Nervous System
Parkinson's Disease

​​​​​Overview:

  • Parkinson's disease is a progressive nervous system disorder that affects movement.
  • Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand, or stiffness in muscles.
  • In the early stages of Parkinson's disease, your face may show no expression. Your speech may become soft or slurred, and symptoms worsen as your condition progresses over time.
  • Although the disease can't be cured, medications might significantly improve your symptoms.
  • Because the cause of Parkinson's is unknown, proven ways to prevent the disease also remain a mystery.

Definition:
Parkinson's disease is a neurodegenerative disorder that affects predominately dopamine-producing neurons in a specific area of the brain 

Other Names:
Essential Tremor. 

Stages of Parkinson's:
There are typical patterns of progression in Parkinson’s disease that are defined in stages.
  • Stage One: During this initial stage, the person has mild symptoms that generally do not interfere with daily activities. Tremor and other movement symptoms occur on one side of the body only. Changes in posture, walking and facial expressions occur. 
  • Stage Tow: Symptoms start getting worse. Tremor, rigidity and other movement symptoms affect both sides of the body. Walking problems and poor posture may be apparent. The person is still able to live alone, but daily tasks are more difficult and lengthy.
  • Stage Three: Considered mid-stage, loss of balance and slowness of movements are hallmarks. The person is still fully independent, but symptoms significantly impair activities such as dressing and eating.
  • Stage Four: At this point, symptoms are severe and limiting. It’s possible to stand without assistance, but movement may require a walker. The person needs help with activities of daily living and is unable to live alone.
  • Stage Five: This is the most advanced and debilitating stage. Stiffness in the legs may make it impossible to stand or walk. The person requires a wheelchair. Around-the-clock nursing care is required for all activities.

Cause:
In Parkinson's disease, certain nerve cells in the brain that are responsible for controlling movement, gradually break down or die. These cells produce a chemical substance called Dopamine, which is a found naturally in the human body, acting as neurotransmitter, meaning that it sends signals between the body and the brain and plays a role in controlling a person's movements, as well as emotional responses. The right balance of dopamine is vital for both physical and mental wellbeing. When dopamine levels decrease, it causes abnormal brain activity, leading to symptoms of Parkinson's disease. The cause of Parkinson's disease is unknown.

Risk Factors:
  • Age: The disease ordinarily begins in middle or late life, and the risk increases with age. 
  • Heredity.
  • Sex: Men are more likely to develop Parkinson's disease than are women.
  • Exposure to toxins, such as: ongoing exposure to herbicides and pesticides. 

Symptoms:
Parkinson's disease signs and symptoms can be different for everyone, and the three main symptoms are:
  • Involuntary tremor in one or more parts of the body.
  • Slowed movement.
  • Stiff and inflexible muscles. 
A person with Parkinson's disease can also experience a wide range of other physical and psychological symptoms, including:
  • Depression and anxiety. 
  • Balance problems.
  • Loss of sense of smell.
  • Problems sleeping (insomnia). 
  • Memory problems.
  • Loss of automatic movements such as: smiling.
  • Speech changes such as: You may speak softly, quickly, slur or hesitate before talking.
  • Writing changes. It may become hard to write, and your writing may appear small.​

When to see a doctor?
See your doctor if you have any of the symptoms associated with Parkinson's disease —to rule out other causes for your symptoms.

Complications:
  • Thinking difficulties: You may experience cognitive problems (dementia) and thinking difficulties. These usually occur in the later stages of Parkinson's disease. 
  • Depression and emotional changes: You may experience depression, sometimes in the very early stages, and may also experience other emotional changes, such as: fear, anxiety or loss of motivation.  
  • Swallowing problems.
  • Chewing and eating problems.
  • Sleep problems and sleep disorders.
  • Bladder problems.
  • Blood pressure changes.
  • Pain.

Diagnose:
No specific test exists to diagnose Parkinson's disease. The doctor will diagnose Parkinson's disease based on your medical history, a review of your signs and symptoms, and a neurological and physical examination. Your doctor may suggest imaging tests and lab tests, such as blood tests, to rule out other conditions that may be causing the symptoms. It is noted that imaging tests aren't particularly helpful for diagnosing Parkinson's disease. 

Treatment:
Parkinson's disease can't be cured, but medications can help control your symptoms, often dramatically. In some later cases, surgery may be advised. Your doctor may also recommend lifestyle changes, especially regular aerobic exercise. In some cases, physical therapy that focuses on balance and stretching also is important. A speech-language pathologist may help improve your speech problems.

Prevention:
The proven ways to prevent the disease remain a mystery.

Living with Parkinson's disease:
Some lifestyle changes may help make living with Parkinson's easier, including:
  • Healthy diet: Some foods may help ease some of the symptoms. For example, eating fiber-rich foods and drinking an adequate amount of fluids can help prevent constipation. A balanced diet also provides nutrients, such as omega-3 fatty acids, that might be beneficial for people with Parkinson's disease.
  • The following suggestions may help with eating and swallowing difficulties: 
    • Take your time, eat in a comfortable and quiet place.
    • Feeling that you spend long time eating, getting your food cold, try snacks or easy to eat foods. 
    • Buy plates that keep food warm for longer, or consider serving smaller amounts so that the second part can be kept warm, or reheat if it is safe.
    • Sit straight. 
    • Make sure your dentures are fitted correctly and appropriate for eating.  
    • Eating semisolid or mashed foods is easier to swallow than dry foods.
    • Having a drink with a meal makes it easier to chew and swallow.
    • Medications: Some people may experience problems after taking the medicine, especially if taken on an empty stomach; therefore, have a snack, such as biscuits, or take the medicine with plenty of water, to reduce nausea.
Some people with Parkinson's disease may experience postural hypotension, a significant drop in blood pressure when standing or changing position, and can be treated by the followings:
  • Avoid eating large meals, and reduce the amount of carbohydrates, and sugary foods.
  • Increase the amount of salt in your diet. 
  • Increase the amount of fluids, especially caffeinated beverages.
  • Drink a glass of water before getting out of bed.
  • Exercise; sports increase muscle strength, flexibility, and balance. If the symptoms are severe, it is best to focus on daily movements and activities, such as getting up from the chair.
Avoid falling: In late stage of Parkinson's disease, you may fall easily. To avoid falling:​
  • Remove all loose wires, cords and make sure rugs are anchored and straightened.
  • Use nonskid bath and kitchen mats on the floor to prevent slipping. 
  • Make sure halls, stairways, and entrances are well lit. Install a night light in your bathroom or hallway.  Make sure there is a light switch at the top and bottom of the staircase.
  • Turn lights on if you get up in the middle of the night. Make sure lamps or light switches are within the reach of your hands. 
  • Use one hand or backpack to carry things, and don't carry them with both hands while walking to avoid imbalance. 
  • While walking, lift your feet instead of dragging it. 
  • Do one thing at a time. Don't try to walk and accomplish another task.
  • Do not wear rubber shoes, they may cause tripping. 
  • Us a walking aid when needed, count 15 seconds between each movement. For example, when rising from a seated position, wait 15 seconds after standing to begin walking.
  • Activities of daily living such as: dressing, eating, bathing and writing can be difficult for some patients, so therapist has to provide patient with some techniques that make his life easier. 
FAQ:
Does deep brain stimulation (DBS) treat symptoms of Parkinson's disease?
Deep brain stimulation may not help treat symptoms of Parkinson's disease, or prevent its exacerbation, but it may reduce the side effects of medications.
Does Parkinson's disease cause dental problems?
It is difficult for Parkinson's patients to use toothbrushes and floss because of tremor, and their saliva production decreases, which can lead to tooth decay.





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