Quick Facts...
- Parkinson's Disease is a chronic, progressive, neurological disorder resulting from a lack of the chemical dopamine in the brain.
- The specific cause is unknown but research shows it results from the destruction of the part of the brain called the substantia nigra.
- There is no cure but there are many medicines that help alleviate the symptoms.
- Levodopa (L-dopa) is usually prescribed. Once it is in the brain, it is converted to dopamine.
- Rehabilitation plays a key role in treating a Parkinson's patient. Rehabilitation consists of physical, speech and occupational therapy.
Incidence
More than 1.5 million Americans have
Parkinson's Disease; nearly 60,000 new cases are reported each
year. Although Parkinson's can strike people in their 20s, 30s
and 40s, it is most likely to affect adults over 50. One out of
every 500 people over 50 in the United States is afflicted with
Parkinson's. It affects more people than multiple sclerosis,
muscular dystrophy, and Lou Gehrig's Disease combined. Although
the incidence of Parkinson's increases with age, it is not part
of normal aging. Only 0.5 percent of people 65 and older have
Parkinson's.
Definition and Symptoms
Parkinson's Disease is a chronic, progressive, neurological
disorder resulting from a lack of the chemical dopamine in the
brain. Symptoms are many and can be different for each person.
The four major symptoms are tremors, muscle stiffness or
rigidity, slowness of movement, and difficulty with balance and
walking. Other symptoms include a change in handwriting (small,
cramped handwriting), trouble getting in and out of a car or a
chair, a change in voice or difficulty in speaking, diminished
facial expressions (loss of smiling and the appearance of
staring), and depression.
Causes
The specific cause of Parkinson's Disease is unknown.
We do know from research that this disease results
from the destruction of the part of the brain called the
substantia nigra. The substantia nigra is made up of cells called
neurons or nerve cells that perform the work of the brain. When
the nerve cells in the substantia nigra are destroyed, the
symptoms of Parkinson's result.
The substantia nigra works with another part of the brain called the
basal ganglia, which itself is made up of the caudate nucleus and the
putamen. Together, these parts of the brain initiate and control body movements.
The nerve cells in the substantia nigra make a chemical
called dopamine, which is important for the basal ganglia to correctly
program body movements. Most of the therapies for Parkinsonism are
directed towards replacing the action of the lost dopamine in the basal ganglia.
Diagnosis
The clinical picture of Parkinson's can be so varied that
absolute clinical diagnosis may not always be possible. Several
diverse factors (including toxins, pharmacologic agents, and the
simultaneous atrophy of many systems) can produce clinical
symptoms almost indistinguishable from Parkinson's. Nevertheless,
a sufficient number of criteria exist to make a fairly accurate
diagnosis. The presence of at least two of three
motor signs -- tremors, bradykinesia (extreme slowness of movement)
and rigidity -- is usually used. Persistence of these signs for several years may
clarify and specify the diagnosis. However, until a definitive
biological marker of Parkinson's is discovered, clinical
diagnosis remains difficult.
Treatment
There is no cure for Parkinson's Disease.
However, there are many medicines that help alleviate the
symptoms. A neurologist may try several medicines before finding the one
that will help the most. Each patient reacts to medicines
differently. Daily exercise is as important as the medication.
A drug known as levodopa (L-dopa) is usually prescribed for the treatment of symptoms of
Parkinson's Disease. Once in
the brain, L-dopa converts to dopamine, replacing the
substance that is lost through the disease process. When taken in
pill form, the drug is absorbed into the bloodstream and
ultimately into the brain.
To ensure that sufficient amounts
reach the brain, carbidopa is prescribed. Carbidopa reduces the
conversion of L-dopa in tissues other than the brain. Sinemet, a
drug frequently prescribed for Parkinson's patients, combines L-dopa and carbidopa.
Sinemet helps improve the patient's response
to L-dopa, and reduces some of its side effects. L-dopa
is absorbed into the blood stream through the small intestine.
However, if Sinemet is taken with meals, there may be a delay in
the Sinemet getting out of the stomach and reaching the small
intestine. The effect of the Sinemet may then be delayed. Sinemet
should be taken on an empty stomach.
Occasionally, physicians and pharmacists may recommend that
Sinemet be taken with meals. This recommendation is left over
from the days when there was no carbidopa to counteract the side
effects of L-dopa. In the past, patients who took plain L-dopa
frequently became nauseated, and taking L-dopa with something to
eat often helped prevent the nausea. Now, with the addition of
carbidopa, nausea is seldom a problem. As a result, there is no
reason to take Sinemet with meals and many good reasons not to.
The drugs described above treat only the symptoms of
Parkinson's. Recently, medicines have been discovered
that help delay the progression of the disease. One of these
medicines is Deprenyl. In a study involving 800
patients, Deprenyl bought time for patients by delaying the
progression of Parkinson's for roughly nine months, compared to a
control group of patients who did not take the drug. Deprenyl and
similar drugs such as Eldepryl are still being researched with
regard to their effectiveness in arresting the progression of
Parkinson's.
Nutrition
Careful attention to diet is important for Parkinson's
patients taking L-dopa. These patients must avoid (or eat
sparingly) foods high in protein and amino acids (e.g., milk and
milk products, lentils, meats, peas and nuts). These foods
disrupt the process whereby levodopa is absorbed into the brain.
L-dopa has to be carried from the blood to the brain by an enzyme
in order to work. This enzyme also transports certain amino acids
into the brain. If there are large amounts of these amino acids
in the blood stream (such as occurs after eating a meal high in
protein), the enzyme will be too busy transporting the amino acids
and not transport the L-dopa. Not enough L-dopa will get into the
brain to relieve the symptoms of Parkinson's. Some patients even
find their symptoms worse following a large protein meal.
However, for most patients this is not a problem.
There has been considerable publicity about restricting
protein in the diet of Parkinson's patients. Research indicates
this is not necessary for all patients. Furthermore, it is
necessary to eat a certain amount of protein each day in order
to get enough of the amino acids. Otherwise, the body will break
down its own tissues for protein. For patients who find that high
protein meals worsen their symptoms, reducing the protein and
breaking the diet into several smaller meals may help.
Dietitians can help plan diets since not all proteins contain
enough of the essential amino acids.
Vitamin B6 can interfere with the action of L-dopa; however,
it usually takes large doses to dampen the effects
of L-dopa. Normal amounts of B6 in a regular diet usually are too
small to be of much consequence.
Parkinson's patients should not attempt to restructure their
diets without the advice of their physicians.
Exercise
Parkinson's Disease causes slowness of movement, muscle
rigidity and joint stiffness. It also can create changes in
posture, walking and endurance. Daily tasks, such as rising from
a chair or turning in bed, can be difficult. Many Parkinson's
patients are encouraged to perform regular exercise to help
improve mobility.
Checklist for an Exercise Program
- Exercise when you are well rested and move most freely.
- Wear loose, comfortable clothing and shoes with good
support.
- Include adequate rest periods in your exercise program or
divide your program into shorter sessions.
- Move slowly through each exercise and avoid bouncing
motions.
- Maintain normal breathing throughout exercises.
Rehabilitation
Rehabilitation plays a key role in treating a Parkinson's
patient. Physical therapists teach exercises to improve speed and
movement. Stretching and manipulative exercises help improve
speed and movement and decrease muscle rigidity. Techniques and
exercises to deal with speech difficulties, nasal monotone, and
decline in speech volume are taught by a speech therapist.
Occupational therapists find ways to modify activities and use
adaptive equipment to compensate for physical losses.
Resources
Parkinson's patients and their families can receive information and help by
joining a local chapter of the American Parkinson's Disease
Association. Contact the national office at
60 Bay St., Staten Island, New York 10301; (800) 223-2732. The following publications are
available from APDA:
- Basic information about Parkinson's Disease (4-page
brochure; available in English).
- Parkinson's Disease Handbook (40-page booklet available in
English, Spanish and Italian).
- Coping With Parkinson's Disease (88-page booklet available
in English).
- Be Active -- A suggested exercise program for people with
Parkinson's Disease (25-page pamphlet available in English
and Japanese).
- Equipment and Suggestions (19-page pamphlet available in
English).
- Speech problems and swallowing problems in Parkinson's
Disease (17-page booklet available in English and Japanese).
- Good nutrition and Parkinson's Disease (26-page booklet
available in English).
All of the pamphlets and booklets listed above cost $.55
each.
APDA chapters have been established in Denver, Greeley,
Pueblo and Grand Junction. For more information about local
resources, contact the APDA Information and Referral Center,
Colorado Neurological Institute, 300 E. Hampden, Suite 205,
Englewood, Colorado 80110, (303) 781-5788. Help may also be
received by contacting the University of Colorado Health Sciences
Center at (303) 270-7296.
References
- A Patient's Perspective: Living With Parkinson's Disease or
Don't Rush Me! I'm Coping as Fast as I Can, by Jon Robert Pierce,
Knoxville, Tennessee: Spectrum Communications, 1989.
- Caring for the Parkinson Patient -- A Practical Guide, edited by
J. Thomas Hutton and Raye Lynne Dippel, Buffalo, New York:
Prometheus Books, 1989.
- Parkinson's Disease -- A Guide for Patient and Family, by Roger
Duvoisin, New York: Raven Press, 1991.
- Improving Communication in Parkinson's Disease: A Guide for
Patient, Family, and Friends, by Richard Katz, Marsha Davidoff and
Gary Wolfe, Danville, Illinois: Interstate Printers and Publishers, 1988.
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