Notes from the Parish Nurse
April is Parkinson’s Awareness Month. Parkinson’s is a nervous system disease that affects your ability to control body movements. It causes “nerve cells in one part of the brain to slowly degrade (get damaged) or die over time. As this nerve damage gets worse, it causes a cascade of symptoms throughout your body.” (www.clevelandclinic.org) These nerve cells normally produce dopamine, which is a chemical (neurotransmitter) that helps the cells of the brain to communicate. With decreased dopamine, movement symptoms occur. Norepinephrine, another neurotransmitter, is also lost by people who have Parkinson’s disease. This affects the sympathetic nervous system which controls heart rate, digestion, breathing, and blood pressure.
It is estimated that 1 million people in the United States and 10 million worldwide have Parkinson’s disease. There are about 90,000 new Parkinson’s cases diagnosed each year in the United States. (www.parkinson’s.org) Most commonly, people are in their 60s or 70s when they are diagnosed, and men are more likely than women to develop the disease.
“There’s no blood test or imaging scan that can definitely confirm whether” a person has Parkinson’s or not. (www.clevelandclinic.org) A neurologist can diagnose Parkinson’s based on signs and symptoms, history, and neurological and physical exams. A therapeutic drug trial can help confirm the diagnosis if a person’s signs and symptoms improve while take the Parkinson’s medication.
There are four main groups of signs and symptoms that are used to diagnose Parkinson’s. They are all movement related.
• Tremor. It often begins with shaking of hands and arms (occasionally jaw or foot) on one side of the body and on one limb. As the disease progresses, the tremor becomes more widespread and worsens with stress.
• Bradykinesia (slowed movement). Body movements slow because the brain transmits instructions slowly from lack of dopamine. This can be unpredictable and disabling.
• Rigid muscles/stiff limbs. Muscles cannot relax normally so it is difficult to move about freely and range of motion is limited. Aches and pains in muscles occur.
• Coordination and balance problems. Walking becomes unsteady and short shuffling steps occur. Difficulty to start and stop walking also occurs, as does a forward leaning posture, which makes falls more likely to happen.
People with Parkinson’s disease experience symptoms in their own unique way. Some people have many symptoms and others have just a few. Also the speed with which symptoms develop varies from person to person. In general though, there are four stages of Parkinson’s disease.
• Early stage is where symptoms are mild, don’t interfere with daily activities, and may seem like normal aging. They include fatigue, slow and small handwriting, lack of facial expression, speech changes, depression and anxiety, constipation, and sleep problems.
• Mid stage has worsening symptoms, balance problems and falls, difficulty in bathing and dressing, and increased tremors and muscle stiffness that affect both sides of the body.
• Mid-late stage is signaled by more difficulty standing and walking, which may result in the need to use a walker. Some mild cognitive impairment may set in during this stage. Chewing and swallowing problems may also occur.
• Advanced stage signs and symptoms may include increasing dementia and the development of hallucinations and delusions. At this point the person may need to use a wheelchair or might be bedridden.
Exercise is very beneficial, both physically and psychologically, for the well-being of a person who has Parkinson’s. Motor coordination, walking, balance, and movement can all improve with exercise. Types of exercise should include aerobic, strength training, flexibility training, and balance and agility training. Activities can include dancing, gardening, golfing, no-contact boxing, water aerobics, tai chi, yoga, or pilates. An exercise program can be set up by a physical therapist after an assessment of walking and balance is made. Occupational and speech therapy should also be included in an exercise plan.
Medication is also a very important part of the treatment for Parkinson’s. The goal is to help nerve cells in the brain make dopamine or to mimic the effects of dopamine in the brain. Other medications can help reduce some of the specific symptoms of Parkinson’s. About 15% of people with Parkinson’s find that medications don’t alleviate their symptoms very well. They can usually get relief from surgical treatment. “Although there’s still no cure for Parkinson’s…treatment can make a big difference in managing symptoms and quality of life.” (www.mayoclinic.org) Future treatments may include gene therapy, stem cell transplants, biomarkers, or vaccines.