Understanding Parkinson’s Disease: Symptoms, Science, and Management

Let’s talk about that disease which is given importance in both psychological and physiological field of science. It’s been studied by psychology as well as medical students as a part of their syllabus. A disease that is shown in so many movies. A neurodegenerative disease that’s second most common in the U.S., as about 90,000 people are diagnosed every year. However, in India, it shows the lowest from all over the world i.e. 70/100000 normal populations. But the Parsis in Mumbai show a relatively high rate of PD i.e. 328/100000.

History of Parkinson’s Disease

This disease was discovered by James Parkinson, who wrote an essay called “An Essay on the Shaking Palsy” in 1817, after whom it’s called Parkinson’s Disease. Interestingly, it was also used in the Indian medical system, Ayurveda, and in this context, it is known as Kampavata – the Sanskrit word ‘Kampa’ stands for tremor which is the name of Parkinson.

Science Behind it

To explain in scientific terms, the symptoms occur when the nerve cells of the Basal ganglia, a part of the brain that controls movement, become impaired or die. These nerve cells are the one that produces the dopamine chemical also known as the happy hormone, as the neuron dies or becomes impaired, they produce less dopamine causing movement problems. The strange thing is, that scientists are still figuring out what’s causing the neurons to die.

Apart from that. PD also love nerve endings that produce norepinephrine, the main chemical messenger sympathetic nervous system, which controls the function of the body, such as Heart rate and blood pressure. Loss of norepinephrine explains some non-movement features, like fatigue, irregular blood pressure, decreased movement of food through the digestive tract as well as the sudden drop in blood pressure when the person is standing up from the lying or sitting position. 

Signs and Symptoms

In his essay, James Parkinson defines Parkinson’s disease as a degenerative neurologic illness of the brain that causes the death of dopamine-producing cells.  This causes neurons to fire out of control, leading to Parkinson’s disease symptoms.

• Legs or neck
• Gait difficulty
• Tremors or trembling
• Stiffness or rigidity of the arms
• Instability of posture or balance
• General slowness of movements

Other symptoms may include:

• Depression
• Skin problems
• Difficulty writing
• Mental confusion
• Speech problems
• Urinary problems are constipation
• Difficulties with swallowing chewing and speaking

Psychology Behind Parkinson’s Disease

• Parkinson’s disease is related to changes in neurotransmitters in the brain, which results in depression, anxiety, and even hallucinations. Patients also experience sleep problems and apathy as the disease progresses.
• Patients with apathy are said to be devoid of feeling or interest.

There are 5 Stages in Parkinson’s Disease

This H-Y staging system was invented in 1967, by Dr. Hoehn and Dr. Yahr. These stages are based on motor symptoms and the ability to take care of oneself.

Stage One

• Unilateral tremor and motor symptoms
• Abnormal gait, facial expression, posture; subtle changes
• Not easily diagnosable (as it’s so mild to be recognized as PD symptoms)

Stage Two

• Still able to live alone
• Affects daily tasks; speech change
• Motor symptoms worsen; bilateral involvement

Stage Three

• Person still independent
• Loss of balance; slower movements and more falls
• Symptoms affect tasks including dressing and eating.

Stage Four

• Living alone becomes difficult.
• Severe symptoms; marked limitation of activities.
• Standing is possible without support, but locomotion requires a walker.

Stage Five

• Needs constant care; many are wheelchair-bound.
• Severe stiffness makes walking very difficult or impossible.
• Non-motor symptoms such as depression, anxiety, and hallucinations start to appear.

Late-Stage Complications

• high likelihood of dementia and frequent falls
• Need for increasing amounts of supportive care.
• Complex symptoms and medication management

Transformational Considerations And Parkinson’s Disease

Dyskinesias affects patients with Parkinson’s in different ways, for instance, changes in their cognition, memory, and attention as well as impairments in the way they prioritize and execute tasks. One may derive stress, depression, and some other medicines as the most influential causes of these changes in the cognition of Christy.

In the later stages of the disease or when the dementia occurs, the people might be diagnosed with Parkinson’s dementia, a form of Lewy body dementia. Parkinson’s dementia is a form of dementia that may cause severe memory and thinking disorder in patients which hinders their normal functioning in activities they undergo. If the patient with Parkinson’s is facing issues related to thinking or memory, one should discuss it with the doctor.

Things We don’t know about Parkinson’s Disease

1. A clear risk factor is age.

• Parkinson’s disease begins beyond the age of 60. However, up to 1 in 10 people diagnosed with Parkinson’s have onset before the age of 50.

2. Smell loss is one of the initial signs of Parkinson’s disease.

• Other early signs include developing smaller but more crowded handwriting, a softer or lower tone of voice.

3. Parkinson’s disease also has non-movement symptoms

• Parkinson’s also gave symptoms like bladder problems, mood disorders, depression, anxiety, cognitive impairments like memory loss or slow thinking, trouble in sleeping and constipation.

4. Exercise is very important in Parkinson’s Disease.

• According to Denise Padilla Davidson, physical therapist at John Hopkins who have worked with patients diagnosed with Parkinson’s Diseases, says that exercise can actually slow down the progression of the disease. 
• Exercise works as a medicine for Parkinson’s disease. Exercise and physical activities have shown great improvement in mobility, flexibility and balance in people with Parkinson’s disease. 

5. Self-care is as important as ever

• Self-care is an important factor for not only people diagnosed with Parkinson disease but for each and every individual.
• But for people with Parkinson’s disease, symptoms worsen when stressed and is associated with the onset of certain symptoms like tremors, with stressful events.

Myths and Facts about Parkinson’s Disease

Myth 1: Parkinson’s is purely a motor disorder

• Fact: Parkinson’s has much more to do with non-motor symptoms. Nonmotor symptoms like cognitive impairment, anxiety, depression, sleep disturbance can be more disabling. It’s important for you to tell all your symptoms with your doctor.

Myth 2: Parkinson’s medications are the cause of symptoms

• Fact: Levodopa, the main drug therapy does not accelerate the disease’s progression. It helps with motor symptoms and is not toxic, as proven by clinical trials.

Myth 3: All Parkinson’s patients have tremors.

• Fact: Not all Parkinson’s patients experience tremors. Some never have them, and others may not have them at the onset.

 Myth 4: There Isn’t Much You Can Do Besides Medication.

• Fact: Keeping active is important. Exercise improves everyday functioning. 

 Myth 5: Parkinson’s Disease is Terminal 

• Fact: Parkinson’s is not an outright killer. The quality of care and keeping active are imperative in the management of the disease to forestall its complications, like falling and infection.

 Myth 6: Research-based Deep Brain Stimulation

• Fact: Deep Brain Stimulation is a long-established intervention practiced for several years to help alleviate motor symptoms when medications start losing their effectiveness.

Myth 7: Parkinson’s research has come to a stop

• Fact: The Research continues with exciting breakthroughs in understanding Parkinson’s pathology leading to new clinical results in the coming years.

Other Myths with Reality and Facts

Myth: Individuals With Parkinson’s Develop “Flare-Ups”

• Fact: Treating these conditions frequently improves Parkinson’s disease symptoms.
• Reality: Parkinson’s disease symptoms seldom worsen rapidly. If they do, it is critical to investigate alternative possibilities, such as drug changes, illnesses, or stress.

Myth: Doctors Can Predict Parkinson’s Symptoms’ Progression

• Fact: Regular physical activity, adequate sleep, proper diet, and neurology care all increase quality of life. Exercises improve mobility, stamina, and mood.
• Reality: Parkinson’s disease progresses differently for each person.

Myth: Levodopa Becomes Ineffective After a Short While

• Reality: Levodopa has a long track record of effectiveness. On the other hand, the dose might need to be changed.
• Fact: Levodopa is extremely effective and enhances the quality of life for persons with Parkinson’s.

Myth: Individuals With Parkinson’s Develop “Flare-Ups”

• Fact: Treating these conditions frequently improves Parkinson’s disease symptoms.
• Reality: Parkinson’s disease symptoms seldom worsen rapidly. If they do, it is critical to investigate alternative possibilities, such as drug changes, illnesses, or stress.

Myth: Doctors Can Predict Parkinson’s Symptoms’ Progression

• Fact: Regular physical activity, adequate sleep, proper diet, and neurology care all increase quality of life. Exercises improve mobility, stamina, and mood.
• Reality: Parkinson’s disease progresses differently for each person.

Myth: A Single Look Can Indicate the Severity of Parkinson’s Disease

• Fact: PD patients have “ON” periods when they are feeling good and “OFF” periods when their symptoms are more severe. Keeping note of this might help doctors change their therapies.
• Reality: The symptoms of Parkinson’s disease are not always obvious and might vary widely.

Treatment Plans 

Monitoring and Care Planning

• Regular Monitoring: People should schedule their follow-ups because it helps to monitor the status of their specific symptoms. Sometimes, you could be provided with a device to wear at home that tracks the progression of your symptoms and sends the data to your specialist.
• Care Plan: This coordinated summary of care that involves you, your physicians, and loved ones describes the present and future therapies in the disease management plan. This plan should be reviewed periodically in order to account for changes in the patient’s condition.
• Occupational Therapy: An occupational therapist can help to identify problems or tasks around the home such as dressing of going shopping and then offer appropriate strategies. They can also make sure that your home is safe and appropriate and that your environment will support the longevity of your independence.
• Physiotherapy: So, in case you are working with a physiotherapist their work will involve making sure that the stiffness in muscles and pains in joints are dealt through exercises and movements. The purpose of this therapy is to help you walk more, become more flexible and fit as well as giving you control over daily tasks or physical activities.
• Diet Advice: Some cases could be resolved with simple diet adjustments. undefined Maintaining high fibre diets and ensuring that one drinks a lot of water to minimize the problem. It involved taking multiple small meals throughout the day, avoiding activities that would cause dizziness due to low blood pressure, and using salt to manage the problem.
• Speech and Language Therapy: Some of the complications experienced by many individuals with PD include dysphagia, which is a condition whereby a person is unable to swallow food, water, or both properly, and speech difficulties. A speech and language therapist will be able to show you practices for fixing individuals of these concerns and may provide devices if essential.

Medications

In particular, medications can make a huge difference in the PD symptoms such as tremor and motor disturbances. 

• Levodopa: This is the most commonly used PD medication. In the brain, it is converted to dopamine that enhances movement. Levodopa is administered through tablets or liquid form and is often coupled with benserazide or carbidopa to ensure that it will not be metabolized in the bloodstream before it can affect the brain. Possible adverse effects are vomiting, fatigue, and dizziness. If used for years it can cause problems of rigid movements (dyskinesias) and the so-called “on-off” – the patient suddenly can move and suddenly cannot.
• Dopamine Agonists: These drugs act like dopamine in the brain and in their action they are similar to levodopa but less potent. They come in the form of tablets or skin patches such as rotigotine and can be combined with levodopa in order to reduce dosage. Possible adverse reactions include vomiting, fatigue, vertigo, paranoid episodes, and pathological gambling or spending sprees.
• Monoamine oxidase B (MAO-B) Inhibitors: By inhibiting the enzyme that breaks down dopamine, selegiline and rasagiline are medications that prevent dopamine from being broken down. They are less effective than levodopa but may be administered in early stages of the illness or jointly with other medications. Possible adverse effects include nausea, headaches, and alterations in blood pressure.

Advanced Treatment

• Apomorphine: This is a dopamine agonist which can be administered through subcutaneous injections on an as required basis or through an implantable pump that is worn on the body.
• Continuous Medication Infusion: Other drugs like co-careldopa and foslevodopa-foscarbidopa can be delivered into the stomach around the clock through a tube with an external pump worn on the body. This method is used for severe on-off fluctuations or involuntary movements.

Surgical Options

• Deep Brain Stimulation (DBS): This in entails implantation of device that generates electrical impulses to some sections of the brain. PD is similar to a heart pacemaker and may assist in regulating the features of PD. Although it does not have an ability to cure the PD, it helps to alleviate the symptoms in a number of patients. If medicines are no more effective, then it is opted for DBS.

Additional Considerations

• Lifestyle Changes: It is important to thank that bran exercising, healthy sleep, and proper nutrition significantly improve the quality of life of patients with PD. Also, exercise improves mobility, endurance, and mood; nutrition and adequate fluid intake prevent some of the symptoms, including constipation and hypotension.
• Support and Counseling: It explained ways of dealing with non-motor symptoms such as anxiety and depression that patients could be treated by a psychologist. Ask a counselor or attend a support group to be able to receive some emotional consolation and some tips.

Parkinson’s disease or PD is one of the most important neurodegenerative diseases influencing the mental and bodily well-being of an individual. The second most common kind of neurodegenerative illness in the United States, roughly 90,000 cases are identified each year. While the frequency is comparatively lower in India, the occurrence of its members in Mumbai – Parsis – stands out. Parkinson’s Disease, first identified by James Parkinson in 1817, is characterized by the death of dopamine-producing cells in the basal ganglia region of the brain, resulting in motor and non-motor symptoms such as regular shaking, rigidity, dystonia, anxiety, apathy, and memory and visual problems.

Researchers still work to identify why neuronal loss in PD happens but for now, the goal is the symptom control by using Levodopa, dopamine analogs, MAO-B inhibitors. Additional treatments include even more complex like deep brain stimulation for people with severe illness. Other components that have important functions in the support of patients includes the physiotherapy, occupational therapy, and speech therapy.

PD affects the mental health of their users as most suffer from depression, anxiety, and even become apathetic. It is also vital since it is important to recognize and address both the motor and nonmotor aspects of the condition. Physical activity combined with dietary changes are proven to hinder the progression of CKD and improve the patient’s quality of life.

This is because even today there are numerous mysteries surrounding PD, which is why fresh approaches and novel ways of dealing with the illness needs to be constantly researched and discovered. Thus, a non-pharmacological strategy for the treatment of PD implies the principle of an integrated comprehensive approach based on an individual patient’s treatment plan, engaging various medical branches that assist in providing a better quality of life.