What is Parkinson's
What is Parkinson disease?
Parkinson's
occurs when Dopamine producing cells in a part of the brain
called the Substantia Nigra die or become impaired reducing
the amount of dopamine in the brain. Dopamine allows smooth,
coordinated function of the body's muscles and movement.
When approximately 70% of the Dopamine producing cells are
damaged, the symptoms of Parkinson disease appear.
There
is currently no known cause or cure, however there are many
treatments available to assist in managing symptoms.
Description:
Parkinson's disease
is a neurological disorder which affects the motor nervous
system and alters coordination and movement.
Symptoms result from the progressive degeneration of dopamine
producing cells located in the substantia nigra. This causes
a deficiency in the availability of dopamine; a chemical
neurotransmitter (messenger) necessary for the production
of smooth controlled movements.
The symptoms of Parkinson's appear when about 70% of dopamine
producing cells cease to function normally. Symptoms develop
slowly and gradually progress over years, but are greatly
helped by drug treatment.
Symptoms:
The
presentation of symptoms varies greatly between individuals
diagnosed and no two people will be affected in the same
way. Symptoms usually become evident on one side of the
body initially and will affect both sides as Parkinson's
progresses. The three symptoms used for diagnostic purposes
are:
- Tremor,
(shaking, trembling) is the most well known symptom of
Parkinson's, but is absent in one third of people when
the condition is first diagnosed. Tremor usually begins
in one hand and then spreads to the leg, before crossing
to the other side. It may also be felt internally. Typically
it is most noticeable at rest and when stressed or tired
and disappears during movement and when asleep.
- Rigidity
or stiffness of the muscles is a very common early sign
of Parkinson's whereby the muscles seem unable to relax
and are tight, even at rest. You might feel that your
muscles will not do what you want them to do. Rigidity
may be experienced through the entire range of movement
of a joint (called cog wheel rigidity) or just in parts
(called lead pipe rigidity).
- Bradykinesia
(slowness of movement) occurs because the brain is not
able to control smooth and delicate movements.
- Leads
to a lack of spontaneous activity e.g. arm swing diminishes.
- Fine
motor coordination is reduced e.g. handwriting becomes
smaller.
- May
lead to changes in walking and sometimes episodes of
freezing or periods of immobility.
Other
symptoms:
In
some people symptoms can include pain and discomfort particularly
on the side of the body affected , anxiety and depression,
memory problems and difficulties in multi-tasking, fatigue
and disturbed sleep. Constipation is common and bladder
problems, especially a tendency to pass water more frequently
and with more urgency, may occur. Sexual difficulties may
trouble some people. Speech and swallowing problems tend
to become more of a problem later in the illness.
Cause:
At
present there is no known cause and therefore the illness
is termed; "idiopathic". It is not considered
to be genetic though 2-5% of cases have a familial incidence
in Australia.
Age Group:
Predominantly
those in the middle to later years i.e 50-75 are affected,
though up to 20% of people are diagnosed when they are younger.
Incidence
and Prevalence:
25
people are diagnosed per day in Australia. 20 per cent of
people are diagnosed before the age of 65 years of age.
Approximately 20,000 people are living with Parkinson's
disease in Victoria. This makes Parkinson's one of the most
common progressive neurological conditions seen in the community.
Diagnosis:
It
is difficult to diagnose Parkinson's disease as there are
no diagnostic tests or identifying markers to confirm a
diagnosis. Diagnosis is based on clinical presentation and
a progressive history of deterioration in function.
Rate
of Progression:
Each
person is affected differently and therefore the rate of
progression varies greatly between individuals. The illness
progresses at a very slow rate and longevity of life is
not shortened. Treatment alleviates symptoms though does
not halt or slow the progression of the illness.
Duration:
Parkinson's will affect
the individual for the remainder of their life with symptoms
increasing as the illness progresses.
Impact
on the individual:
While
Parkinson's has many symptoms it is important to remember
that effective symptom control is available to minimize
the impact on the individual.
•
Physical - functional mobility and the ability to perform
activities of daily living becomes more difficult. As
Parkinson's progresses some people experience unpredictable
fluctuations in motor movement and "freezing"
(inability to initiate movement) can occur. Tremor or
other physical abnormality of movement causes embarrassment
and can socially isolate the individual.
•
Bodily Functions - general slowing of muscle activity
particularly with the gut commonly causes constipation
and problems with gastric reflux can occur. Some people
living with Parkinson's may experience difficulties with
bladder control, particularly with urgency. Sleep problems
can occur, often because to difficulty in turning in bed
or with increased movements at night. Changes in intimacy
and impotence can also occur.
•
Emotional – Depression is commonly experienced by up to
70% of people living with Parkinson's and is thought to
relate to the impact of the illness and the disruption
of dopamine production in the brain. Some people living
with Parkinson's may experience difficulties with anxiety
often related to unpredictable symptoms. Anxiety is often
worsened with fluctuating medication levels or if depression
is also experienced.
•
Social – Problems with communication can occur, with some
people developing a soft voice. Hand writing may be affected
and muscular stiffness can limit non verbal gestures.
Stiffening of the facial muscles can limit facial expression
and also can affect speech. Fatigue related to Parkinson's
can limit some people's participation in social activities.
Concern over the impact of symptoms and physical limitations
can lead to reduced socialisation.
•
Cognitive - during the advanced stages of the illness,
some people are affected by some memory and thinking changes.
The most common problem is experiencing difficulty with
multi-tasking. Some people may also experiance hallucinations
or behavioral changes, which are linked to the treatments
for Parkinson's.
Impact
on the family:
Parkinson's
disease can affect a person's role within a family, and
therefore alter the roles and responsibilities of other
family members. Leisure activities, household chores, driving,
and the capacity to maintain current income can be disrupted
or limited.
Treatment:
At
present Parkinson's is incurable, however drug therapy can
alleviate symptoms. The main form of treatment is oral medication.
The medication works by normalising the level of dopamine
in the brain. The main medications used for symptom control
in Parkinson's are medications that directly replace the
dopamine that is no longer being made by the brain, often
referred to as Dopamine Replacement Therapy. Other medicatins
that are commonly used are medications that increase the
uptake of medication by the dopamine receptors in the brain
- Dopamine Agonists, and drugs that slow the breakdown of
dopamine in some way - these are commonly COMT or MAO-B
Inhibitors. The main objective of medication is restoring
the deficiency of dopamine.
In
some people the medications have some side effects, with
the most common early side effect being nausea. Other side
effects may occur later in the treatment of Parkinson's
which can include hallucinations and dyskinesia. The side
effects of the medications used to treat Parkinson's are
manageable and are able to be stopped or reduced with the
addition of other medications.
It
is important to understand that the medications for Parkinson's
will always assist in controlling the symptoms. In latter
illness the medications may need to be taken at more frequent
intervals and may have a diminished effect, however they will
continue to alleviate some of the symptoms.
Neurosurgical management of Parkinson's disease using surgical
techniques has been utilized since the 1940's though its popularity
waned with the introduction of levodopa medication in 1967.
Improved imaging techniques and sophisticated surgical techniques
has seen increasing numbers of patients being selected for
surgical treatment for Parkinson's. The surgery does not cure
or stop Parkinson's, however it does provide another effective
form of symptom control. The most common form of surgery used
to treat Parkinson's is Deep Brain Stimulation (DBS).
Management:
Because of the individual
complex nature of Parkinson's, management requires a holistic
approach which takes account of the whole of the affected
person's life.
Diagnosis:
The
diagnosis of Parkinson's disease is often a shattering experience
both for those diagnosed and their families. It needs to
be given in a sensitive way so as to allow people time and
space to come to terms with the diagnosis, and encourage
them to seek further information and advice as they need
it.
Individual Approach:
Each
person must be prescribed a specific regimen to suit his
or her particular needs, both in terms of timing and dose.
This will often involve a 'cocktail' of different drugs
available to ensure the best possible effects for the patient.
It is important to note again that drug treatment does not
cure Parkinson's and so the disease continues to progress
under treatment. As the disease progresses, the individual
regimen needs to be reviewed and, when necessary, modified.
Multidisciplinary
Support:
Early
access to a multi-disciplinary team is essential. A multi-disciplinary
assessment can be made of the person's abilities, identifying
potential difficulties and teaching coping mechanisms to
put into place before problems start. The multi-disciplinary
team may include physicians, dietitians, podiatrists, counsellors,
psychologists, specialist nurses and volunteers. Continuity
of care, particularly with the involvement of so many different
professionals, is very important.
Carer/Partner:
Many
carers receive no training, guidance or instructions on
how to cope with someone who has Parkinson's disease. Carers
may experience a whole range of feelings; guilt, anger,
resentment, fear and bereavement. They need general information
and practical advice; most importantly they need emotional
support.
