Managing with Parkinson's disease: A complex neurological disorders

Parkinson’s grip normally to elderly people and its management is quite threatening. It is a neurological disease caused by degeneration of dopamine neurones.

Parkinson ailment is a typical brain disorder which occurs when certain nerve cells in substantia nigra die or become damaged. Parkinson’s disease is pigeonholed as constant, progressive, degenerative disorder of basal ganglia. These cells produce an essential chemical such as dopamine which allows smooth, coordinated function of the body's muscles and movement. When most of these nerve cells get damaged, patient shows symptoms of Parkinson disease.

When person suffers from Parkinson’s disease, the area of the brain that controls muscular movements receives less dopamine than usual. Dopamine is an important chemical necessary for coordinating proper body movements as well as responsible for learning, increasing motivation and regulating moods. 

The most common Parkinson disease is the Idiopathic Parkinson. It is a group of movement disorders that have similar features and symptoms.

Major causes:

Till now root cause of this frightening neurological disorder is not found by medical researchers. But medical professionals have explored some visible causes for erupting Parkinson disease.

In Parkinson’s disorder, patient show array of symptoms due to genetic tendency. Person who experiences trauma, other illness, or exposure to an environmental toxin may get this disease. An environmental toxin such as a pesticide reduces dopamine production and produces free radicals and oxidation resulting damage. It has been acknowledged that several genes cause symptoms in younger patients.

Myriads of symptoms of Parkinson’s disorder:

Patients of Parkinson’s disease exhibit following symptoms:

o   Tremor of the hands, arms, legs, jaw, and face.

o   Rigidity or stiffness of the limbs and trunk.

o   Bradykinesia or slowness of movement and postural instability or impaired balance and coordination.

o   Autonomic dysfunctions may also occur.

o   Many patients experience some dissimilarity in their symptoms throughout the day.

Secondary symptoms are constipation, difficulty in swallowing, coughing, or drooling, excessive salivation, excessive sweating, loss of bladder and/or bowel control, loss of intellectual capacity and high level cognitive dysfunction, mood disturbances and subtle language problems.

Individuals who have depression are more vulnerable to Parkinson's disease at a later age. In last stage of this disease, patients show anxiety, depression, isolation, scaling, dry skin on the face and scalp, slow response to questions, Small, cramped handwriting, Soft, whispery voice.

Diagnostic procedure:

Diagnose of Parkinson disease is done on the basis of symptoms and excluding other disorders that produce similar symptoms. It is based on medical history and neurological examination conducted by interviewing and observing the patient using the Unified Parkinson's Disease Rating Scale.

After a systematic neurological examination and medical history, the neurologist may recommend computerized tomography (CT scan) or magnetic resonance imaging (MRI scan) for complete diagnosis of Parkinson's disease. These test may help in determining whether patients are suffering from Parkinson's disease or they may have other disorders such as brain tumour, stroke that produce parkinsonian symptoms.

Prompt treatment must be given:

Since Parkinson disease is irreversible, Patients need immediate treatment as it progresses. Parkinson's disease is a chronic disorder that requires good management including patient and family education, support group services, general wellness maintenance, physiotherapy, exercise, and nutrition.

Medication and dose depends on the severity of disease. The neurologists consider various factors such as symptoms, age, and presence of other medical conditions. As the disease become worse, drug dosages may have to be changed and medication routines are changed. In some severe cases, a surgical procedure is recommended to control symptoms and improve quality of life when medication is ineffective or when medication has side effects, such as jerking and dyskinesias, which are intolerable.

There are three surgical procedures used by surgeons for treating Parkinson's disease. These are ablative surgery, stimulation surgery or deep brain stimulation (DBS), and transplantation or restorative surgery. Deep brain stimulation is presently the most common surgical method of treatment, but other surgical therapies that give positive results include surgical lesion of the subthalamic nucleus and of the internal segment of the globus pallidus, a procedure known as pallidotomy. Surgery cannot be performed for all patients. If a patient never responded to, or responded poorly to levodopa/carbidopa, surgery is not supportive.

Though medical science has not explored the cure for Parkinson’s disease, patients can attain good symptom control during the first few years of treatment, dissimilar to neurodegenerative conditions.

The prime goal of medical management of Parkinson disease is to control the signs and symptoms for as long as possible while reducing adverse effects.

Multidisciplinary management is needed. Ideally, all patients should have access to:

Nurses with a special interest in Parkinson disease who can monitor the clinical condition and adjust medication, as well as providing ongoing support for both patient and family and a reliable source of information about all aspects of care.

Physiotherapy has great role in controlling Parkinson disease. It is recommended to help improve gait, balance and flexibility, improve aerobic activity and movement initiation. Trained physiotherapists may be able to provide specific interventions for overcoming disabilities such as start hesitancy, freezing of gait, festination and falls. The results of clinical trials suggest three broad physical therapy strategies which may be useful:

-      Strategy training, e.g. instruction with reinforcement to use longer stride length.

-      Management of musculoskeletal issues, e.g. weakness and loss of range of movement.

-      General promotion of physical activity with specific interventions for fall prevention.

Speech therapy must be given to the patients of Parkinson disease to manage with the disease.  Soft speech (hypophonia) is major problem for patients with Parkinson’s disease. Voice training can increase voice quality and audibility.

Medical professionals strongly recommend for counselling technique to deal with patients of Parkinson disease. It can assist in the development of self-management techniques for anxiety and depression. Counselling may help the carer and family with coping strategies. In the last stages of Parkinson’s disease, palliative care and advanced care planning may be helpful for the patient and their family.

Food options for Parkinson’s patient:

Patients of Parkinson disease must eat healthy and recommended diet. Following foods can enhance the conditions of patients suffering from Parkinson disease:

-      Raw foods: Raw fruits and vegetables provide antioxidants to help reduce free radical damage and lower inflammation.

-      High fibre foods: Patients must take high fibre food to avoid constipation because it is very common among Parkinson’s patients.

-      Healthy Fats: Consuming healthy fats can support neurological health and help prevent deteriorating moods. Foods like wild-caught fish, avocado, coconut, pastured butter, and sprouted nuts or seeds like walnuts and flax can help in reducing the symptoms of Parkinson disease.

-      Cold-pressed oils: Olive oil used as salad dressing can provide essential vitamin E, which acts as an antioxidant. Coconut oil and palm oil are also beneficial oils to include in diet since they have anti-inflammatory effects.

-      Omega-3 foods: Patients of Parkinson disease must consume Omega-3 foods to elevate dopamine levels and reduce inflammation.

-      Fresh vegetable juices: These foods help to provide essential vitamins and mineral. Fresh juice is also hydrating and can help with constipation.

-      Protein rich food must be taken at dinner only. Keeping protein levels moderate throughout the day has been shown to help reduce the symptoms of Parkinson’s.

-      Green Tea: Green tea contains polyphenol antioxidants that help fight free radicals. It also contains theanine, which elevates dopamine levels in the brain. Patients of Parkinson's disease can drink three cups a day to gain the most benefits.

To reiterate, Parkinson's disease is a common and neurological disorder. The primary neurochemical abnormality in the brain of Parkinson's disease, the deficiency of dopamine is well established. Patients in advanced stage of this disease have difficulty walking, talking, or completing other simple tasks. The disease is both chronic and progressive. But it is to be noted that Parkinson's disease is not infectious nor is it usually hereditary. Some medical scientists explored that Parkinson's disease may occur when either an external or an internal toxin selectively annihilates dopaminergic neurons. It is difficult to diagnosis Parkinson’s disease because other conditions may produce similar symptoms of Parkinson's disease. Medical science has not yet discovered any therapy for Parkinson's disease.