used. Anticholinergic Medications are also used in Parkinson's disease treatment which decrease the amount of acetylcholine in the brain and results in more balanced levels of dopamine. These drugs are often used to treat tremors and prevent drooling. Mild symptoms in early stage Parkinson's are sometimes treated with Amantadine which increases dopamine activity in the brain. (Fox Foundation, n.d.)

Other drugs that are commonly prescribed for Parkinson's patients are medications that treat other symptoms like, depression, sleep disturbances, fatigue, and psychosis. Parkinson's patients are also often diagnosed with dementia and mild to moderate cases can be treated to slow down memory loss. Another important treatment that is often prescribed for Parkinson patients is pain medication to combat joint stiffness and muscle pain from falls or accidents because of loss of coordination. The amount of medications used to treat Parkinson's disease can be overwhelming at first but when used correctly in conjunction with each other, they can make a world of difference for many Parkinson's patients.(PDF, 2017)

References:
Jankovic, J., & Aguilar, L. G. (2008). Current approaches to the treatment of Parkinson’s disease. Neuropsychiatric Disease and Treatment, 4(4), 743–757.

Manage Your Medications. (2017). Retrieved April 04, 2017, from http://www.pdf.org/en/manage_meds

Parkinson's Disease Medication | Parkinson's Disease. (n.d.). Retrieved April 04, 2017, from https://www.michaeljfox.org/understanding-parkinsons/living-with-pd/topic.php?medication

Stages of Parkinson's disease

Slideshare, Hoehn and Yahr staging

Because Parkinson's disease is progressive it is important to know the different stages of Parkinson's and how they change over time. There are two different scales that are used to rate a patient's symptoms and determine what scale they are at. The first scale, the Hoehn and Yahr scale is a simple test that checks symptoms at five different stages. The second scale, the Unified Parkinson Disease Rated Scale is a much more comprehensive test that checks severity each symptom on the scale.(Parkinson Foundation, n.d.) Each stage in these scales has its own set of symptoms and as they progress, the stage at which the patient is at in the disease progresses as well. There is no specific time frame as to how fast each stage progresses. Every patient is different and some could remain healthy and mobile for years while others progress very quickly.

Stage one of Parkinson's

Symptoms are mild and often only present on one side of the body. At this stage, the patient is likely not affected in their day-to-day life but it is recognized by others through facial expressions and locomotion.

Stage two of Parkinson's

In this stage, symptoms become bilateral and begin to affect both sides of the body. The patient is still able to move and complete daily activities but it is slowly becoming more difficult to be mobile.

Stage three of Parkinson's

In this stage, symptoms become much more pronounced. It becomes difficult for the patient to remain consistently mobile because of difficulty balancing and walking. In this stage everyday activities become more difficult as well, simple tasks not only take longer but sometimes the patient needs assistance to get them done.

Stage four of Parkinson's

This stage marks the loss of independence for many Parkinson patients, as living alone becomes impossible. It is common for patients at this stage to need help getting up and may require a walker to move around. Rigidity begins to set in and movements become significantly slower. A caregiver may be required for many daily tasks, however, in some cases at this stage Parkinson's patients experience less of a tremor than in past stages.

Stage five of Parkinson's

This is the most advanced stage of Parkinson's and patients at this stage need constant care. At this point in the disease, patients often can't stand or walk alone and are either in wheelchairs or completely immobile. It is also common for patients to experience non-motor issues as well, like hallucinations and not be totally coherent.(Owen, n.d.)



References:
Believe in Better. (n.d.). Retrieved April 04, 2017, from http://www.parkinson.org/understanding-parkinsons/what-is-parkinsons/The-Stages-of-Parkinsons-Disease

Owen, C. (n.d.). Parkinson's Disease Staging - Neurosurgical Service - Massachusetts General Hospital. Retrieved April 04, 2017, from https://neurosurgery.mgh.harvard.edu/functional/pdstages.htm

Progression. (2017). Retrieved April 04, 2017, from http://www.pdf.org/en/progression_parkinsons

Swati Bhattacharya, Student at Delhi University Follow. (2016, January 04). Functional assessment scale for parkinson disease. Retrieved April 04, 2017, from https://www.slideshare.net/SwatiBhattacharya3/functional-assessment-scale-for-parkinson-disease

Living with Parkinson's disease

Vereen rehabilitation, Parkinson's photo

Being diagnosed with Parkinson's disease can be overwhelming. After an initial diagnosis, there are multiple steps that need to be taken to set up a plan for care. The first big step is to find a physician and support team for medical support. Once there is a plan in place for treatment, the next big step is to begin self-care. This includes paying attention to your body and how you feel after taking medications.

With Parkinson's disease also comes the increased risk for dementia. With this in mind, it is pertinent to keep trusted family members and caregivers in the loop as to medications, where they are kept, dosage and time that they are to be taken. This decreases the risk of losing expensive medications or missing the time at which they are meant to be taken which can lessen the potency of the drugs.

Another important factor of living with Parkinson's disease is taking into consideration safety at home. Parkinson's patients often have difficulty walking and limited motor skills. Having everyday necessities placed at an accessible height and easy to reach area is key. The bathroom and kitchen are both rooms that can cause a myriad of injuries. Rails should be considered for bathrooms to allow easy in and out access. Kitchens should be set up so everything is within easy reach and appliances should be easy to manipulate and use.(Parkinson Foundation, n.d.)

Another everyday component of living with Parkinson's disease is exercise. Parkinson's patients shouldn't take the diagnosis as a sign to slow down physical activity. Exercise is important to reduce joint stiffness and strengthen muscles. It is important to consult a physician before starting a new workout regimen but research has shown that even moderate activity like walking or doing chores around the house is beneficial for Parkinson's patients.(PDF, 2017)

Getting involved in the Parkinson's community can also be beneficial for mental health as a patient. Parkinson's disease is still being actively researched and the knowledge that we have of the disease is continuously growing. By being active in the Parkinson community as a patient it can be empowering to know new research, get in touch with Parkinson advocates and learn how to benefit the community as a patient.

Another important factor for self-care is surrounding yourself with people that truly care about your wellbeing. Having a good support system, other than you medical staff, to keep you in good spirits is very beneficial. Another important factor is making sure that you try to stay positive and keep doing the things that you enjoy or finding new things to keep you occupied. Having a positive outlook on life and doing fun things will help keep you going and keep your mental health in check.

References:
Believe in Better. (n.d.). Retrieved April 04, 2017, from http://www.parkinson.org/understanding-parkinsons/living-well/safety-at-home

Exercise. (2017). Retrieved April 04, 2017, from http://www.pdf.org/en/exercise

Living with Parkinson's Disease. (2017). Retrieved April 04, 2017, from https://www.apdaparkinson.org/resources-support/living-with-parkinsons-disease/

Understanding Parkinson's Disease. (2015, May 21). Retrieved April 04, 2017, from http://www.vereencenter.com/understanding-parkinsons-disease/

Caregiving for a patient with Parkinson's disease

Family caregiver alliance

Caring for a family member or friend with Parkinson's disease can be both time consuming and mentally draining. Studies have shown that most Parkinson's patients are cared for by informal caregivers, the majority of which are women. Almost half of caregivers have a negative impact on their mental and physical health.(Schrag, Hovris, Morley, Quinn, & Jahanshahi, 2006) To avoid some of these negative effects of caregiving and becoming burnt out, caregivers should take time out to care for their own health.


For many caregivers, it is easy to feel isolated and burnt our when attending to loved ones. It is important to take time for yourself as a caregiver to avoid becoming overstressed. For some caregivers, it can be isolating to attend to a patient with Parkinson's every day because distant family and friends may not understand how difficult it can be at times. It is important to know your limit of what you can take on physically and mentally and know when to ask for help. Building a support system with family and friends to share some of the responsibility can provide much-needed breaks. There are also many support groups and resources online dedicated to caregivers of Parkinson's patients. While caregiving is difficult, it is not something that you should have to do alone.

Barrington Behavioral

As a new caregiver to a Parkinson's patient, one of the first, most important, things you should begin to do is educate yourself. Parkinson's is a chronic, degenerative disease, there are many stages and the level of care needed for each one is different. Once you have a diagnosis it is important to talk to a physician about what to expect and more importantly, how to proceed as the disease does.  As a caregiver, it is important to familiarize yourself with medications, different physicians, and insurance. Attending medical appointments is also important to keep up to date with any prescription changes and provide details that your loved one may have forgotten.

Happy healthy caregiver

Staying organized is also key to keep track of any changes in side effects, different appointments, and goals. To get organized it is recommended to make several folders for medical items, bills, and finance information and important property info. Each folder should have comprehension information that allows access to address any problems that may arise. Once are organized and prepared for what comes next, it is important to act as an advocate for your loved one. As a caregiver, you may see signs of the disease or side effects of new medications that other medical professionals missed and as a caregiver, you may be the only person that can promote a positive change.




References:

Caring for the Caregiver. (2015, April 30). Retrieved April 04, 2017, from https://www.barringtonbhw.com/caring-for-the-caregiver/

Caregiver StressNational Parkinson Foundation CareMAP. (n.d.). Retrieved April 04, 2017, from http://caremap.parkinson.org/caregiver-stress/

Caregiver Support Groups Archives. (n.d.). Retrieved April 04, 2017, from http://neurocommunity.org/category/caregiver-support-groups

Organization Tips to help a Family Caregiver Manage a Crisis. (2016, October 02). Retrieved April 04, 2017, from http://happyhealthycaregiver.com/family-caregiver-organization-tips/

Schrag, A., Hovris, A., Morley, D., Quinn, N., & Jahanshahi, M. (2006). Caregiver-burden in parkinson's disease is closely associated with psychiatric symptoms, falls, and disability. Parkinsonism & Related Disorders, 12(1), 35-41. doi:10.1016/j.parkreldis.2005.06.011

Support & Caregiving for Parkinson's Patients: The Michael J. Fox Foundation | Parkinson's Disease. (n.d.). Retrieved April 04, 2017, from https://www.michaeljfox.org/understanding-parkinsons/supporting-caregiving.php