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Introduction
Parkinson's disease is a disorder of the brain
characterized by shaking (tremor) and difficulty with
walking, movement, and coordination. The disease is
associated with damage to a part of the brain that is
involved with movement.
Causes
Reglan or
Haldol,
and some pesticides can decrease dopamine levels and
mimic the symptoms of PD but do not cause it.
Risk Factors
Symptoms
-
Muscle rigidity
-
Unstable, stooped, or slumped-over posture
-
Loss
of balance
-
Gait
(walking pattern) changes
-
Shuffling walk
-
Slow
movements
-
Difficulty initiating any voluntary movement
-
Small
steps followed by the need to run to maintain
balance
-
Freezing of movement when the movement is stopped,
inability to resume movement
-
Muscle aches and pains (myalgia)
-
Shaking, tremors (varying degrees, may not be
present)
-
Characteristically occur at rest, may occur at any
time
-
May
become severe enough to interfere with activities
-
May
be worse when tired, excited, or stressed
-
Finger-thumb rubbing (pill-rolling tremor) may be
present
-
Changes in facial expression
-
Reduced ability to show facial expressions
-
"Mask" appearance to face
-
Staring
-
May
be unable to close mouth
-
Reduced rate of blinking
-
Voice
or speech changes
-
Slow speech
-
Low
volume
-
Monotone
-
Difficulty speaking
-
Loss
of fine motor skills
-
Difficulty writing, may be small and illegible
-
Difficulty eating
-
Difficulty with any activity that requires small
movements
-
Uncontrolled, slow movement
-
Frequent falls
-
Decline in intellectual function (may occur, can be
severe)
-
A
variety of gastrointestinal symptoms, mainly
constipation.
Note: Initial symptoms may be mild and nonspecific.
For instance, the patient may have a mild tremor or a
slight feeling that one leg or foot is stiff and
dragging.
Additional symptoms that may be associated with this
disease:
-
Depression
-
Confusion
-
Dementia
-
Seborrhea (oily skin)
-
Loss
of muscle function or feeling
-
Muscle atrophy
-
Memory loss
-
Drooling
-
Anxiety, stress, and tension
Screening and Diagnostics
-
There is no special blood test or
scan for diagnosis of PD while the patient is alive.
-
The brain of a patient after
death can be examined and may show lesions called
Lewy bodies.
-
History and clinical exam
-
Doctor may consult with a
neurologist (brain and nerve specialist)
-
A neurological and medical exam
can rule out other diseases and is the first step in
diagnosis.
-
CAT scan, MRI, and PET scans are
all special brain scans that can be of help in
ruling out other causes.
Treatment
-
Understanding the disease and
its limitations.
-
Make home comfortable for the
patient -- special devices such as chairs, eating
utensils and toilet seats, and railings in
bathtubs can help.
-
Assistants and caregivers can
aid in eating, dressing, shopping, driving, etc.
-
Caregivers can also be stressed
and overworked.
-
Physical therapy, occupational
therapy, and speech therapist may be recommended
by the doctor.
-
There may be a need for dietary
evaluation to make sure the patient is drinking or
eating adequately.
-
If there is weight loss,
supplements or tube feeding (tube placed in the
stomach) can be considered.
-
Medications can reduce symptoms
and improve function.
-
Medications either replace
dopamine, prevent its destruction, stimulate its
release, or offset the effects of the acetylcholine
system.
-
Medications can be taken in
combination or alone and include:
-
Selegiline or
Eldepryl
Sinemet
Tolcapone
Cogentin
Artane
Numerous others
Some recommend Vitamin E and
other antioxidants (need further studies).
-
Nicotine and caffeine may have
beneficial effects. Further research is needed.
-
Neuro-surgery, brain surgery:
-
Used in severe cases
-
Associated with great risk
-
Adrenal medullary
transplantation of fetal tissue (from fetus) and
genetically- engineered cells are still
experimental.
-
Pallidotomy and thalamotomy
can be used to improve movements.
-
Deep brain stimulation acts
as a pacemaker for the brain and helps control
abnormal movements in PD.
Prognosis
Untreated, the disorder progresses to total
disability, often accompanied by general deterioration
of all brain functions, and may lead to an early
death.
Treated, the disorder impairs people in varying ways.
Most people respond to some extent to medications. The
extent of symptom relief, and how long this control of
symptoms lasts, is highly variable. The side effects
of medications may be severe.
Complications
-
Varying degrees of disability
-
Difficulty swallowing or eating
-
Difficulty performing daily activities
-
Injuries from falls
-
Side
effects of medications
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