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Parkinson's disease

What is it?

Parkinson's disease (PD) is a slowly progressive brain disease. This will usually cause trouble with normal body movement. As the disease becomes worse, other problems with the brain and body can occur. The average age of people diagnosed with PD is 60 years old. People all over the world have PD and about 1 million people in the United States have it. There are about 60,000 new cases of PD every year. There is no cure for PD, but it can be treated.

Causes:

The exact cause of PD is not known. What is known, is that the brain of someone with PD does not make a chemical called dopamine (dope-uh-meen). Dopamine helps the brain control movement. Since someone with PD cannot make dopamine properly, the signs and symptoms listed below can occur.

Signs and Symptoms:

The signs and symptoms of PD are usually mild in the early stages of the disease. In the beginning, a mild tremor (shaking), change in walking, or a decreased arm swing when walking may be noticed. As the disease progresses, these and other symptoms may appear and become worse. The following are the 4 most common signs of PD. These 4 signs and symptoms are sometimes called the "cardinal signs" of PD. It usually requires at least 2 of these symptoms to be present for a caregiver to diagnose someone with PD.

Tremor (shaking) of an arm or leg is usually the first sign of PD. It is seen in about 70% of people with PD. The tremor usually starts in the fingers and hand on one side of the body. It usually happens when the person is relaxed. It will usually go away once asleep or if the hand is being used to grab something. The most common tremor seen is called "pill rolling." This is when the thumb and fingers rub together like a pill is being rolled between them. The tremors may then move to the arms, legs, and jaw as the PD worsens. Tremors may spread to both sides of the body.

Rigidity (stiffness or jerking) of the muscles in your body. Your limbs (arms, legs, and neck) for example, may also feel weak, tight, and tired. Your caregiver may test for rigidity. Your caregiver will move your arm, for example, and it may be difficult to move. The rigidity may start and stop quickly. This is called "cogwheel rigidity."

Bradykinesia (slowed movement) is a common symptom of PD. It may take you longer to complete most activities because you cannot move as fast as normal. You may have trouble starting to move, like standing up from a chair. You may have what is called "freezing." This is when you stop in one place and cannot move and someone may need to help you. It usually happens while walking through doorways.

Postural instability (balance and coordination problems) is when you stand or walk in a stooped position. This is when your back is hunched over and you are leaning forward. You may shuffle your feet when you walk. You may take smaller and quicker steps when you are walking. This is called "festination." It may be difficult for you to turn or pivot on your feet. You may feel off balance when walking or standing. A caregiver may test your balance by watching you walk or slightly pushing you off balance.

Other signs and symptoms of PD may include:

  • Anxiety.
  • Blank facial expression.
  • Confused thinking.
  • Constipation (difficulty having a bowel movement).
  • Decrease in the amount of eye blinking.
  • Depression.
  • Difficulty and changes with handwriting.
  • Drooling.
  • Low blood pressure when you stand up, causing light-headedness.
  • Oily face and skin.
  • Problems with sleeping.
  • Problems swallowing.
  • Restless legs.
  • Sexual problems.
  • Sweating.
  • Urge to go to the bathroom.

Medical Care:

Keeping a good quality of life for as long as possible is the treatment goal. The treatment for PD involves trying to control its symptoms. Medicine may be used to try to improve symptoms of the disease, such as tremors or stiffness. Some of the medicines used to treat PD have side effects. Caregivers will tell you about these possible side effects.

Brain surgery is sometimes done to treat the tremors and muscle tightness of Parkinson's disease. It is important to exercise, eat healthy foods, and spend time with friends and family. You and your family will get much information about PD. This information will help you understand the different problems and treatments for PD.

Dietary Measures:

  • Eat healthy foods from all of the 5 food groups: fruits, vegetables, breads, dairy products, and meat and fish. Eating healthy foods may help you feel better and have more energy.
  • Eating food that is high in animal fats may increase PD risk.
  • Discuss with your caregiver how much protein you should eat daily. Protein can cause problems with how some of the PD medicine works. Your caregiver will tell you how much meat, fish, nuts, soybeans and dairy products you can safely eat.
  • Vitamin B6 (pyridoxine) also causes problems with how some PD medicine works. Vitamin supplements or multivitamins that contain vitamin B6 should be avoided.
  • Drinking alcohol and caffeine may also cause problems with how well your medicine works. Alcohol can also make you feel more depressed. Caffeine may make your body movements shakier.
  • You may want to eat small meals often. Cutting your food into small pieces may help with swallowing problems. Using a straw to drink liquids may also be helpful. Mealtime should be relaxing so do not hurry.
  • Drink 6 to 8 (soda pop can size) glasses of liquid each day. Or, follow your caregiver's advice if you must limit the amount of liquid you drink. Good liquids to drink are water, juices, and milk. Limit the amount of caffeine you drink, such as coffee, tea, and soda.
  • Do not carry hot foods or drinks if your hands shake badly. The food or drink could spill and cause a burn. To keep your food warm, you may want to use a warming tray.
  • Stop drinking liquids 3 to 4 hours before going to bed. Urinate before getting into bed, so you do not have to get up in the middle of the night.

Herbs and Supplements:

Before taking any herbs or supplements, ask your caregiver if it is OK. Talk to your caregiver about how much you should take. If you are using this medicine without instructions from your caregiver, follow the directions on the label. Do not take more medicine or take it more often than the directions tell you to. The herbs and supplements listed may or may not help treat your condition.

Supplements:

  • 5-HTP (5-hydroxytryptophan) has been used, but has not been studied in people with PD.
  • Alpha lipoic acid has been used, but has not been studied in people with PD.
  • NAD (nicotinamide adenine dinucleotide) may be helpful for PD and has been studied in people.
  • Coenzyme Q10 (Co Q10) may be helpful for PD and has been studied in people.

Complementary Therapies:

  • Acupuncture and TCM (Traditional Chinese medicine) may help PD.
  • Biofeedback may help PD.

SEEK CARE IMMEDIATELY IF:

  • You are so depressed you feel like killing yourself.
  • You, family, or friends notice a big change in your behavior, such as being very confused or excited.
  • You are afraid or are not able to calm down.

Care Agreement:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

References:

1. Anderson C, Checkoway H, Franklin GM et al: Dietary factors in Parkinson's disease: the role of food groups and specific foods. Mov Disord 1999; 14(1):21-27.

2. Birkmayer GJD, Vrecko C, Volc D et al: Nicotinamide adenine dinucleotide (NADH)-a new therapeutic approach to Parkinson's disease: comparison of oral and parenteral application. Acta Neurol Scand Suppl 1993; 87:32-35.

3. Li G: Clinical analysis of Parkinson's disease treated by integration of traditional Chinese and western medicine. J Tradit Chin Med 1995; 15(3):163-169.

4. Manyam BV & Sanchez-Ramos JR: Traditional and complementary therapies in Parkinson's disease. Adv Neurol 1999; 80:565-574.

5. Puca FM, Genco S, Specchio LM et al: Clinical pharmacodynamics of acetyl-L-carnitine in patients with Parkinson's disease. Int J Clin Pharmacol Res 1990; 10(1-2):139-143.

6. Shults C, Oakes D, Kieburtz K et al: Effects of coenzyme Q10 in early Parkinson disease. Arch Neurol 2002; 59(10):1541-1550.


Last Updated: 4/4/2014

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