Parkinson's Disease

________________________________________________________________________

KEY POINTS

• Parkinson's disease is a movement disorder caused by a problem in the brain. Parkinson's gets worse over time.
• Parkinson’s disease can’t be cured, but your symptoms often can be controlled or reduced with medicines. Treatment may also include physical, occupational, and speech therapy, and sometimes surgery.
• Your healthcare provider can suggest ways to help you keep doing your daily activities for as long as possible.

________________________________________________________________________

What is Parkinson's disease?

Parkinson's disease is a movement disorder caused by a problem in the brain. It is one of the most common diseases affecting movement in people over age 55. Parkinson's disease gets worse over time. There is no cure for Parkinson's disease, but treatments can help with some of the symptoms.

What is the cause?

Parkinson's disease happens when nerve cells in parts of the brain die or stop working properly. The nerve cells in the brain stop making an important chemical called dopamine. Without enough dopamine, the brain cells that control movement do not work properly. You lose the ability to control muscle movements. The exact cause of Parkinson's disease is unknown. Risk factors include:

• Damage to cells caused by free radicals, which are harmful chemicals created by the body when your cells process oxygen
• Older age
• Family history of Parkinson’s Disease
• Changes in the genes passed from parents to children. Genes are in each cell of your body. They contain the information that tells your body how to develop and works.
• Exposure to some pesticides
• Head injury

What are the symptoms?

The main symptoms of Parkinson’s disease are:

• Rhythmic shaking that you cannot control (resting tremors)
• Rigidity (looking and feeling stiff and not being able to start moving)
• Slowed-down movements
• Losing your balance and falling easily. This symptom usually starts after you have had the disease for several years.

You may have shaking of your hands or head as well as a constant rubbing together of your thumb and forefinger that looks like you are rolling a pill. Tremors from Parkinson’s disease happen more when your arm and hand are resting, so they are called resting tremors. The tremors stop when you deliberately do something, such as move or change position.

In the earliest stages of the disease, symptoms may not be noticed or may be very slight. Someone close to you might notice a slight limp, stooped posture, or a mild hand tremor. Over time, you may stop swinging your arms when you walk. It may get harder to:

• Write or speak clearly
• Start to do something such as change positions or get out of a chair
• Keep your balance when you walk
• Swallow
• Think and remember

Other symptoms may include drooling, constipation, trouble urinating, and erectile dysfunction.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. He or she will look for the physical signs of tremor, rigid muscles, and slow movements that suggest Parkinson's disease. Shaking of your head, hands, or arms, or having a voice that sounds shaky may be caused by other conditions. You may need to be monitored over time to see how the symptoms change for your provider to be sure that you have Parkinson’s disease.

There are no X-ray or blood tests that can confirm the diagnosis. You may have tests or scans to check for other possible causes of your symptoms. If you have the typical symptoms of Parkinson’s disease such as rigidity and tremor without symptoms of other brain diseases, brain scans may not be needed.

Your provider may refer you to a specialist for more tests and treatment.

How is it treated?

The treatment depends on your symptoms and how well you respond to medicines and therapy.

Your provider may prescribe medicines to:

• Help your body make and use dopamine effectively
• Control tremors and reduce other symptoms of Parkinson’s disease

There are claims that supplements, such as vitamin E, vitamin C, and foods such as blueberries, may help the symptoms of Parkinson's disease. The US Food and Drug Administration (FDA) does not regulate or approve supplements. Be careful when you choose supplements. Supplements can cause problems with other medicines that you take. Always talk with your healthcare provider about what you are taking or plan to take.

You may have several kinds of therapy to help you have better use and control of your muscles:

• Physical therapy to help you regain muscle strength and teach you ways to move safely
• Occupational therapy to help you learn to do things differently or use tools to help do daily tasks
• Speech therapy to help if you have problems with swallowing or speaking

In rare cases, brain surgery may help control advanced symptoms of Parkinson’s disease. In this surgery, a very thin wire (electrode) is placed into the part of your brain causing symptoms. It is attached by a wire that runs under your skin to a very small device (a deep brain stimulator) placed under the skin usually in your upper chest. The device sends small electrical signals to block nerve signals that cause Parkinson’s disease symptoms. Surgery is not a cure and is usually done only when medicines do not help enough.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. Ask your healthcare provider:

• How and when you will get your test results
• If there are activities you should avoid
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Your healthcare provider will regularly check how well your treatment is working. Discuss any questions and concerns you have at these visits.

To cope with Parkinson's disease and to help relieve your symptoms:

• Be sure you and your family know how your medicines work. Know what the side effects are and when you should call your healthcare provider. Carefully follow your provider’s instructions for taking your medicines. You should take these medicines at the correct time as prescribed by your provider.
• Watch how your body responds to the medicine you are taking. For example, are there times of day when your tremors are worse? Overall, are your symptoms getting worse or better? Are you having any problems with your medicine? Share this information with your healthcare provider.
• Don’t take any medicines, including nonprescription products, without first checking with your healthcare provider.
• Get your annual flu shots and get a pneumonia vaccine. Infections can worsen symptoms and disability from Parkinson’s disease.
• Make your home safer:
  • Put up handrails along walkways and stairs and in all bathrooms.
  • Remove anything that might cause falls, such as loose rugs or electric cords on the floor.
  • Use chairs with high arms.
  • Be sure seats (including shower seats) have sturdy backs.
  • Use an elevated toilet seat.
  • Use an electric shaver to avoid cuts from razors.
• If dressing is a problem, wear clothing that is easy to get on and off:
  • Wear loafers or shoes that close with Velcro instead of shoes with laces.
  • Use Velcro on clothing instead of zippers or buttons.
  • Wear elastic waist pants.
• If you have problems swallowing:
  • Take as much time as you need to eat meals.
  • Sit upright.
  • Try thick liquids, which are easier to swallow than thin liquids as directed by your speech therapist.
  • Weigh yourself once a week to make sure that you are not losing too much weight.
• Drink plenty of fluids and eat foods that are high in fiber to help prevent constipation. High-fiber foods include whole-grain breads and cereals, beans, fruits, and vegetables.
• Focus on staying active, even though it may be hard to do some things. Keep involved in your work, hobbies, and other activities. Try to keep a positive attitude.
• Get support from family and friends or local support groups.
• Make plans for long-term care before you become very disabled. Involve your family as much as you can. Think about your wishes for your care later, and make sure your family or other caregivers know your wishes. A durable power of attorney for medical and financial matters should be signed before you become unable to make legal or healthcare decisions. If desired, a living will should be made out as well.
• A living will is a legal document that states your wishes for your medical care if you have a serious or terminal illness. You can complete this document at any time and it is best to do it when you are healthy and able to ask questions and make these important decisions about your care. A living will is not used to say who you want to make decisions for you when you cannot make them yourself.
• You need to know the laws in your state and fill out the forms your state recognizes. Ask your healthcare provider or lawyer for more information about these documents.

You can get more information from:

• Parkinson's Disease Foundation
  800-457-6676
  http://www.pdf.org
• National Parkinson Foundation, Inc.
  800-327-4545
  http://www.parkinson.org