Parkinson's disease is a disorder of the central nervous system that affects one and one-and-a-half million Americans. Because it is not contagious and does not have to be reported by physicians, the incidence of the disease is often underestimated. Parkinson's disease may appear at any age, but it is uncommon in people younger than thirty. The risk of developing it increases with age. It occurs in all parts of the world and men are affected slightly more often than women. Letís talk about the history of Parkinson's disease and the affects of the disease on younger patients.
Probably the earliest physical finding of Parkinson's disease is that of a masked face, with significantly reduced blinking giving the patient a "stare". Victims of Parkinson's disease also have trouble with muscular functions which causes many symptoms including vibrations, or shakes. These vibrations usually involve the fingers and the wrist, but sometimes involves the arms, legs, or head, causing the entire body to shake. The vibration occurs mostly when the patient is at rest. It stops or slows down when voluntary muscular movement has been stopped. Luckily, there is no vibration when the patient is asleep.
Other symptoms are drooling and difficulty swallowing which may cause the patient to spill food or liquid from the mouth or to send food to the back of the throat before it is ready to be swallowed. Individuals with drooling, or difficulty swallowing may become more likely to choking on food or drink. People with Parkinson's disease and their caregivers need to take care to watch for signs of choking, food stuck in the throat, or increased congestion after eating. There are many remedies for this problem such as sucking hard candy or chewing gum which may facilitate the swallow reflex. Anticholinergies are not recommended because they make saliva sticky.
The patient may experience nausea, delayed gastric emptying and constipation which can be helped by using asapride, a prokinetic agent that accelerates gastric emptying and colonic transit. Exercise and a high fibre diet can also help.
Another symptom that is associated with Parkinson's disease is foot cramps which can be helped by using muscle relaxants such as cyclobenzaprine and baclofen. Changing the dose or dosage schedule may help since cramping can be caused by either too much or too little dopamine.
Another common symptom of the disease is depression. Approximately forty percent of Parkinson's disease patients develop depression, either endogenous (due to an imbalance of neurotransmitters) or exogeneous (due to the stress of having a chronic debilitating illness states the Pharminfo website. Some other symptoms include weight loss, sleep disturbances, forced eyelid closure, infections, excessive sweating and problems with sexual performance. The speech is slurred, and the handwriting is small and uneven because of the rigidity and the vibration.
In the early stages of the disease, the patient is aware that one leg seems a bit stiff, later, the arms does not swing normally at the side when the individual is walking. The patient has trouble beginning to walk but once they have started they can't stop unless the individual grabs the wall or some other object.
According to the Hoehn and Yahr scale, Parkinson's disease has the following five stages:
Even though there is no known cure for Parkinson's disease, if the disease progresses beyond minor symptoms, drug treatment may be indicated. The most commonly prescribed medication is Levodopa which helps replenish some of the lost dopamine. Levodopa almost always loses its efficiency over time as the disease progresses. Administration of the drug is associated with side effects, including response fluctuations, involuntary movements, peakdose chorea, severe end-of-dose symptoms, and psychosis and hallucinations. Levodopa helps smooth the response, although poor absorption of the first dose in the morning can lead to the not uncommon side effects associated with the drug, including nausea, involuntary movements, some mental changes, cardiac irregulations urinary retention.
Other drugs, designed to stimulate the dopamine system or mimic its controlling effect on the nerve cells, are used, such as bromocriptine, perolide, selegilence, and trihexphendyl. Patients with histories of coronary or peripheral vascular disease should not take these drugs. Side effects may include confusion, nasal congestion, liver problems, and swelling of the feet. A combination of Levodopa and Carbidopa called Sinement is usually the drug most doctors use to treat Parkinson's disease. Side effects include large uncontrollable movements called "dyskinesias" and confusion may develop after about eight years. Drug therapy for Parkinson's disease typically provides relief for about ten to fifteen years or more.
Many other medicines have been tried through clinical tests. Among them are such toxic compounds as strychnine and cigarettes made from limsonweed. In nearly all cases the results were less than gratifying.
Parkinsonís Disease and Young People
Many young people have a fear that they will not be able to keep their jobs and support their families. Many are forced to retire early because of this disease.
Another concern of the young patient is the cost of medical treatment. Most young patients are many years away from medicare and must rely on health insurance provided by their employers. This increases the concern about maintaining a job. Some young patients find themselves unable to advance in their careers.
Younger patients and their families find that the misconceptions and prejudices about Parkinson's disease have a greater impact on them than it would have on the older patient. The younger patient often bears a greater burden in trying to hide their illness from neighbours, employers and coworkers. This can result in a state of denial where patients ignore the effect their illness has on them. It may keep younger patients from seeking the kind of help that could make a significant difference in their lives.
Often younger patients deny the existence of the disease even when the symptoms are quite obvious to everyone around them. The closest observers of the symptoms are children of Parkinsonís patients. They will become alarmed if the Parkinson's patient insists that there is nothing wrong when you can see the symptoms quite clearly.
Many children of Parkinsonís patients are reassured when told that, although their parent has an illness that won't go away, that the disease can be managed.
Another form of surgery available is Pallidotomy, which destroys certain cells in the globus pallidos, the part of the brain that controls movement. This surgery is performed when the patient is conscious and operation may help correct problems in slow movement, vibration, and imbalance.
The last form of surgery available is fetal tissue implantation. This is an experimental technique used to restore the brain's ability to produce dopamine. There is political and ethical disagreement over this procedure which may lead to future development and use of genetically engineered cells for this type of surgery. This surgery can dramatically decrease the need for medication, although this improvement may not begin until six months after the surgery and may not peak for 12 to 24 months.
Regular exercise is very important to people with Parkinson's disease. It keeps them strong and flexible. A physical therapist can help develop and monitor a home exercise program, that will ensure that the Parkinson's patient get their muscles moving, their heart pumping, and that they can keep up with every day.