Park Parkinson’s disease (PD) is a complex or chronic disorder of the central nervous system and it is the second most common neurodegenerative disease in the world today. People suffering from this disease have impaired coordination and balance and their movements are slow. PD was first described in 1817 by Dr James Parkinson but it was not until after 1960 that the medication was established. It entails the loss of brain cells which are responsible for the production of dopamine a chemical that helps in coordination and control of the muscle activity. (http://www.biobasics.gc.ca/english/View.asp?x=771)
Complete cure has not been established but researches are being carried out intensively. PD first affects the substancia nigra (SN) which contains the specialized neurons that send signals in the form of a neurotransmitter, the dopamine. When the neurons degenerate they cause a loss of dopamine and consequently making it difficult to control movement. (US Department of Health and Human Services, 2004).
Frequency of occurrence of PD is equal for both men and women. It affects the older people more than the younger people and it mostly develops when people are in their late fifties or early sixties. The rate among people between 75-84 years is approximately 30%.
Symptoms
Symptoms include tremors and stiffness while walking. Some people experience shuffling of their feet as they walk and unusual swinging of the arms. The body becomes rigid affecting movements. Speech impairments can also be noted which reduces or limits one’s social interactions. At the progressed stages patients experience difficulties in walking, talking or performing simple tasks effectively. Depression may also be experienced and insomnia problems may occur. (US Department of Health and Human Services, 2004).
Other symptoms include difficulties when swallowing or chewing, urinary problems or constipation, excessive sweating and other skin problems. However, the symptoms vary with different people. Falls may be experienced when people lose balance and have problems with their postures. The rate of eye blinking reduces and they seem to lack facial expression. Changes in the way people speak and others experience restlessness and nightmares. (NHS, 2006).
Emotional changes may also occur for instance, increased fear, irritability and feeling insecure. Others may suffer from inconsistency where they lose their bladder control. Some patients change their handwritings. Dementia which refers to increased problems with the mental functions could also occur. Again symptoms like sweating, problems maintaining an erection, dribbling and difficulties when swallowing are experienced by some PD patients. (Ramig O et al, 2001)
Diagnosis
PD diagnosis is done after a visit to the GP who may refer someone to a Parkinson’s specialist for further diagnosis on suspecting one could be suffering from PD. The specialist ought to be sought between 2-6 weeks depending on the stage that one is in. Since there lacks a definite test to tell if one is suffering from PD, the specialist uses a trial method where he compares one’s present condition with previous health conditions. Clinical observations are used. Thorough assessment and examination is done to establish if one is actually suffering from PD. (NHS, 2006)
Treatment
PD treatment can be through drugs or surgery. Drugs administered could have a direct or indirect impact on increasing the amount of dopamine. Treatment should not be started if a specialist is not consulted. People suffering from tremors can be offered the SPECT brain scan to verify if the tremor is caused by PD. The scan will establish the causes of the tremor. The structural MRI test used to further establish the causes of the tremor. Other tests should be done only if one is under clinical trial. (NHS, 2006)
Upon diagnosis that one is suffering from PD one needs to be reviewed regularly by their specialist. The review will clarify if one is actually suffering from PD for if new symptoms not linked to PD arise they could be due to the other causes.
Other treatments of PD include regular, moderate exercises to improve the motor control. These exercises can be used to improve someone’s circulation, increase their appetite and free up stiff muscles. Since PD patients may lose their appetite or feel nausea due to their drugs good nutrition would be very appropriate. Inclusion of more fiber and soft foods in their diet would be a plus in their digestive system.
The efficiency and effectiveness of drugs largely depend on the patient, their chemical composition, rate of PD progression and duration of drug use. Side effects could limit the drugs efficiency. Drugs used can be to replace dopamine. This approach is however, faced by the challenge of the body’s blood-brain barrier (BBB) which controls entry of substances into the brain. It may prohibit important or helpful chemicals from entering into the brain.
Parkinson disease cannot be treated by injecting someone with dopamine because it is a neurotransmitter which will be barred entry into the brain by the blood brain barrier. Levodopa (L-Dopa) can be used as it can pass the BBB and then it can be turned to dopamine. It can be effective for 5 years after which it can cause detrimental effects. Enzyme prohibitors can also be used to prevent the breakdown of dopamine. Dopamine agonist can be used which perform the same functions as dopamine. This drug can restore the imbalance caused by changes in the dopamine levels. Again since dementia entails memory loss, confusion and speech problems they should be addressed. Cholinesterase inhibitors are most preferred for Dementia.
Surgical option is sought when drugs no longer seem to work. In the 60’s surgical treatments for PD were pallidotomy and thalamotomy which involve destroying of some brain portions. This exercise works to improve the body strength so that patients can better handle their disabilities. Through surgery some region of the brain can be prevented from being over active and others controlled to become more active. Today they have been replaced by deep brain stimulation (BDS) which blocks tremors in patients. It is reversible and widely used. (US Department of Health and Human Services, 2004).
Prognosis
Doctors should let the patients know that the disease has no cure and that the drugs used would only work to suppress the effects. Supportive therapies should be made available for people with PD to help them adjust to their new roles. Speech and language therapies are sought to help one’s voice become loud, more natural and easier to understand. Since there is no cure, selegiline is used to slow down destruction of SN brain cells. (NHS, 2006)
Treating depression of PD patients should suit their individual circumstances. The PD specialist should be careful to offer treatment that does not cause hallucinations or psychotic problems. Care is taken to ensure that antipsychotic symptoms do not aggregate the effects of PD. Health care professionals have the duty of explaining what the PD care entails especially at the advanced stages. Family members are also affected if one of their members is affected and they should also seek support. (NHS, 2006).
References:
Government of Canada. 2006. The science and the issues. Parkinson’s disease. Retrieved on 3rd December 2007 from
http://www.biobasics.gc.ca/english/View.asp?x=771
Ramig O., Countryman S., Fox A., and Sapir S. 2001. Speech, voice and swallowing disorders. Parkinson’s disease: Diagnosis and clinical management.New York.
National Institute for Health and Clinical Excellence. NHS. 2006. Parkinsons Disease. High Holborn.London.
US Department of Health and Human Services.2004. Parkinson’s disease: Challenges, Progress and promise. National Institute of Neurological Disorders and Stroke. NationalInstituteofHealth. NH Publication.
