Wednesday, January 28, 2009
Tuesday, January 6, 2009
A different kinf presentation on speech therapy
Haroon Basheer Chairman Pakistan Parkinson's Society presented at a seminar at Karachi AKUH.The presentation on speech therapy was light hearted made the audience laugh and wholeheatedly participate.
Friday, October 17, 2008
Sunday, July 20, 2008
gp material
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parkinson's .......a new world
a collection of info on parkinson's by a pwp
Sunday, July 13, 2008
pd primer for GP'S
Parkinson's DiseaseQuality of Life IssuesBarbara Fitzsimmons, RN, MSLisette K. Bunting, RN, MScN--------------------------------------------------------------Individuals who develop Parkinson's disease (PD) are confronted not onlywith the physical manifestations of the disorder but with the psychosocial issuesthat impact on quality of life. Psychosocial aspects of PD may present as subtlechanges with progression of the disease. Many patients with PD are reluctant todiscuss these concerns with health care providers, however. Unfortunately, theseunvoiced concerns have a negative effect on acceptance of the disease state, corn-phance with treatment, and response to therapy, and they can significantly affectquality of life.Current nursing literature has focused on management of mobility in PD, andlittle attention has been devoted to psychosocial issues. This paucity of literature isattributed to the belief that if motor symptoms are treated, psychosocial aspects ofthe disease will spontaneously improve. Quality of life has been reported to be theprimary concern of patients with PD and their famidy members.(12) Medicine islearning to recognize and accept quality of life as a major criterion in evaluation ofhealth interventions. "The concept of quality of life then goes beyond the dimen-sions of health functioning to performance of social roles, mental acuity, emotionalstates, subjective well-being, and interrelationships."(5) Life satisfaction, self-esteem,and physical health have also been identified as key elements of quality of fife.This article briefly reviews salient points regarding PD as a degenerativeneurologic process and focuses primarily on the motor and nonmotor features thatimpact on quality of life. In addition, nursing care is presented and reviewed toassist the reader in facilitating the development of goals with the patient and familythat are congruent with achieving maximum quality of life (Table 1).HISTORY OF PARKINSON'S DISEASEJames Parkinson, a London general practitioner, first described Parkinson'sdisease in a monograph entitled "An Essay on the Shaking Palsy" in 1817. It was--------------------------------------------------------------------------------------Table 1. NURSING PLAN OF CARE-----------------------------------------------------------------------------------------------------------Nursing Diagnosis Expected Outcomes Nursing InterventionsImpaired physical mobility Patient will demonstrate Consult with physicalrelated to rigidity, maximal independence therapy for exercises andbradykinesia, and/or with performing activities assistive devices topostural instability of daily living. maximize independencewith self-care activities.Plan for patient toparticipate in care whenmedications are at peaklevel.Provide for safety inenvironment.Impaired verbal Patient will communicate Facilitate consultation withcommunication related to effectively with others. speech therapy.softening of voice Provide opportunities forpatient to practice speechexercises.Encourage patient not tohurry to complete speech.Refrain from completingsentences for patient.Altered self-esteem related Patient will actively Incorporate patient intoto dependency on participate in decisions decision-making processspouse/significant other related to care prior to about taking medication,discharge, participating in diversionalactivities, and so on.Offer suggestions forpatient to haveopportunities to socializein the community.Altered thought processes Patient will state that Provide reality orientation torelated to hallucinations hallucinations are not real patient as needed.and confusion prior to discharge. Be calm and offerreassurance if patientbecomes fearful.Umit environmental stimuli.Promote restful sleep-wakecycle.-----------------------------------------------------------------------------------------------------------here that Dr. Parkinson described the classic parkinsonian symptoms of restingtremor, propulsion, and stooped posture. Parkinson wrote that he found that11 senses and intellect" were "uninjured;" however, he went on to describe patientsas "unhappy," "dejected," and "melancholic."(2)PD is a chronic, progressive disease of the central nervous system. The classi(-triad of symptoms is resting tremor, rigidity, and bradykinesia. PD has been de-scribed as a collection of symptoms rather than one distinct clinical picture. Thus,diagnosis can be difficult in the early stages of the disease. Typically tremor orrigidity are noted on one side of the body, although they may progress to bilateralinvolvement. (13)Physicians often refer to PD as the "waiting room diagnosis." This refers to theclassic signs of pill-rolling tremor, stooped posture, bradykinesia, and masked facethat are easily observed in the clinical setting. Patients typically seek consultationwith a neurologist to confirm or rule out a diagnosis of PD. Frequently patients willrequest testing to substantiate the diagnosis. No such test exists, however. PD is adiagnosis made by history and physical. In today's technologic health care environ-ment, patients are often frustrated with the fact that PD is a clinical diagnoSis.13EPIDEMIOLOGYApproximately 1 million Americans are currently diagnosed with PD. Menhave a slightly higher incidence of the disease, and whites are disproportionatelyaffected when compared with other races. PD is typically considered to be a diseaseof the aged. The mean age of onset is 60 years of age, although cases have beenidentified in individuals as early as 30 years of age.With increased incidence of PD in young patients, that is, in those diagnosedbefore the age of 50, a new set of quality-of-life issues has emerged.(6,8) For example,an older patient, a more "traditional Parkinson's patient," has probably plannedfor retirement. Facing a degenerative disease in what had been hoped to be the"golden years," elderly couples are often confronted with not being able to traveland thus change their focus to planning for long-term care. On the other hand, theconcerns of the younger patient with PD focus on raising children, managing acareer, and maintaining a home. These two age groups have distinct differences inissues affecting their quality of life.CAUSEThe cause of PD is unknown. However, the following theories are the focus ofcurrent research: genetic, viral, and environmental toxins. Genetic research is fo-cusing on mitochondrial defects and family linage.'-' Twin studies have failed todemonstrate any clear inherited trait, however. The viral theory was first suggestedwith the outbreak of encephalitis lethargica, which occurred worldwide from 1918to 1926. This viral epidemic resulted in postencephalitic parkinsonism killing morethan 2000 Americans. The mortality rate approached 40%, and only 15% ofpatients fully recovered. As survivors of this viral epidemic die, fewer individualswith this form of PD are seen. Environmental toxin theories have continued to be afocus of epidemiologic studies. (13)PATHOLOGYThe hallmark pathologic feature of PD is the degeneration of the dopaminergicnigrostriatal pathway. It has been shown that 80% of the dopan-dne-producingcells must be lost before manifestations of the disease can be seen. The severity ofPD is associated with the degree of neuronal loss in the midbrain at the level of thesubstantia nigra.11Dopamine, a neurotransn-titter, is the primary neurocheniical responsible forthe signs and symptoms of PD. The balance of dopamine and acetylcholine areresponsible for normal motor function. The development of symptoms is explainedby an imbalance of dopaminergic (inhibitory) and chohnergic (excitatory) activity inthe caudate and putamen of the basal ganglia. When degeneration of the dopamin-ergic nigrostriatal pathway occurs, there is depletion of dopan-dne and relativeexcess of cholinergic activity in the feedback circuit involving the cerebral cortex,basal ganglia, and thalamus. This change in neuronal activity is responsible for theclassic manifestations seen in PD.(9)MOTOR FEATURESThe Motor features of PD include the classic triad of tremor, rigidity, andbradykinesia. In addition, there is postural instability and disordered gait as well asdisorders in fine motor movement. A brief description of each motor featurefollows.TremorResting tremor is the most classic and visible sign of PD. Seventy percent ofpatients present with resting tremor as their chief complaint for seeking diagnosisand treatment. Parkinsonian tremor has been described as having a pfll-rollingquality and can affect all four limbs and the head.(13)Many patients express feelings of embarrassment related to their tremor.Tremor is the most difficult symptom to treat but the least disabling. It subsideswith action and is thus described as a resting tremor. The resting quality of theParkinson tremor allows patients to maintain activities of daily living within somelin-titations. Unfortunately, patients will restrict social activities due to fear of socialstigma and being labeled as ill. In addition, stress can intensify tremor, whichfurther restricts the patient's willingness to participate in social life,RigidityRigidity is often described as a plastic resistance to passive movement. Patientsoften describe this characteristic as stiffness. On examination, rigidity can be de-tected as a coglike release of muscle resistance in the wrist, elbows, neck, and kneesas the limb is moved through passive range of motion.(13)Rigidity can cause the face of the patient with PD to take on a masklike quality.The face appears fixed and rigid, and previously recognizable nonverbal messagesare misinterpreted or lost in communication. Fanifly members find this change tobe most disturbing because the patient no longer has a change of facial expression.BradykinesisBradykinesia refers to difficulty with initiating and continuing movement.Movements are slowed and are performed with conscious effort. Patients havedescribed bradykinesia as feeling as if "My brain is sending the message to thebody, but the body won't listen."(7)Postural Instability and Gait DisordersAs PD progresses, patients may demonstrate difficulty maintaining erect pos-ture. Typically, there is forward flexion of the neck, hips, knees, and elbows.Postural abnormalities greatly reduce the patients' ability to be ambulatory andplaces them at high risk for injury.(7) This may also lead to reliance on assistivedevices.Because of rigidity and postural changes, patients also develop a shufflingquality to their gait and use small steps. Another abnormal gait characteristic ispropulsion, a disturbance in which the patient goes from a slow walking pace torunnin with an inability to stop. Patients are only able to stop themselves bygrabbing stationary objects such as a door frame. It is important to note thatpatients who develop an unsteady festinating gait may appear to be under theinfluence of drugs or alcohol.The inability to be freely ambulatory restricts the independence of the patientwith PD. The use of a cane, walker, or wheelchair gives the patient a message thatthe disease is progressing. Resistance to the use of assistive devices is often anattempt to maintain self-esteem as the patient is dealing with declining health.Limitations of mobility further restrict social fife, and many patients express aninability to maintain pace with friends or family members. Often patients willexpress embarrassment due to their gait disturbance and verbalize a realistic fearthat others will assume they have a substance abuse problem.On-Off PhenomenonAs the disease advances, patients enter a narrow therapeutic window. Re-sponse to treatment is less predictable, resulting in what is termed the "on-off"phenomenon. This phenomenon refers to a syndrome in which patients are freelyambulatory one n-tinute and then find they are "frozen" and unable to move thenext. Patients also describe "off" periods as if someone has turned off the switchand their feet have sprouted roots. The cause of the on-off phenomenon is un-known but may be associated with years of therapy compounded with continuedloss of dopan-tine-producing cells.(13)Because the on-off phenomenon is unpredictable, it can play a major role infamily dynan-dcs. The concept of a person exhibiting a behavior that is severelydisabling, sudden in onset, and resolving without intervention is a difficult conceptfor patients and health professionals to grasp. Understanding that on-off phenom-enon behavior is not intentional and is not psychogenic in origin is essential.Patients and farnfly members need education about this feature of the diseaseprocess to assist the patient with PD to maintain a sense of control.Swallowing and Speech DefectsDysphagia is a common disorder that affects patients with PD and was firstrecognized by James Parkinson. He described patients as having significant weightloss with complaints of difficulty swallowing solid foods as compared to liquids. Asthe disease progresses, patients report difficulty with chewing or moving food tothe back of the mouth. This may lead to choking episodes and places the patient athigh risk for aspiration. Management of dysphagia in PD may be difficult. Consul-tation with a dietitian and swallowing therapist may be beneficial in providingoptimal nutrition. In addition, meals should be eaten when levodopa dosages arereaching maximum effectiveness. (10,16)The motor disturbances responsible for swallowing deficits can also lead todisorders of speech in the patient with PD. Dysarthria, a form of speech distur-bance, is characterized by deviations in phonation, prosidic disturbances in whichspeech may be slow or extremely fast, and an articulatory disorder in which vocalsounds are distorted. Dysarthria is a common problem for patients with PD and canhave a dramatic and devastating effect in a patient's interpersonal communicationand self-image. Management of dysarthria involves the use of medication andspeech therapy. Levodopa has been shown to improve speech intelligibility, andspeech therapy can assist the patient in using techniques to enhance projection. Togain maximum benefit from speech therapy, the patient must be invested inpracticing the exercises assigned by the speech therapist. (10)HandwritingDifficulty with handwriting can be an early sign of PD. Patients with PDtypically will initiate handwriting with normal-sized penmanship and trail offwords and sentences with smaller illegible handwriting. This small writing isreferred to as "n-dcrographia." Patients with micrographia can have difficulty sign-ing checks, and banks frequently request patients to sign a new bank card becauseof the dramatic change in signature. The inability of patients to spontaneouslywrite can also inhibit communication. (14)NONMOTOR FEATURESDepressionDepression in PD has been the focus of numerous studies. Research indicatesthat 20% to 90% of patients with PD will experience a major depressive episode ascompared to 7% of the general population. Depression accounts for the majority ofpsychiatric referrals in patients with PD and can be the initial feature of PD. It hasbeen hypothesized that the shared neurochemistry of these two disorders accountsfor the high incidence of depression in PD.(2)Depression can be viewed in two ways. Some patients may become demora-lized with the diagnosis of PD and experience a "reactive depression." Reactivedepressions are linked to external events and are short in duration. Typically thepatient experiencing a reactive depression is able to resolve the issue and accept thediagnosis. Individuals experiencing a reactive depression may benefit from sup-portive psychotherapy, however.(2)The most typical depression experienced by the patient with PD is endogenousdepression. Endogenous depression is caused by a biochemical imbalance in thebrain and can be life-threatening if not treated. The difficulty in diagnosing depres-sion in patients with PD lies in the shared clinical features of the two disorders(Table 2).DementiaDementia is also a common feature of PD. It is estimated that 20% of patientswith PD will become demented.(11,14) Dementia can be defined as an acquired,-------------------------------------------------------------------------------------------------------------Table 2. COMPARISON OF CLINICAL FEATURES ASSOCIATED WITH PARKINSON'SDISEASE AND DEPRESSIONFeatures Parkinson's Disease DepressionMotor manifestations Stooped posture, bradykinesia, Slumped posture, psychomotormasked face retardation, diminished facialaffectSleep disturbances Insomnia, sleep fragmentation Insomnia, early morningawakeningGastrointestinal Constipation, weight loss Constipation, weight lossConcentration Bradyphrenia Poor concentrationHallucinations Visual, usually nonthreatening Visual, auditory, olfactory andtactileAdapted from Bunting LB, Fitzsimmons, B: Depression in Parkinson's disease. J Neurosci Nurs23(3):160, 1991; wwith permission.-------------------------------------------------------------------------------------------------------------persistent impairment of intellectual function with compron-dse in at least three ofthe following areas of mental activity: language, memory, visuospatial skills, emo-tionality and personality and cognition in the presence of clear consciousnesS.3,4The retention of long-term memory permits the patient to maintain aspects ofnormal social behavior early in the disease. The severe loss of ability to learn newmaterial and the limitations of short-term memory result in episodes of frustrationthat can escalate into agitation, however. In addition, individuals with dementingillnesses may have enough insight to experience a clear sense of loss, thus leavingpatients and families demoralized and dispirited.(4) Nursing management of demen-tia care should encompass the principles of preservation of dignity and provision ofsafety.Sleep DisturbancesSleep disorders are a frequent complaint in patients with PD. Disorders ofsleep initiation, sleep fragmentation, early morning awakening, excessive daytimesomnolence, and parasomnias represent the disorders of sleep seen in PD. Adetailed history of the sleep complaint, validated by a bedpartner, is the bestmethod of establishing the cause of sleep disturbances.(11)Patients may complain of initiation insomnia as, "I can't get to sleep." C)nceasleep they are able to sleep soundly through the night, however. Researchers haveconcluded that sleep initiation insomnia in PD is related to anxiety, agitated de-pression, or levodopa therapy.The more typical sleep disorders seen in PD are sleep fragmentation and earlymorning awakening." Sleep fragmentation can be related to the inability to turnover in bed. Rigidity compounded by the wearing off of medication reduces pa-tients' ability to reposition themselves in bed. Patients state that they must wake upto change sleeping positions and then are unable to return to sleep. One solution tothis problem is the use of satin sheets to decrease friction and facilitate turning.Early morning awakening typically represents onset of a depressive episode, andthe nurse should evaluate the patient for other vegetative symptoms such asdecreased appetite, psychomotor retardation, and constipation. Early morningawakening may be related to focal dystonic cramping in the calf and feet, however.Focal dystonia is related to diminished levels of levodopa.(11)Excessive daytime somnolence is the most frequent sleep complaint made byfamily members of PD patients. In some individuals, daytime somnolence is relatedto a disturbance in the circadian control of sleep. These patients are up at night andtake multiple naps throughout the day. Families report that daytime sonuiolence isdisruptive to normal family life. Families should discourage day time napping in anattempt to correct the circadian clock. Patients who are described as sleeping allday, however, should be screened for metabolic abnormalities that may causedisturbances in the sleep-wake cycle.Parasomnias are the most debilitating and difficult of the sleep disorders tomanage. Sleep talking, sleep walking, vivid dreams, and nightmares are the mostfrequently reported parasomnias experienced by patients with PD. Most typically,these occur as a side effect of levodopa therapy. Unfortunately, treatment forparasomnias is limited.(11)Sexual DysfunctionSexual functioning in patients with PD has received inadequate attention. Thepaucity of literature can be attributed to the assumption that patients with PD areelderly and therefore have a diminished interest in sex. Research indicates thatfrequency of sexual intercourse decreases with age; however, sexuality continues toplay a role in the lives of the elderly. Sexual dysfunction has a significant impact onpatients who are diagnosed with PD in their midadult years when an active sex lifeis the norm.(1)Dysfunction of the autonomic nervous system, depression, medications, andinterpersonal issues all play a role in sexual dysfunction in PD. Autonomic dys-function in the urogenital system resulting in impotence is the primary reason forsexual dysfunction in male patients with PD. Secondary issues affecting sexualfunction include motor fluctuations, fatigue, medications, sleep disorders, depres-sion, and interpersonal issues.(1)The motor fluctuations and fatigue can be related to antiparkinsonian drugs,primarily levodopa. Patients with PD find that they are better able to function inthe morning, after their initial dose of medication, and become more fatigued withgreater motor fluctuations as the day progresses. Numerous reports documenthypersexuality with the use of levodopa. This may result in a problem when onepartner has heightened sexual interest that is not shared by the other partner. Toadapt to these changes in their sexual life, couples may need to change their dailyroutine to accommodate morning sexual activity and take advantage of optimumenergy levels and motor functioning. Unfortunately, sleep disorders experienced inpatients with PD may result in bedpartners sleeping in separate beds, whichdiminishes opportunity for spontaneous sexual activity.(1)Depression can also have a significant impact on sexual activity in patientswith PD. As discussed earlier, depression is common in patients with PD and canproduce a markedly decreased libido. Sexual partners may also experience depres-sion and fatigue as they struggle with the caregiving role in the relationship; thus,they also may not have the energy or interest to engage in sexual activity. Inaddition, autonon-dc dysfunctions that result in droohn& diaphoresis, and excessivefacial oiliness may interfere with perceived attractiveness of the patient by thesexual partner.(1)The issues surrounding sexuality in PD are complex. Patients should be rou-tinely questioned regarding satisfaction of their sexual life. A referral to a urologistor sex therapist can assist in identifying issues affecting sexuality. Open conununi-cafion regarding sexual issues can be limited by the patient's reduced facial expres-sion and altered speech pattern. The ability of the couple to communicate theirsexual needs within the liniitafions of the disease state can have a significant impacton the couple's marriage and sexual life.(1)Driving PerformanceWhen a patient is seen for the management of PD, no discussion would becomplete without addressing driving. Motor manifestations of the disease as well asa decline in cognition may impair the pafient's ability to function safely behind thewheel. Some patients may willingly retire their driver's license, whereas others mayview this as giving up valued independence. Evaluation of driving skills by aprofessional driving instructor may provide a nonthreatening avenue to assess autosafety. Family members should be involved in the evaluation of driving to arrangealternate transportation if the patient's driving is found to be unsafe.EmploymentPD can be a disability and liability in the work place. Many patients ask,"Should I tell my boss?" There is no clear answer to this question because eachsituation is different. Patients should be encouraged to have a frank and opendiscussion with their health professionals regarding the limitations imposed bytheir symptoms and the effect of these lin-dtations on their job responsibilities. Thisdiscussion should include the benefits and potential disadvantages of revealing thisinformation to their supervisor. Frequently, coworkers have suspected that a prob-lem exists. By sharing the diagnosis, an empathefic supervisor may facilitate apafient's medical appointments and make environmental adjustments to expeditean optimum working relationship. Unfortunately, the risk of sharing the diagnosisof PD can have a negative impact on job security. It has been the experience ofthese authors that patients have been reassigned to other job responsibilities orpressured into early retirement. Physicians and nurses should strive to providestrategies and guidance for handling this difficult situation.DRUG THERAPYDrug therapy is the mainstay of management of PD. The primary medicationsused in PD are classified as anticholinergics, antihistamines, dopaminergics, anddopamine agonists (Table 3). (17) Unfortunately, all drugs used in the treatment of PDhave potential for side effects that impact on quality of life. Indication for medica-tion is determined when the patient develops deficits in activities of daily living oris expressing embarrassment from tremor or gait disturbances. The approach todrug therapy is to maintain the patient on conservative levels of medication whilemaintaining mobility. As the disease progresses, patients become less responsive tomedications and experience end of dose failure, peak dose dyskinesias, and painfuldystonic cramps. They are also more prone to developing de@um and hal-ludnations.(13,14)Levodopo TherapyLevodopa is the drug of choice for treatment of PD. It is marketed as acombination drug called Sinemet and is composed of carbidopa and levodopa. The-------------------------------------------------------------------------------------------------------------------Table 3. SUMMARY OF MEDICATIONS USED IN PARKINSON'S DISEASE-------------------------------------------------------------------------------------------------------------------Type Drug Name Indications Side Effects-------------------------------------------------------------------------------------------------------------Anticholinergics Tdhexyphenidyl Tremor, rigidity, Dry mouth,(Artane), drooling constipaflon,benztropine blurred vision,(Cogentin) confusion, visualhallucinationsAntihistamine Diphenhydramine Tremor, rigidity, Dry mouth, lethargy,(Benadryl) insomnia confusionDopaminergics Amantadine Rigidity, Leg edema, livedo(Symmetrel), bradykinesia, reticularls,carbidopa/ tremor hallucinations,levodopa orthostatic(sinemet) hypotension,nausea, confusionDopamine agonists Bromocriptine Motor fluctuations in Hallucinations,(Parb"), Parkinson's mental cloudinesspergolide (Permax) disease orthostatichypotension,confusion-------------------------------------------------------------------------------------------------------------action of carbidopa is to block the breakdown of levodopa in the peripheral organsand allows more levodopa to cross the blood-brain barrier. Levodopa is convertedto dopamine. in the brain through a series of enzymatic reactions.(13)Levodopa therapy is responsible for promoting quality of life for the vastmajority of patients with PD. Levodopa therapy has lin-dtations, however. Early intreatment, patients are maintained on low doses of levodopa to preserve thetherapeutic window for the future. Typically patients respond well to levodopa andonly experience mild side effects such as nausea and orthostatic hypotension. Asthe illness progresses, patients require higher levels of levodopa, a@d'response totherapy is less predictable.(13)Levodopa has a relatively short half-life. It has a rapid onset of actions andpatients report getting a surge of energy with each dose. Similarly, patients com-plain of "wearing off" symptoms as levodopa is metabolized and PD featuresreturn. When levodopa is at therapeutic levels, the patient's functioning mayappear quite normal. As the medication "wears off," however, patients may be-come akinetic and rigid. Like the on-off phenomenon, wearing off can be frustrat-ing for the patient and family. In contrast to the on-off phenomenon, however, thewearing-off symptoms are predictable and are associated with declining levodopalevels. When levodopa alone is not maintaining symptomatic control, the physicianmay add a dopamine agonist such as bromocriptine (Parlodel) or pergofide (Per-max). There agents act to smooth out levodopa levels and help to control the rapidrise and fall of levodopa levels.(13,14)With progression of symptoms, patients with PD may experience peak-dosedyskinesias. The term "dyskinesia" describes the development of extra movementsof the head, neck, trunk, and extremities as levodopa doses rise and peak rapidly.Most patients find that these extraneous movements limit social activities. Al-though dyskinesias can be devastating, patients can function within the limitationof the movement disorders.(13)ComplianceCompliance in taking prescribed drugs is essential to successful managementof PD. Patients with PD often verbalize feelings of being chained to the clockbecause they require levodopa to maintain mobility. Levodopa dosage schedulescan be prescribed as frequently as every 2 hours during the waking day. The needfor levodopa can overshadow all other aspects of the patients life because he or sheis unable to function without it. If medications are late or missed, the patient canexperience dystonic pain, increased tremor, rigidity, and personality changes. Com-pliance can also be an issue when patients with PD take extra doses of levodopa toboost their levels of energy and function. This behavior should be discouraged, andany change in treatment plan should be discussed with the physician. Alarm clocksor pill boxes with alarms can assist the patient with remembering to take themedication on time.Cost of medication can also affect compliance. It is not uncommon for patientsto spend approximately $300 per month on medications for PD. The financialimpact of medications can preclude physicians from ordering additional therapy.Nurses can assist in deterring the cost of therapy by investigating drug-cost-sharing programs sponsored by drug companies or pricing mafl-order pharmaciesto find lower Cost medications.Side Effects of Delirium and HallucinationsMedications used in the management of PD often need to be titrated. Usually,the higher the dose of drug, the more frequently side effects are encountered. (13) Theside effect of delirium is a constant danger with all medications usld in PD. Theprobability of delirium is determined by each patient's tolerance to the medicationand predisposing factors such as age and general health. Living with a drug-induced delirium is a difficult issue for many patients and families. Families areoften asked to make a choice between clear mentation and motor functioning. Itmay be easier for a family to care for a mobile patient with PD who is cognitivelyimpaired.The occurrence of hallucinations is well documented in the management ofpatients with PD. Amantadine, a dopaminergic medication, is notorious for causingvisual hallucinations. Other medications in which hallucinations have been docu-mented as a side effect include anficholinergic medications such as trihexyphenidyl(Artane) and benztropine (Cogentin), levodopa in the form of carbidopa/levodopa,and dopan-dne agonists such as bromoctiptine and pergolide. All of these drugs actto increase the levels of dopamine in the brain through different mechanisms ofaction. (13)Patients frequently are able to tolerate continued use of medications knowingthat hallucinations are a side effect of therapy. Typical treatment-induced halluci-nations in PD are visual and may consist of seeing small children or animals. Thesehallucinations are seldom threatening. If hallucinations become auditory or threat-ening in content, patients should be evaluated for depression or dementia by aqualified psychiatrist.SUMMARYPD affects many dimensions of quality of life. This article has identified motorand nonmotor features of PD that are directly related to a patient's quality of life.Medication therapy can help to ameliorate some of the symptoms, yet side effectscan be as disabling as the symptoms of PD. Nursing care should include assess-ment, intervention, and evaluation of both physical and psychosocial aspects ofcare for patients with PD to assist them in achieving maximum functioning,References1. Brown RG, Jahanshahi M, Quinn N, et al: Sexual function in patients with Parkinson'sdisease and their partners. J Neurol Neurosurg Psychiatry 53:480-486, 19902. Bunting LK, Fitzsimmons B: Depression in Parkinson's disease. J Neurosci Nurs 23(3):158-164, 19913. Cummings JL, Benson DF: Dementia: Definition, prevalence, classification, and approachto diagnosis. In Dementia: A Clinical Approach. Massachusetts, Butterworth, 1992, p 14. Folstein MF, Ross C: Cognitive impairment in the elderly. In Kelly WN led); Textbook ofInternal Medicine. JB Lippincott, 1992, p 24085. Gentile KM: A review of the literature on interventions and quality of fife in the fradelderly. In Birren JE, Lubben JE, Rowe JC, et a] (eds): The Concept and Measurement ofQuality of Life in the Frafl Elderly. San Diego, Academia Press, 1991, p 746. Giovannini P, Piccolo 1, et al: Early onset Parkinson's disease. Movement Disorders6(l):36-42, 19917. Hickey J: Nervous system degenerative diseases. In The Clinical Practice of Neurologicaland NeUTOSurgical Nursing. Philadelphia, JB Lippincott, 1992, p 6518. Marttila Rj: Epidemiology. In Koller WC led): Handbook of Parkinson's Disease. NewYork, Marcel Dekker, 1987, p 359. McCance KL, Huether, SE: Alterations in neurologic function. In Pathophysiology: Thebiologic basis for disease in adults and children. St. Louis, CV Mosby, 1990, p 50910. Micoch AG: Diagnosis and treatment of patkinsonian dysarthria. In Koller WC (ed):Handbook of Parkinson's Disease. New York, Marcel Decker, 1987, p 181
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Labels: PD PRIMER FOR GP'S
PD HEARTOUT
Letter to My Family and Friends about Parkinson'sAuthor Unknown(please advise me if you know its author)I have Parkinson's Disease. It is not contagious or hereditary. No one knows what causes it, but some of the dopamine cells in the brain begin to die at an accelerated rate. Everyone slowly loses some dopamine cells as they grow older.If the cells suddenly begin to die at a faster rate, Parkinson's Disease develops. It is a slowly progressive disease usually occurring as people get older. Medicine can help. I'll take newer, stronger kinds over the years. Some make me sick and take lots of adjustments. Stick with me. I have good days and bad days.Emotions:Sometimes I cry and appear to be upset and you think you have done something to hurt my feelings. Probably not. It is the Parkinson's. Keep talking to me. Ignore the tears. I'll be OK in a few minutes.Tremors:You are expecting me to shake. Maybe I do, maybe I don't. Medicine today takes care of the tremors. If my hands, feet, or head are shaky, ignore it. I'll sit on my hands or put them in my pockets. Treat me as you always have. What's a little shakiness between friends?My Face:You think you don't entertain me anymore because I'm not grinning or laughing. If I appear to stare at you, or have a wooden expression, that's the Parkinson's, I hear you. I have the same intelligence; it just isn't easy to show facial expressions. If swallowing, I may drool. This bothers me, so I will mop it up.Stiffness:We are ready to go somewhere and I get up. I can hardly move. Maybe my medicine is wearing off. The stiffness or rigidity is part of Parkinson's. Let me take my time. Keep talking.Exercise:I need to walk each day. Two to three miles is good. Walk with me. Company makes walking fun. It may be a slow walk, but I'll get there. Remind me if I slump or stoop. I don't always know I'm doing this. My stretching, bending and exercises must be done everyday. Help me with them if you can.My Voice:As my deeper tones disappear, you'll notice my voice is getting higher and wispy. That's the Parkinson's I know you can talk louder, faster and finish my sentences for me. I don't care for that. Let me talk, get my thoughts together and speak for myself. I'm still there. My mind's okay. Since I'm slower in movement, my thoughts are slower too. I want to be part of the conversation. Let me speak.Sleeplessness:I may complain that I can't sleep. If I wander around in the middle of the night, that's Parkinson's. It has nothing to do with what I ate or how early I went to bed. I may nap during the day. Let me sleep when I can. I can't always control when I'm tired or feel like sleeping. Be patient, my friends. I need you. I'm the same person; I've just slowed down. It's not easy to talk about Parkinson's, but I'll try if you really want to know. I need my friends. I want to continue to be part of life.Please remain my friend.Posted by Kate Kelsall on July 13, 2008 in Parkinson's: General Permalink
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Sunday, June 8, 2008
parkinson's web site
the pakistan parkinsons society web site is up address www.parkinsons.org.pk
the red tulip... our symbol of hope
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Thursday, May 8, 2008
psique: Introduction to Parkinson's Disease
psique: Introduction to Parkinson's Disease
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Friday, March 21, 2008
i am all shook-up
Shaking Up Life: Parkinson's Diseaseby Janet M. Schneider -- Library Journal, 1/15/2003Although Parkinson's Disease (PD) is one of the most common neurological disorders, many Americans were unaware of the condition until actor Michael J. Fox revealed his diagnosis to the public in 1998. An estimated 1.5 million people in North America now have the disease, including other luminaries like Muhammad Ali and Janet Reno.It also is an expensive disease; according to the National Parkinson Foundation, each patient spends an average of $2500 per year on medications alone. The total annual cost to the United States exceeds $5.6 billion.First identified by physician James Parkinson in 1817, PD is a slowly progressing, degenerative disorder that manifests itself with tremors, stiffness, slowness of movements, slurred speech, and impaired balance and coordination. (PD patients, or Parkinsonians, are often mistaken by the public as being inebriated or mentally deficient.) The disease's progression varies from individual to individual. Some are so mildly affected that they are never diagnosed, while others become completely incapacitated. A small percentage eventually develop dementia. Although primarily found in people over the age of 50, the disease is increasingly affecting younger adults. Fox himself was 30 when he was diagnosed. Treatments but no cure What triggers the disease is still unknown; its physical cause—a loss of nerve cells in the substantia nigra part of the brain—was only recognized in 1960. It appears that heredity plays a minor part, if any, in its development. Some medications used in the treatment of mental illness can produce symptoms that mimic PD, and in the early 1980s a "designer drug," MPTP, was found to cause PD in its users. Scientists now theorize that currently unidentified environmental toxins or viruses may also be a factor; a recent report that three other people who worked in the same television studio as Michael J. Fox during the late 1970s also developed PD has excited interest among researchers. First approved for use in 1970, the drug levodopa is still the best avenue for replacing the brain's lost dopamine and alleviating symptoms. (Without dopamine, signals from the brain cannot "transmit" properly to the body, and movement is impaired.) Research in the last decade has resulted in a better understanding of the disease process and some new drug therapies to enhance levodopa's effectiveness and reduce its side effects. Complementary therapies such as exercise and fall prevention have only recently been added to the PD treatment regimen. And surgeons are now experimenting with fetal tissue transplants, neuroblation, deep brain stimulation, and pallidotomy as possible treatments. But despite these advances, there is still no known cure. Collection diagnosis Because Parkinson's can mimic other neurological disorders (there is no definitive test), it is frequently misdiagnosed by family physicians unfamiliar with the disease; some patients have gone for years before receiving a correct diagnosis. It's important, therefore, for consumer health collections to offer authoritative resources for anxious patients and families seeking reliable information.Consumer health information on the disease has only begun to emerge since the 1990s, and much of that is far more technical than the lay literature on other health topics. Still, a number of leading experts and pioneers in the field (Abraham Lieberman, William Wiener, and Curt Freed) have recently written authoritative medical guides specifically for PD patients, and libraries should make sure they have these titles in their collections. Because advances in treatments mean people are living longer than ever before with the disease, and therefore are experiencing more complications, look for books that address these factors as well as discuss psychosocial issues and life skills. Personal narratives that describe how the PD patient or family member cope are also necessary purchases. Supplement your collection with good texts that deal with chronic diseases in general, especially those that emphasize patient control and coping skills, since these volumes are often far more positive in tone than the sometimes grim PD guides.There are currently few consumer periodicals on PD (most newsletters are only available online via PD associations), and quality up-to-date videos are rare. Starred [* ] items are core purchases for consumer health and most public library collections.Medical Guides *Blake-Krebs, Barbara & Linda Herman. When Parkinson's Strikes Early: Voices, Choices, Resources and Treatment. Hunter House. 2001. 270p. illus. bibliog. index. ISBN 0-89793-340-0. pap. $15.95.The authors, who were diagnosed with PD in their mid-40s, met on an online discussion list and discovered that the disease was becoming increasingly common in a younger population. Their guide incorporates e-mailings from the members of the Parkinson's Information Exchange Network (PIEN), with detailed advice on diagnosis, treatment, and self-help options. The vivid essays, poetry, and stories personalize the disease's impact; the resources section is outstanding.Cram, David L., M.D. Answers to Frequently Asked Questions in Parkinson's Disease: A Resource Book for Patients and Families. Acorn Pub. 2002. 170p. bibliog. index. ISBN 0-9710988-8-3. pap. $19.95.Dermatologist Cram has suffered with PD for over 12 years. Drawing on his personal experience and the latest medical research, he answers commonly asked questions submitted to his online column on Agenet.com. Especially helpful is his advice on the importance of the PD patient using an advocate when he or she is hospitalized or is navigating the healthcare system. A glossary and resources listing are included.Duvoisin, Roger C., M.D & Jacob Sage, M.D. Parkinson's Disease: A Guide for Patient and Family. 5th. ed. Lippincott Williams & Wilkins. 2001. 195p. illus. index. ISBN 0-7817-2977-7. pap. $29.95.This instructive text updates the 1996 edition with the latest details on the progression of PD treatments, genetics, and molecular biology. The complications of advancing disease are particularly well described. While the reading level is high, the determined reader can find a great deal of detailed information not found in other guides. Duvoisin is a pioneer in the development of levodopa therapy.Hauser, Robert A. with Theresa A. Zesiewics. Parkinson's Disease: Questions and Answers. 3d ed. Merit Pub. Intl. 2000. 182p. illus. index. ISBN 1-873413-92-0. pap. $17.95.Although primarily aimed at general clinicians, this manual may be useful for patients wishing more in-depth knowledge than what the consumer guides offer. Hauser (neurology, Univ. of South Florida) covers tests, clinical characteristics, staging and classification, medical management, and issues frequently missed in the lay literature.*Lieberman, Abraham, M.D. with Marcia McCall. 100 Questions About Parkinson Disease. Jones & Bartlett. Feb. 2003. 160p. index. ISBN 0-7637-2057-7. pap. $16.95.The national medical director of the National Parkinson Foundation has compiled common questions asked by newly diagnosed Parkinsonians. Lieberman is particularly good at telling patients what they should expect from their physicians, how they can select a competent movement disorders specialist, how they can make the most of living with PD, and what they should know about the new advances in medical, alternative, and surgical therapies. An optimistic resource that should be much in demand.*Lieberman, Abraham, M.D. Shaking Up Parkinson Disease: Fighting Like a Tiger, Thinking Like a Fox. Jones & Bartlett. 2002. 250p. illus. ISBN 0-7637-1866-1. pap. $18.95.Lieberman's sympathetic, thorough book explains PD and its symptoms (with steps to alleviate them) and extensively covers treatment options such as drugs and surgery. A plus is the author's discussion of anxiety and depression as a biological rather than a psychological symptom of the disease. Disorders that mimic PD are listed, and questionnaires help readers measure their personal mobility, emotional status, quality of life, and more. Although nonreligious readers may be put off by the biblical quotes, this is still an outstanding text. (LJ 1/02)*Parkinson's Disease. DK. (ACP Home Medical Guides). 2000. 80p. ed. by David R. Goldman, M.D. & David A. Horowitz, M.D. illus. index. ISBN 0-7894-4169-1. pap. $6.95.This excellent entry in the American College of Physicians series features DK's typical lush full-color photos and illustrations. The concise text covers types of Parkinson's, causes and characteristics, signs and symptoms, and diagnosis, as well as standard medical and surgical treatments. Especially good are the clearly written evaluation scales for disease assessment.*Silverstein, Alvin & others. Parkinson's Disease. Enslow Pub. 2002. 128p. illus. bibliog. ISBN 0-7660-1593-9. $20.95.Although written for children, this reassuring guide is also excellent for adults with limited reading skills. Covering the basics (causes, treatment, symptoms, and progression), the volume also highlights ongoing research, the use of service dogs for Parkinsonians, and PD celebrities such as Michael J. Fox.Weiner, William J., M.D. & others. Parkinson's Disease: A Complete Guide for Patients & Families. Johns Hopkins. 2001. 272p. illus. index. ISBN 0-8018-6555-7. $45; pap. ISBN 0-8018-6556-5. $15.95.While somewhat clinical in tone, this guide by the director of the Maryland Parkinson's Disease Center offers excellent current information. Physical, behavioral, and psychiatric signs and symptoms exhibited during mild, moderate, and advanced stages are explained, as are diseases that can mimic Parkinson's. Emphasizing the questions to be asked and the tests that the patient should undergo before a diagnosis is made, the text also discusses the latest drug and surgical treatments, including alternative therapies. (LJ 5/15/01)Treatment & Therapy *Argue, John. Parkinson's Disease & the Art of Moving. New Harbinger. 2000. 220p. photogs. index. ISBN 1-57224-183-7. pap. $15.95.PD destroys the ability of patients to perform many routine physical skills necessary to daily living. Argue, who has taught movement and speech classes for Parkinsonians since 1985, presents ten exercise routines (clearly demonstrated in over 100 photographs) to improve flexibility, balance, coordination, speech, swallowing, and more.Hutton, J. Thomas, M.D. Preventing Falls: A Defensive Approach. Prometheus. 2000. 115p. illus. bibliog. ISBN 1-57392-761-9. pap. $19.Falls are a major concern for balance-impaired Parkinsonians as resulting injuries can cause even more disability or even death. Hutton, medical director of the National Parkinson Foundation Center of Excellence at Covenant Health System (Lubbock, TX), briefly explains major causes of falls and what the caregiver or patient can do to anticipate and minimize risks. He includes some assessment tools and a reassuring chapter on how to recover from a fall. A companion video is available.Leader, Geoffrey & Lucille Leader. Parkinson's Disease: The Way Forward!; An Integrated Approach Including Drugs, Surgery, Nutrition, Bowel and Muscle Function, Self-Esteem, Sexuality, Stress Control and Careers. Denor Pr. 2001. 301p. illus. index. ISBN 0-9526056-8-6. pap. $22.95.While the British viewpoint may not always translate well, this volume covers alternative treatments for PD, such as chelation therapy, Chinese medicine, electromagnetic therapy, and more. The authors also discuss sexuality and PD, pregnancy, and the role of other healthcare professionals such as osteopaths and physiotherapists in the treatment of the disease.Rosenstein, Ann. Water Exercises for Parkinson's: Maintaining Balance, Strength, Endurance, and Flexibility. Idyll Arbor. 2002. 244p. illus. index. ISBN 1-882883-49-7. pap. $18.In her introduction, water aerobics instructor Rosenstein argues persuasively that water exercises can significantly enhance mobility and ease the physical impact of PD, as well as ward off depression and improve self-esteem. She addresses pool safety, drugs, proper attire, equipment, and methods of entering the pool; her exercises are well illustrated.Coping Issues Biziere, Kathleen E., M.D. & Matthias C. Kurth, M.D. Living with Parkinson's Disease. Demos Medical. 1997. 160p. illus. index. ISBN 1-888799-10-2. pap. $24.95.While the first half presents a technical explanation of the etiology, symptoms, and medical and surgical management of PD, this book's real strength lies in the second-half discussion of clinical trials, including points to consider before participating in a clinical trial and lines of research being pursued. An extensive glossary is included.Caring for the Parkinson Patient: A Practical Guide. 2d ed. Prometheus. 1999. 251p. ed. by Thomas J. Hutton & Ray Lynne Dippel. illus. ISBN 1-57392-684-1. pap. $22.Sixteen contributed chapters address medical and surgical treatments, physical and occupational therapy to enhance the patient's daily living skills, psychological and cognitive changes caused by the disease, and caregiver issues. Also helpful are the photos and descriptions of adaptive equipment.Jahanshahi, Marjan, M.D. & C. David Marsden, M.D. Parkinson's Disease: A Self-Help Guide. Demos Medical. 2000. 392p. illus. index. ISBN 1-888799-38-2. pap. $24.95.This practical handbook gives essential information to PD patients and their families on how best to cope with the life changes brought about by the disease. The authors emphasize patient empowerment through information, resources, and assistive devices.* Parkinson's Disease and Quality of Life. Haworth. 2000. 223p. ed. by Lucien Cote. index. ISBN 0-7890-0763-0. $49.95; pap. ISBN 0-7890-0810-6. $19.95.Published simultaneously as an issue of Loss, Grief and Care (2000. Vol. 8, #3/4), this volume features 31 contributors (nurses, doctors, patients, speech therapists, etc.) who cover a wide array of topics about PD not found in other guides: dental health, shortness of breath, sexuality, incontinence, medical expenses and health insurance benefits, tax planning, and occupational therapy, among others. Some essays are more technical, but this is still a valuable resource.Schwarz, Shelly Peterman. 300 Tips for Making Life with Parkinson's Disease Easier. Demos Medical. 2002. 144p. index. ISBN 1-888799-65-X. pap. $18.95.Multiple sclerosis (MS) sufferer Schwarz has written similar books on MS and arthritis. Her new guide offers tips, techniques, shortcuts, and resources that can assist Parkinsonians adapt to their environment and maintain their daily personal living skills. She also gives advice to caregivers. While some suggestions are too simplistic to be actually useful, others are concrete and practical enough to help PD patients keep their independence.Research *Freed, Curt, M.D. & Simon LeVay. Healing the Brain: A Doctor's Controversial Quest for a Cell Therapy To Cure Parkinson's Disease. Times Bks. 2002. 288p. index. ISBN 0-8050-7091-5. $26.Freed's absorbing account details his initial involvement with neurology and his later specialization in Parkinson's studies. His use of stem cells in 1994, in which monkeys with Parkinson's-like disease had dopamine cells from embryos transplanted into their own brains, showed great promise for humans. Detailing the outcomes from the human clinical trials, Freed also discusses the ethical and legal issues involved in fetal tissue research, although his bias in favor of this controversial technique is obvious. (LJ 8/02)Personal Narratives Fox, Michael J. Lucky Man: A Memoir. Hyperion. 2002. 260p. photogs. ISBN 0-7868-6764-7. $22.95.Actor Fox hid his PD for seven years before announcing his illness in 1998. He recounts his life from childhood to stardom, his efforts to deny his disease to himself as well as his fans, and ultimately his decision to go public. In a down-to-earth style, Fox reveals his struggles to deal with and find meaning in his changed life.Grady-Fitchett, Joan. Flying Lessons: On the Wings of Parkinson's Disease. Forge. 1998. 240p. ISBN 0-312-86490-6. $17.95; pap. 2000. ISBN 0-312-86491-4. $12.95.A successful 47-year-old professional woman, Grady-Fitchett was diagnosed with PD in 1979. Refusing to allow the disease to dampen her positive attitude, she entered clinical trials, remarried, and maintained an independent lifestyle. Ultimately the disease progressed until, in 1996, she was accepted into the University of Colorado's experimental stem cell transplant program. Readers will be inspired by her attitude and disappointed that the book ends before knowing the surgery's outcome. (LJ 10/15/98)*Havemann, Joel. A Life Shaken: My Encounter with Parkinson's Disease. Johns Hopkins. 2002. 200p. bibliog. index. ISBN 0-8018-6928-5. $24.95.Los Angeles Times Senior Editor Havemann movingly chronicles the physical and emotional effects the disease has had on his life since his diagnosis in 1990. While he briefly discusses PD's history, possible causes, medical and surgical treatments, and research progress, it is the account of his personal struggle that is the heart of this book. Havemann realistically accepts his condition yet also resists its limitations; his appreciation of life in spite of disability is inspiring. (LJ 3/15/02)Kondracke, Morton. Saving Milly: Love, Politics, and Parkinson's Disease. Perseus. 2001. 288p. photogs. index. ISBN 1-58648-037-5. $25; pap. Ballantine. 2002. ISBN 0-345-45197-X. $14.Recounting his first reactions after his wife was diagnosed with PD at age 47, political journalist Kondracke honestly describes his denial and retreat from Milly and his eventual transformation into the role of caregiver and PD political activist. Readers will be moved by his account of Milly's struggle to achieve a decent quality of life through traditional and alternative therapies and later pallidotomy and deep brain stimulation. (LJ 7/01)Morgan, Eric. Defending Against the Enemy: Coping with Parkinson's Disease. QED. 1997. 122p. bibliog. index. ISBN 0-936609-36-2. pap. $12.95.A year after Morgan's wife, Audrey, was found to have PD, Morgan was diagnosed as well. His unique perspective as caregiver and patient offers insight into how the disease can manifest itself and progress differently in each affected person. Morgan also details the emotional strains that PD places on relationships. Chapters define medical terms and concepts, and the book ends with tips for the patient and the caregiver.Associations & Web Sites *American Parkinson Disease Association. 1250 Hylan Blvd., Staten Island, NY 10305-1946; 800-223-2732; e-mail: apda@apdaparkinson.org; www.apdaparkinson.org.With 65 chapters and over 800 support groups nationwide, the APDA seeks to "ease the burden and find the cure" for PD. Its web site offers full-text booklets, video rentals, news releases, and reports on current research and political efforts.Awakenings www.parkinsonsdisease.com This comprehensive site lists pertinent materials for patients (support groups and associations; book, audiotape, and video lists; tips for living with PD, etc.), primary care physicians, and PD specialists. The information on assistive technology and resources for caregivers is excellent. Michael J. Fox Foundation for Parkinson's Research, PO Box 4777, Grand Central Sta., New York, NY 10163; www.michaeljfox.org.Founded by the actor in 2000, the foundation strives to assist in the cure of PD through an "aggressively funded" research agenda. It also provides information for patients and caregivers about the disease, disability benefits, research, and advocacy efforts. On the web site, the organization's newsletter is available in PDF format, and readers can access excerpts of Fox's book (above) in English and Spanish.*National Institute of Neurological Disorders and Stroke. PO Box 5801, Bethesda, MD 20824; 800-352-9424; www.ninds.nih.gov.The National Institute of Neurological Disorders, a part of the National Institutes of Health, conducts and supports basic and clinical research on the causes, prevention, diagnosis, and treatment of neurological disorders and stroke. It provides a great deal of free information on the more than 600 disorders, including PD. The web site includes a link to clinical trials seeking volunteers.*The National Parkinson Foundation. Bob Hope Parkinson Research Ctr., 1501 NW 9th Ave., Bob Hope Rd., Miami, FL 33136-1494; 800-327-4545; www.Parkinson.org.NPF offers a wealth of information, from the basics to a multimedia library and chat groups. Online full-text pamphlets are available in English and Spanish. Listings and contact information for PD Research Centers of Excellence are noted, and the quarterly Parkinson Report can be downloaded in PDF format.Parkinson's Action Network. 300 N. Lee St., Alexandria, VA 22314; 800-850-4726; e-mail: info@parkinsonsaction.org; www.parkinsonsaction.org.Founded by a PD patient, the Parkinson's Action Network seeks to strengthen funding for PD research through grass-roots efforts, legislation, and promoting increased awareness of the disease. PAN's Advocacy Handbook can be downloaded from the web site, which also features a multimedia library.*Parkinson's Disease Caregiver's Information www.parkinsonscare.com Caregivers will find crucial information, including links to other caregiving resources, and online chat forums at this NPF-sponsored site. Parkinson's Disease Foundation. (PDF). William Black Medical Bldg., Columbia-Presbyterian Ctr., 710 W. 168th St., New York, NY 10032-9982; 800-457-6676; e-mail: info@pdf.org; www.pdf.org.Users of the organization's web site can find support groups, clinical neurologists specializing in PD, an Ask-the-Expert section to which they can submit questions, and a wide variety of other resources. They can also register to receive via e-mail select portions of the Parkinson's Disease Foundation's quarterly newsletter. [The merger between the PDF and the National Parkinson Foundation (NPF) is expected to be completed in early 2003; the new organization will be known as The Parkinson Foundation (TPF).—Ed.]The Parkinson's Institute. 1170 Morse Ave., Sunnyvale, CA 94089-1605; 800-786-2958; www.parkinsonsinstitute.org.Founded by neurologist J. William Langston in 1988 after his experience with heroin addicts who had developed PD after taking a designer drug (as he recounted in The Case of the Frozen Addicts, now out of print), the nonprofit organization conducts patient care as well as clinical and basic research. Other services include a Movement Disorders Clinic, a resource library, physical therapy, monthly seminars, and referrals to support groups and specialists. The semiannual newsletter is available online.The Parkinson's Web spauldingrehab.mgh.harvard.edu/parkinsonsweb/Main/Pdmain.html From Harvard Medical School's Department of Neurology, this web page provides links to PD national organizations, federal resources, clinical centers, support groups, advocacy groups, and more. Young Onset Parkinson's Associationwww.youngparkinsons.com Younger Parkinsonians, whose needs and concerns differ from older patients, will find here personal narratives, a reading list, message board, and chat room. --------------------------------------------------------------------------------Author Information Janet M Schneider is Patient Education Librarian, James A. Haley Veterans' Hospital, Tampa, FL, and has reviewed health books for LJ for ten years. 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Labels: shaking up life - PD
Saturday, January 5, 2008
parkinson's....useful info
Adult Medicine Children's Health Dental Health Emotional Well Being/Psychiatric Dysfunction Health,Prevention, & Care HIV Issues and Topics Nutritional Consultation Sexual Health Issues Parkinson's Disease Description What Is Parkinson's Disease?Parkinson's Disease is a chronic progressive nervous disease that is linked to decreased dopamine production in the substantia nigra (a layer of deeply pigmented gray matter situated in the midbrain and containing cell bodies of a tract of dopamine-producing nerve cells). It is marked by tremor, weakness of resting muscles, and by a shuffling gait. The disorder is named for British Physician James Parkinson, who first described the disease in a report called "An Essay on the Shaking Palsy", in 1817. Parkinson called the disorder paralysis agitans; Latin words meaning "shaking palsy".Dopamine is a neurotransmitter, a chemical that carries messages from one nerve cell to another. Loss of dopamine disrupts the communication pathways among the nerves that help control movement. Symptoms of Parkinson's may cause problems with walking or talking and sometimes may produce severe disabilities. Scientists do not know the cause of Parkinson's disease, and while there is no cure there are various treatments and therapies that may alleviate some of the more troubling symptoms.Parkinson' disease occurs in people worldwide, however the incidence is higher in men than in women, and Caucasians have a higher incidence than people of other races. In the United States and Canada more than 50,000 people are diagnosed with the disease each year. It is hard to estimate how many people have the disease, however, as the symptoms are often mistaken for the normal effects of aging, or are believed to be caused by other diseases. It most commonly develops around the age of 60, and the incidence rises with age. At least ten percent of cases occur in people under the age of forty, and there is a rare form that affects teenagers.Signs and SymptomsMotor Problems For the motor disorders, the four classic symptoms that Health Care Providers look for in assessing a person that is suspected of having Parkinson's are:Tremor (the involuntary shaking of limbs): Tremor often starts with the slight shaking in one hand that later spreads to the entire arm. In the beginning, tremors sometimes cause the hand to rub back and forth between thumb and forefinger (this is called pin rolling). Tremors may also develop in the head, lips or feet. These symptoms may occur on one or both sides of the body, and while they can be distressing, they are not usually disabling, and generally disappear during sleep. At least a third of people diagnosed with the disease do not develop this symptom. Rigidity (stiffness of limbs and joints): Rigidity usually occurs in the limbs and the neck. The stiffness in the joints is similar to arthritis. Often rigidity impairs the small muscles of the hands, making tasks such as buttoning a shirt, writing, or typing difficult. Bradykinesia (generalized slowness of movements): this is the most debilitating symptom and produces a physical and mental sluggishness. The slowness in the voluntary movements contributes to varied problems, such as a distinctive shuffling walk, stooped posture, indecipherable handwriting, and even simple tasks become difficult and time consuming. The slowness in the speech patterns makes communication difficult and frustrating for not only the patient but also for the patient's friends and family. In the later stages of the disease, the muscles may freeze up, making it difficult to resume normal movement. This sluggishness may also affect the digestive tract and can contribute to constipation, which is often a major problem for people with Parkinson's. Postural Instability (difficulty adjusting to changes in body positions): This impaired reflex appears as unsteadiness or lack of balance and contributes to falls and injuries for people with Parkinson's. A person without Parkinson's who trips and starts to fall is usually able to quickly move the trunk and limbs in such a way as to prevent or ease the fall. People with postural instability, on the other hand, are unable to respond as quickly, and cannot move in a way that stops or lessens their fall. Often just simple turning, or rising from a chair are difficult and can result in an imbalance that can lead to falling.Symptoms usually affect one side of the body more than the other side and there are always two primary symptoms present when a diagnosis of Parkinson's is made. According to the Hoehn and Yahr scale, Parkinson's disease has the following five stages:Stage I: Symptoms are only on one side of the body Stage II: Symptoms are on both sides of the body Stage III: Balance is impaired Stage IV: Assistance is required to walk and other symptoms are severe Stage V: Wheelchair bound There are several secondary symptoms that are caused by one or more of these four major symptoms. Many people have difficulty walking, resulting from a combination of postural instability and bradykinesia. The balance problems may cause them to stagger and add to a lurching gait. They may experience difficulty in turning or stopping as they walk, or they may inexplicably come to an abrupt stop. Loss of automatic movements may lead to a freezing of the facial muscles resulting in a "mask like" expression. They may also develop a fixed staring expression, and unblinking eyes. They may develop drooling, dizziness when moving from a seated to a standing position, difficult or frequent urination, difficulty speaking or swallowing, restlessness, eyelid closure, skin problems, excessive sweating, and sexual problems. Mental DisordersDepression: Due to the toll of living with their illness, and also due to the deficiencies of brain chemicals that are a part of the disease, many Parkinson's patients experience depression. Depression is marked by deep hopelessness and pessimism, and occurs in at least 40 percent of Parkinson's patients. A majority of patients experience anxiety that in turn may produce panic attacks. Panic attacks are overpowering fears, accompanied by breathlessness, sweating, chest pain, choking, and dizziness. Depression or anxiety that appears before motor symptoms develop are most likely caused by the disease itself, while depression or anxiety that occurs after the disease is diagnosed are usually due to the natural reaction to having a chronic and debilitating illness.(It should be noted here that many Parkinson's patients and their families have found much relief in dealing with this disease by joining support groups. By checking with your healthcare provider, or by contacting the Parkinson's Foundation, you should be able to find one in your area.) Dementia: At least thirty percent of Parkinson's patients develop dementia. Dementia is deterioration in intellect marked by memory losses, short attention span, impaired judgment, as well as personality changes. Twenty percent of People with Parkinson's experience cognitive impairment in which the information processes become slow. Planning or organizing skills, a decline in initiative and creativity may be compromised and completing simple tasks, such as balancing checkbook, becomes difficult. Dementia may be preceded by cognitive impairment.Sleep problems: Sleep problems are also a symptom of Parkinson's. The sleep disturbance may be caused by depression or anxiety, or the drugs that are used to treat the Parkinson's could cause it. These patients may wake up frequently during the night, and may also act out their dreams (REM sleep behavior disorder). The disease may also cause this sleep disorder, as the sleep centers are located near the substantia nigra and may be altered by the disease. CausesWhile scientists do not understand the mechanisms underlying nigral cell deterioration in Parkinson's disease, most researchers believe that it results from a combination of factors that involve genetics, environmental agents, and abnormalities in cellular processes. Although Parkinson's has been thought to be mostly a genetic disease, a report published in the January 27,1999 issue of the Journal of the American Medical Association (JAMA), stated that it is instead more likely to be caused by environmental factors. The genetic factor has been debated for more than a century. Researchers have noted, however, that the disease is more common in the developed Western nations, fueling speculation that a byproduct of industrialization is to blame. A new study, the largest ever undertaken to examine the role of genetic or environmental causes of Parkinson's disease, was conducted by researchers at the Parkinson's Institute in Sunnyvale, California. The six-year study drew on the health records of nearly 20,000 white male twins. The records were contained in a registry of twins who fought in World War II (1939-1945). It was found that among men who developed the disease after the age of 50, the chance that their twin brother would also have the disease was equal to that of an unrelated stranger. About ninety percent of all cases of Parkinson's were diagnosed in men aged 50 or older. In the rare instances where Parkinson's developed before the age of 50, the researchers determined that genetic factors were important. Having eliminated genetic factors as a primary cause of the most common form of Parkinson's, the researchers concluded that an environmental agent most likely triggers the disease. These agents are unknown, but scientists have speculated that they could include exposure to pesticides and other chemicals, or something in the diet. In an editorial accompanying the new study, neurologist Jeffrey Cummings at the University of California (UCLA), wrote that the study findings should help refocus research on Parkinson's.(It should be noted here, however, that scientists have yet to identify a particular drug or toxin that causes Parkinson's disease.) DiagnosisIt is difficult to diagnose Parkinson's in the early stages, as no definitive tests exist for the disease. Many of the symptoms may be dismissed as the effects of aging, particularly in older adults. Healthcare Providers sometimes miss Parkinson's disease in the young, precisely because they believe it mainly affects older patients. A diagnosis is based on a patient's medical history, observations of the symptoms, and a neurological examination. The neurological examination includes an evaluation of the patient's walking, coordination, and some simple dexterity tests. Subtle signs such as reduced facial expressions, or lack of gestures or a subtle tremor are also noted. Healthcare providers may use brain-imaging techniques to help in their diagnosis. Magnetic resonance imaging (MRI), which uses electromagnetic radiation to view soft tissues of the body, can help the healthcare provider exclude other medical conditions that produce symptoms similar to Parkinson's disease.TreatmentA person who suspects he/she might have Parkinson's should always contact their healthcare provider for a diagnosis and for treatment possibilities.Depending on the symptoms, one healthcare provider may first try lifestyle changes such as diet, exercise, and physical therapy, while another may begin drug treatment at the first signs of the disease. Although the symptoms may be controlled by use of various drugs, and in some cases by surgery, there is no treatment that prevents the progressive brain changes in patients who have the disease. Physical therapy can be helpful both in the early and later stages. It can help improve not only mobility, range of motion and muscle tone, it can also help improve gait and balance. Working with a speech pathologist can help improve problems with speaking and swallowing. Drugs are used primarily for managing problems with walking, movement, and tremors, by increasing the brain's supply of dopamine. Dopamine itself cannot pass from the bloodstream to the brain, therefore, the drugs used to treat Parkinson's disease, known as antiparkinson drugs, use other methods to temporarily restore dopamine in the brain or closely mimic dopamine's actions.Drugs Used IncludeLevodopa (laradopa): an oral drug introduced in 1967 that treats bradykinesia, rigidity, tremor, and difficulty walking. Levodopa enters the brain where it transforms into dopamine. The body breaks down about 95 percent of the drug into dopamine before it reaches the brain if the drug is taken by itself. Therefore, it is usually combined with a drug such as carbidopa, which enables more levodopa to enter the brain before it converts into dopamine. Carbidopa/levodopa (Atamet, Sinemet) lessens rigidity and bradykinesia but is less effective in treating temor or balance problems. A similar drug (Madopar) combines carbidopa and benserazide and is available in Canada. As the disease progresses, the drug works less evenly. As a result some people may experience involuntary movements (dyskinesias), especially when the medication is having its peak effects. This causes what is known as the "off-on" phenomenon. Therefore, it is very important to work closely with your healthcare provider who can monitor the progress, and the treatment. Drugs that sustain levodopa's effectiveness, such as a controlled-release form of carbidopa/levodopa (Sinemet CR) are often used. Side effects include hallucinations, a drop in blood pressure (especially when standing), and nausea.Dopamine Agonists: these are drugs that unlike levodopa are not changed into dopamine. Instead, they mimic the effects of dopamine in the brain and cause neurons to react as though sufficient amounts of dopamine were present. They are primarily used as adjuncts to levodopa therapy, but are also used in early therapy, and in younger adults. The side effects are similar to those of levodopa. This class of drugs includes bromocriptine (Parlodel) and pergolide (Permax) and the new drugs, pramipexole (Mirapex) and ropinirole (Requip). Only by working closely with the healthcare provider, however, can a person with Parkinson's receive the correct care for him/her.Selegiline (Carbex, Eldepryl, Atapryl): this drug is used as an adjunct to levodopa therapy and helps prevent the breakdown of both naturally occurring dopamine and dopamine formed from levodopa. This occurs by inhibiting the activity of the enzyme monoamine oxidase B (MAO-B); the enzyme that metabolizes dopamine in the brain. Toxic reactions have occurred in some patients who took selegiline with the narcotic drug, meperidine (Demerol).COMT inhibitors: are a newer class of drugs that work to prolong the effect of levodopa therapy by blocking an enzyme that breaks down dopamine in the liver and other organs. Tolcapone (Tasmar) is a potent COMT inhibitor that easily crosses the blood-brain barrier and doubles the time that levodopa is effective in the brain, and reduces the on-off effect. However, it has been linked to liver damage and liver failure and is normally used only in people who are not responding to other therapies. Entacapone (Comtan) is a milder COMT inhibitor that may help manage fluctuations in the response to levadopa.Anticholinergics: these were the main drugs used before the introduction of levodopa. They are mildly beneficial in the earlier stages of Parkinson's and may lesson tremor and drooling, but are not effective in treating bradykinesia or posture instability. Anticholinergics block the action of acetycholine, which is responsible for problems with motor skills.Amantadine (Symmetrel): this drug was originally developed as an antiviral drug. It is usually prescribed for people in the latter stages of Parkinson's disease, especially if they have problems with involuntary movements induced by levodopa (dyskinesias). Side effects include swollen ankles and a purple mottling of the skin.(If you are taking medications for Parkinson's disease, it is extremely important not to stop taking them on your own. Always talk to your healthcare provider.) Surgical TreatmentsSurgical procedures were commonly used in the 1950's and 1960's to treat tremor and rigidity in Parkinson's patients. The success rate varied and life-threatening complications often occurred. Surgical treatment fell out of favor with the introduction of levodopa and other drug therapies. However, the surgical approaches are being re-evaluated to be used for times when symptoms cannot be controlled with medications. These surgical procedures include:Thalamotomy: this procedure, used to reduce tremors in people with Parkinson's disease involves the destruction of small amounts of tissue in the thalamus - a major brain center for relaying messages and transmitting sensations. The surgery can cause extreme weakness and slurred speech if it is performed on both sides of the brain, and the benefits are usually confined to one side of the body. Pallidotomy: in this procedure, an electric current is used to destroy a small amount of tissue in the globus pallidus, a part of the brain responsible for many symptoms of Parkinson's disease. It may improve tremors, rigidity and slowed movement by interrupting the neural pathway between the globus pallidus and the thalamus. It has proven helpful for some patients, but it is not a cure, and the effects do not always last. The surgery includes certain risks such as slurred speech, disabling weakness and vision problems, especially when performed on both sides of the body. Deep brain stimulation: this is a device that helps control the disabling shaking and trembling caused by Parkinson's disease. A probe is inserted into the thalamus or globus pallidum and connects to a battery-powered generator outside of the body. When tremor or other uncontrolled movement starts, the patient turns the generator on and an electric signal sent to the brain halts the movement. In 1997, the Food and Drug Administration approved a new device that is implanted in the chest and transmits electrical pulses via a wire to an implant in the thalamus. Potential risks exist with the DBS, including infection caused by the wire connecting the electrode to the stimulator and the need to perform minor surgery to change the unit's battery. Experimental Treatments IncludeFetal cell transplantation: a procedure in which fetal cells are implanted into the brains of people with Parkinson's. This procedure is used to replace the dopamine-producing cells in the substantia nigra. However, a study, published in the March 8, 2001 issue of the New England Journal of Medicine, suggested that fetal cells implants only benefit people under the age of 60, and about 15 percent of the study participants later developed severe involuntary movements (dyskinesias) as a result of too much dopamine.Embryonic stem cells: these are the parent cells of all tissues in the body, and the hope is that they may one day be used to reproduce specific types of cells - such as dopamine-producing neurons - that can be used to treat disease. Stem cells can also be obtained from the discarded umbilical cord from healthy babies, and the bone marrow of adults. Using stem cells from these sources make this treatment more acceptable and may go far in alleviating the controversy surrounding the use of embryonic stem cells.(Both of these treatments are still in the research phase, and are not available to the public. At this time they are still experimental treatments.) Self-HelpIn addition to the various treatment procedures there are many things a person diagnosed with Parkinson's can do to help him/herself. While any and all treatments and therapies should be discussed with one's healthcare provider, the following may be of help:Nutrition/Diet: Because it is believed that Parkinson's may be associated with free radicals (potentially damaging molecules produced in cells as part of cell activity or in response to injury), it is important to eat foods that contain antioxidants. Foods that contain antioxidants are fruits, vegetables and whole grains. A balanced diet that contains these can help protect against free radical damage. They are also high in fiber, which is important for the Parkinson's patients that suffer from constipation. Your healthcare provider may advise taking a fiber supplement, such as Metamucil or Citrucel, however, it should be introduced slowly and it is imperative to drink eight to ten glasses of water daily. Limiting caffeine and alcohol is also helpful. Reducing the consumption of fat, especially saturated fats can be helpful in maintaining an acceptable weight. Because Parkinson's disease slows gastric motility, swallowing is prolonged, and therefore food absorption is slower. Eating small amounts of food throughout the day is better for the Parkinson's patient than three large meals. If a Parkinson's patient is taking Simemet, it should be taken on an empty stomach. Even taking it fifteen minutes before eating is preferable. If nausea is present, it may be taken with a non-dairy fluid and a small cracker, bite of fruit, even a pretzel. Ginger has been found to be helpful in offsetting nausea. Taking Simemet on an empty stomach allows it to be absorbed more easily and quickly. Some healthcare providers may recommend vitamin or antioxidant supplements. Talk to your healthcare provider about the benefit of adding these to your diet. Parkinson's patients often have trouble swallowing, especially in the latter stages of the disease, therefore it is important to remember to take small bites of food, chewing them completely and swallowing before taking another bite. Chopping food in a food processor may also be helpful, as would using a plate warmer under the plate to insure the food doesn't get cold, thus allowing you to take your time in eating.Exercise: Regular exercise is important for Parkinson's patients. It aids in mobility, balance, and range of motion. Your healthcare provider may recommend an exercise program for you, however, walking, swimming, and gardening have all proved beneficial. Studies have shown that activities such as walking, jogging, and even dancing may be more helpful than physical therapy. Making sure that your medicines are working well and you are feeling strong, as the energy level may go up and down, are important things to consider before beginning any exercise. In the case of fatigue, it may be helpful to do part of your exercise routine in the morning, and another part in the evening. Make sure and stretch before exercising as this helps to warm up the muscles and also helps to prevent stiffness. Stretching also improves balance and flexibility. Some healthcare providers are suggesting that their patients try Tai Chi, a Chinese form of exercise that uses slow, graceful movements to relax and strengthen the muscles and joints. It is also known to be beneficial in improving balance. It is imperative to always consult with your healthcare provider before starting any exercise program.Walking: Walking is difficult for the Parkinson's patients, especially in the latter stages due to the shuffling and foot drag that is common to this disease. Making sure to use proper posture and wearing the right shoes, such as a pair of good walking shoes can help. One of the problems that Parkinson's patients face is what is known as "freezing". This usually happens when a person with Parkinson's stops or tries to pivot in order to turn and their feet become "frozen" in place. Rocking gently from side to side, or pretending to step over an object on the floor can aid in this. Avoiding prolonged standing, using a large rubber tipped cane, using a forward facing wide U-turn rather than the usual pivoting and keeping distractions to a minimum can help the patient avoid falls. Also, standing with feet eight to ten inches apart instead of close together may be of help. There are many products on the market that can help the people who have Parkinson's disease. These would include handrails (especially on staircases) and grab bars for around the tub and beside the toilet. Removing area rugs can also help. Music Therapy, a therapy that uses music and rhythm to help improve the patient's mobility and balance has been used with some success. You can check with your healthcare provider to find this therapy in your area.Dressing: As dressing can become an ordeal for a person who has Parkinson's, it might be helpful not only to allow plenty of time for dressing, but also to choose clothes that slip on easily or that have Velcro fasteners rather than buttons or zippers.Speaking: A person who has Parkinson's often speaks with a soft of hoarse voice. In order to communicate more easily, face the person you are talking to and speak deliberately and more loudly than you think necessary. Reading or singing out loud while focusing on breathing aids in strengthening the vocal cords and the throat muscles which in turn aid in swallowing. Consulting with a speech pathologist that is trained to treat Parkinson's patients can also be beneficial.Parkinson's is a progressive disease, and while none of these tips can eliminate or cure any of the problems associated with Parkinson's, making certain lifestyle changes can help make living with the disease easier.The information in this or any article should never be used to diagnose oneself. If Parkinson's or any disease is suspected, a healthcare provider should be contacted as soon as is possible, in order to detect early symptoms and begin treatment.Additional ResourcesAmerican Healthcare Association (202) 842-4444 Americans with Disabilities Act Regional and Technical Assistance Centers (800) 949-4232 The National Council On the Aging, Inc. (202) 479-1200 National Council on Disability (202) 347-1234 The National Parkinson's Foundation encourages all patients to request a Parkinson's Medical Alert card if they don't already have one. This card alerts anyone rendering assistance that the individual has Parkinson's disease. It provides emergency contact numbers so that the family and/or healthcare provider may be contacted, as well as important medical information. To request your card call: 1 (800) 327-4545. /em> post
Wednesday, January 2, 2008
the secret...........by Rhindo Byrne
Disease is held in the body by'thoughts' and by the attention given to it.By talking about you add energy to it......
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About Me
haroon
retired CEO and Banker now working as ombudsman financial services View my complete profile
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parkinson's .......a new world
a collection of info on parkinson's by a pwp
Sunday, July 13, 2008
pd primer for GP'S
Parkinson's DiseaseQuality of Life IssuesBarbara Fitzsimmons, RN, MSLisette K. Bunting, RN, MScN--------------------------------------------------------------Individuals who develop Parkinson's disease (PD) are confronted not onlywith the physical manifestations of the disorder but with the psychosocial issuesthat impact on quality of life. Psychosocial aspects of PD may present as subtlechanges with progression of the disease. Many patients with PD are reluctant todiscuss these concerns with health care providers, however. Unfortunately, theseunvoiced concerns have a negative effect on acceptance of the disease state, corn-phance with treatment, and response to therapy, and they can significantly affectquality of life.Current nursing literature has focused on management of mobility in PD, andlittle attention has been devoted to psychosocial issues. This paucity of literature isattributed to the belief that if motor symptoms are treated, psychosocial aspects ofthe disease will spontaneously improve. Quality of life has been reported to be theprimary concern of patients with PD and their famidy members.(12) Medicine islearning to recognize and accept quality of life as a major criterion in evaluation ofhealth interventions. "The concept of quality of life then goes beyond the dimen-sions of health functioning to performance of social roles, mental acuity, emotionalstates, subjective well-being, and interrelationships."(5) Life satisfaction, self-esteem,and physical health have also been identified as key elements of quality of fife.This article briefly reviews salient points regarding PD as a degenerativeneurologic process and focuses primarily on the motor and nonmotor features thatimpact on quality of life. In addition, nursing care is presented and reviewed toassist the reader in facilitating the development of goals with the patient and familythat are congruent with achieving maximum quality of life (Table 1).HISTORY OF PARKINSON'S DISEASEJames Parkinson, a London general practitioner, first described Parkinson'sdisease in a monograph entitled "An Essay on the Shaking Palsy" in 1817. It was--------------------------------------------------------------------------------------Table 1. NURSING PLAN OF CARE-----------------------------------------------------------------------------------------------------------Nursing Diagnosis Expected Outcomes Nursing InterventionsImpaired physical mobility Patient will demonstrate Consult with physicalrelated to rigidity, maximal independence therapy for exercises andbradykinesia, and/or with performing activities assistive devices topostural instability of daily living. maximize independencewith self-care activities.Plan for patient toparticipate in care whenmedications are at peaklevel.Provide for safety inenvironment.Impaired verbal Patient will communicate Facilitate consultation withcommunication related to effectively with others. speech therapy.softening of voice Provide opportunities forpatient to practice speechexercises.Encourage patient not tohurry to complete speech.Refrain from completingsentences for patient.Altered self-esteem related Patient will actively Incorporate patient intoto dependency on participate in decisions decision-making processspouse/significant other related to care prior to about taking medication,discharge, participating in diversionalactivities, and so on.Offer suggestions forpatient to haveopportunities to socializein the community.Altered thought processes Patient will state that Provide reality orientation torelated to hallucinations hallucinations are not real patient as needed.and confusion prior to discharge. Be calm and offerreassurance if patientbecomes fearful.Umit environmental stimuli.Promote restful sleep-wakecycle.-----------------------------------------------------------------------------------------------------------here that Dr. Parkinson described the classic parkinsonian symptoms of restingtremor, propulsion, and stooped posture. Parkinson wrote that he found that11 senses and intellect" were "uninjured;" however, he went on to describe patientsas "unhappy," "dejected," and "melancholic."(2)PD is a chronic, progressive disease of the central nervous system. The classi(-triad of symptoms is resting tremor, rigidity, and bradykinesia. PD has been de-scribed as a collection of symptoms rather than one distinct clinical picture. Thus,diagnosis can be difficult in the early stages of the disease. Typically tremor orrigidity are noted on one side of the body, although they may progress to bilateralinvolvement. (13)Physicians often refer to PD as the "waiting room diagnosis." This refers to theclassic signs of pill-rolling tremor, stooped posture, bradykinesia, and masked facethat are easily observed in the clinical setting. Patients typically seek consultationwith a neurologist to confirm or rule out a diagnosis of PD. Frequently patients willrequest testing to substantiate the diagnosis. No such test exists, however. PD is adiagnosis made by history and physical. In today's technologic health care environ-ment, patients are often frustrated with the fact that PD is a clinical diagnoSis.13EPIDEMIOLOGYApproximately 1 million Americans are currently diagnosed with PD. Menhave a slightly higher incidence of the disease, and whites are disproportionatelyaffected when compared with other races. PD is typically considered to be a diseaseof the aged. The mean age of onset is 60 years of age, although cases have beenidentified in individuals as early as 30 years of age.With increased incidence of PD in young patients, that is, in those diagnosedbefore the age of 50, a new set of quality-of-life issues has emerged.(6,8) For example,an older patient, a more "traditional Parkinson's patient," has probably plannedfor retirement. Facing a degenerative disease in what had been hoped to be the"golden years," elderly couples are often confronted with not being able to traveland thus change their focus to planning for long-term care. On the other hand, theconcerns of the younger patient with PD focus on raising children, managing acareer, and maintaining a home. These two age groups have distinct differences inissues affecting their quality of life.CAUSEThe cause of PD is unknown. However, the following theories are the focus ofcurrent research: genetic, viral, and environmental toxins. Genetic research is fo-cusing on mitochondrial defects and family linage.'-' Twin studies have failed todemonstrate any clear inherited trait, however. The viral theory was first suggestedwith the outbreak of encephalitis lethargica, which occurred worldwide from 1918to 1926. This viral epidemic resulted in postencephalitic parkinsonism killing morethan 2000 Americans. The mortality rate approached 40%, and only 15% ofpatients fully recovered. As survivors of this viral epidemic die, fewer individualswith this form of PD are seen. Environmental toxin theories have continued to be afocus of epidemiologic studies. (13)PATHOLOGYThe hallmark pathologic feature of PD is the degeneration of the dopaminergicnigrostriatal pathway. It has been shown that 80% of the dopan-dne-producingcells must be lost before manifestations of the disease can be seen. The severity ofPD is associated with the degree of neuronal loss in the midbrain at the level of thesubstantia nigra.11Dopamine, a neurotransn-titter, is the primary neurocheniical responsible forthe signs and symptoms of PD. The balance of dopamine and acetylcholine areresponsible for normal motor function. The development of symptoms is explainedby an imbalance of dopaminergic (inhibitory) and chohnergic (excitatory) activity inthe caudate and putamen of the basal ganglia. When degeneration of the dopamin-ergic nigrostriatal pathway occurs, there is depletion of dopan-dne and relativeexcess of cholinergic activity in the feedback circuit involving the cerebral cortex,basal ganglia, and thalamus. This change in neuronal activity is responsible for theclassic manifestations seen in PD.(9)MOTOR FEATURESThe Motor features of PD include the classic triad of tremor, rigidity, andbradykinesia. In addition, there is postural instability and disordered gait as well asdisorders in fine motor movement. A brief description of each motor featurefollows.TremorResting tremor is the most classic and visible sign of PD. Seventy percent ofpatients present with resting tremor as their chief complaint for seeking diagnosisand treatment. Parkinsonian tremor has been described as having a pfll-rollingquality and can affect all four limbs and the head.(13)Many patients express feelings of embarrassment related to their tremor.Tremor is the most difficult symptom to treat but the least disabling. It subsideswith action and is thus described as a resting tremor. The resting quality of theParkinson tremor allows patients to maintain activities of daily living within somelin-titations. Unfortunately, patients will restrict social activities due to fear of socialstigma and being labeled as ill. In addition, stress can intensify tremor, whichfurther restricts the patient's willingness to participate in social life,RigidityRigidity is often described as a plastic resistance to passive movement. Patientsoften describe this characteristic as stiffness. On examination, rigidity can be de-tected as a coglike release of muscle resistance in the wrist, elbows, neck, and kneesas the limb is moved through passive range of motion.(13)Rigidity can cause the face of the patient with PD to take on a masklike quality.The face appears fixed and rigid, and previously recognizable nonverbal messagesare misinterpreted or lost in communication. Fanifly members find this change tobe most disturbing because the patient no longer has a change of facial expression.BradykinesisBradykinesia refers to difficulty with initiating and continuing movement.Movements are slowed and are performed with conscious effort. Patients havedescribed bradykinesia as feeling as if "My brain is sending the message to thebody, but the body won't listen."(7)Postural Instability and Gait DisordersAs PD progresses, patients may demonstrate difficulty maintaining erect pos-ture. Typically, there is forward flexion of the neck, hips, knees, and elbows.Postural abnormalities greatly reduce the patients' ability to be ambulatory andplaces them at high risk for injury.(7) This may also lead to reliance on assistivedevices.Because of rigidity and postural changes, patients also develop a shufflingquality to their gait and use small steps. Another abnormal gait characteristic ispropulsion, a disturbance in which the patient goes from a slow walking pace torunnin with an inability to stop. Patients are only able to stop themselves bygrabbing stationary objects such as a door frame. It is important to note thatpatients who develop an unsteady festinating gait may appear to be under theinfluence of drugs or alcohol.The inability to be freely ambulatory restricts the independence of the patientwith PD. The use of a cane, walker, or wheelchair gives the patient a message thatthe disease is progressing. Resistance to the use of assistive devices is often anattempt to maintain self-esteem as the patient is dealing with declining health.Limitations of mobility further restrict social fife, and many patients express aninability to maintain pace with friends or family members. Often patients willexpress embarrassment due to their gait disturbance and verbalize a realistic fearthat others will assume they have a substance abuse problem.On-Off PhenomenonAs the disease advances, patients enter a narrow therapeutic window. Re-sponse to treatment is less predictable, resulting in what is termed the "on-off"phenomenon. This phenomenon refers to a syndrome in which patients are freelyambulatory one n-tinute and then find they are "frozen" and unable to move thenext. Patients also describe "off" periods as if someone has turned off the switchand their feet have sprouted roots. The cause of the on-off phenomenon is un-known but may be associated with years of therapy compounded with continuedloss of dopan-tine-producing cells.(13)Because the on-off phenomenon is unpredictable, it can play a major role infamily dynan-dcs. The concept of a person exhibiting a behavior that is severelydisabling, sudden in onset, and resolving without intervention is a difficult conceptfor patients and health professionals to grasp. Understanding that on-off phenom-enon behavior is not intentional and is not psychogenic in origin is essential.Patients and farnfly members need education about this feature of the diseaseprocess to assist the patient with PD to maintain a sense of control.Swallowing and Speech DefectsDysphagia is a common disorder that affects patients with PD and was firstrecognized by James Parkinson. He described patients as having significant weightloss with complaints of difficulty swallowing solid foods as compared to liquids. Asthe disease progresses, patients report difficulty with chewing or moving food tothe back of the mouth. This may lead to choking episodes and places the patient athigh risk for aspiration. Management of dysphagia in PD may be difficult. Consul-tation with a dietitian and swallowing therapist may be beneficial in providingoptimal nutrition. In addition, meals should be eaten when levodopa dosages arereaching maximum effectiveness. (10,16)The motor disturbances responsible for swallowing deficits can also lead todisorders of speech in the patient with PD. Dysarthria, a form of speech distur-bance, is characterized by deviations in phonation, prosidic disturbances in whichspeech may be slow or extremely fast, and an articulatory disorder in which vocalsounds are distorted. Dysarthria is a common problem for patients with PD and canhave a dramatic and devastating effect in a patient's interpersonal communicationand self-image. Management of dysarthria involves the use of medication andspeech therapy. Levodopa has been shown to improve speech intelligibility, andspeech therapy can assist the patient in using techniques to enhance projection. Togain maximum benefit from speech therapy, the patient must be invested inpracticing the exercises assigned by the speech therapist. (10)HandwritingDifficulty with handwriting can be an early sign of PD. Patients with PDtypically will initiate handwriting with normal-sized penmanship and trail offwords and sentences with smaller illegible handwriting. This small writing isreferred to as "n-dcrographia." Patients with micrographia can have difficulty sign-ing checks, and banks frequently request patients to sign a new bank card becauseof the dramatic change in signature. The inability of patients to spontaneouslywrite can also inhibit communication. (14)NONMOTOR FEATURESDepressionDepression in PD has been the focus of numerous studies. Research indicatesthat 20% to 90% of patients with PD will experience a major depressive episode ascompared to 7% of the general population. Depression accounts for the majority ofpsychiatric referrals in patients with PD and can be the initial feature of PD. It hasbeen hypothesized that the shared neurochemistry of these two disorders accountsfor the high incidence of depression in PD.(2)Depression can be viewed in two ways. Some patients may become demora-lized with the diagnosis of PD and experience a "reactive depression." Reactivedepressions are linked to external events and are short in duration. Typically thepatient experiencing a reactive depression is able to resolve the issue and accept thediagnosis. Individuals experiencing a reactive depression may benefit from sup-portive psychotherapy, however.(2)The most typical depression experienced by the patient with PD is endogenousdepression. Endogenous depression is caused by a biochemical imbalance in thebrain and can be life-threatening if not treated. The difficulty in diagnosing depres-sion in patients with PD lies in the shared clinical features of the two disorders(Table 2).DementiaDementia is also a common feature of PD. It is estimated that 20% of patientswith PD will become demented.(11,14) Dementia can be defined as an acquired,-------------------------------------------------------------------------------------------------------------Table 2. COMPARISON OF CLINICAL FEATURES ASSOCIATED WITH PARKINSON'SDISEASE AND DEPRESSIONFeatures Parkinson's Disease DepressionMotor manifestations Stooped posture, bradykinesia, Slumped posture, psychomotormasked face retardation, diminished facialaffectSleep disturbances Insomnia, sleep fragmentation Insomnia, early morningawakeningGastrointestinal Constipation, weight loss Constipation, weight lossConcentration Bradyphrenia Poor concentrationHallucinations Visual, usually nonthreatening Visual, auditory, olfactory andtactileAdapted from Bunting LB, Fitzsimmons, B: Depression in Parkinson's disease. J Neurosci Nurs23(3):160, 1991; wwith permission.-------------------------------------------------------------------------------------------------------------persistent impairment of intellectual function with compron-dse in at least three ofthe following areas of mental activity: language, memory, visuospatial skills, emo-tionality and personality and cognition in the presence of clear consciousnesS.3,4The retention of long-term memory permits the patient to maintain aspects ofnormal social behavior early in the disease. The severe loss of ability to learn newmaterial and the limitations of short-term memory result in episodes of frustrationthat can escalate into agitation, however. In addition, individuals with dementingillnesses may have enough insight to experience a clear sense of loss, thus leavingpatients and families demoralized and dispirited.(4) Nursing management of demen-tia care should encompass the principles of preservation of dignity and provision ofsafety.Sleep DisturbancesSleep disorders are a frequent complaint in patients with PD. Disorders ofsleep initiation, sleep fragmentation, early morning awakening, excessive daytimesomnolence, and parasomnias represent the disorders of sleep seen in PD. Adetailed history of the sleep complaint, validated by a bedpartner, is the bestmethod of establishing the cause of sleep disturbances.(11)Patients may complain of initiation insomnia as, "I can't get to sleep." C)nceasleep they are able to sleep soundly through the night, however. Researchers haveconcluded that sleep initiation insomnia in PD is related to anxiety, agitated de-pression, or levodopa therapy.The more typical sleep disorders seen in PD are sleep fragmentation and earlymorning awakening." Sleep fragmentation can be related to the inability to turnover in bed. Rigidity compounded by the wearing off of medication reduces pa-tients' ability to reposition themselves in bed. Patients state that they must wake upto change sleeping positions and then are unable to return to sleep. One solution tothis problem is the use of satin sheets to decrease friction and facilitate turning.Early morning awakening typically represents onset of a depressive episode, andthe nurse should evaluate the patient for other vegetative symptoms such asdecreased appetite, psychomotor retardation, and constipation. Early morningawakening may be related to focal dystonic cramping in the calf and feet, however.Focal dystonia is related to diminished levels of levodopa.(11)Excessive daytime somnolence is the most frequent sleep complaint made byfamily members of PD patients. In some individuals, daytime somnolence is relatedto a disturbance in the circadian control of sleep. These patients are up at night andtake multiple naps throughout the day. Families report that daytime sonuiolence isdisruptive to normal family life. Families should discourage day time napping in anattempt to correct the circadian clock. Patients who are described as sleeping allday, however, should be screened for metabolic abnormalities that may causedisturbances in the sleep-wake cycle.Parasomnias are the most debilitating and difficult of the sleep disorders tomanage. Sleep talking, sleep walking, vivid dreams, and nightmares are the mostfrequently reported parasomnias experienced by patients with PD. Most typically,these occur as a side effect of levodopa therapy. Unfortunately, treatment forparasomnias is limited.(11)Sexual DysfunctionSexual functioning in patients with PD has received inadequate attention. Thepaucity of literature can be attributed to the assumption that patients with PD areelderly and therefore have a diminished interest in sex. Research indicates thatfrequency of sexual intercourse decreases with age; however, sexuality continues toplay a role in the lives of the elderly. Sexual dysfunction has a significant impact onpatients who are diagnosed with PD in their midadult years when an active sex lifeis the norm.(1)Dysfunction of the autonomic nervous system, depression, medications, andinterpersonal issues all play a role in sexual dysfunction in PD. Autonomic dys-function in the urogenital system resulting in impotence is the primary reason forsexual dysfunction in male patients with PD. Secondary issues affecting sexualfunction include motor fluctuations, fatigue, medications, sleep disorders, depres-sion, and interpersonal issues.(1)The motor fluctuations and fatigue can be related to antiparkinsonian drugs,primarily levodopa. Patients with PD find that they are better able to function inthe morning, after their initial dose of medication, and become more fatigued withgreater motor fluctuations as the day progresses. Numerous reports documenthypersexuality with the use of levodopa. This may result in a problem when onepartner has heightened sexual interest that is not shared by the other partner. Toadapt to these changes in their sexual life, couples may need to change their dailyroutine to accommodate morning sexual activity and take advantage of optimumenergy levels and motor functioning. Unfortunately, sleep disorders experienced inpatients with PD may result in bedpartners sleeping in separate beds, whichdiminishes opportunity for spontaneous sexual activity.(1)Depression can also have a significant impact on sexual activity in patientswith PD. As discussed earlier, depression is common in patients with PD and canproduce a markedly decreased libido. Sexual partners may also experience depres-sion and fatigue as they struggle with the caregiving role in the relationship; thus,they also may not have the energy or interest to engage in sexual activity. Inaddition, autonon-dc dysfunctions that result in droohn& diaphoresis, and excessivefacial oiliness may interfere with perceived attractiveness of the patient by thesexual partner.(1)The issues surrounding sexuality in PD are complex. Patients should be rou-tinely questioned regarding satisfaction of their sexual life. A referral to a urologistor sex therapist can assist in identifying issues affecting sexuality. Open conununi-cafion regarding sexual issues can be limited by the patient's reduced facial expres-sion and altered speech pattern. The ability of the couple to communicate theirsexual needs within the liniitafions of the disease state can have a significant impacton the couple's marriage and sexual life.(1)Driving PerformanceWhen a patient is seen for the management of PD, no discussion would becomplete without addressing driving. Motor manifestations of the disease as well asa decline in cognition may impair the pafient's ability to function safely behind thewheel. Some patients may willingly retire their driver's license, whereas others mayview this as giving up valued independence. Evaluation of driving skills by aprofessional driving instructor may provide a nonthreatening avenue to assess autosafety. Family members should be involved in the evaluation of driving to arrangealternate transportation if the patient's driving is found to be unsafe.EmploymentPD can be a disability and liability in the work place. Many patients ask,"Should I tell my boss?" There is no clear answer to this question because eachsituation is different. Patients should be encouraged to have a frank and opendiscussion with their health professionals regarding the limitations imposed bytheir symptoms and the effect of these lin-dtations on their job responsibilities. Thisdiscussion should include the benefits and potential disadvantages of revealing thisinformation to their supervisor. Frequently, coworkers have suspected that a prob-lem exists. By sharing the diagnosis, an empathefic supervisor may facilitate apafient's medical appointments and make environmental adjustments to expeditean optimum working relationship. Unfortunately, the risk of sharing the diagnosisof PD can have a negative impact on job security. It has been the experience ofthese authors that patients have been reassigned to other job responsibilities orpressured into early retirement. Physicians and nurses should strive to providestrategies and guidance for handling this difficult situation.DRUG THERAPYDrug therapy is the mainstay of management of PD. The primary medicationsused in PD are classified as anticholinergics, antihistamines, dopaminergics, anddopamine agonists (Table 3). (17) Unfortunately, all drugs used in the treatment of PDhave potential for side effects that impact on quality of life. Indication for medica-tion is determined when the patient develops deficits in activities of daily living oris expressing embarrassment from tremor or gait disturbances. The approach todrug therapy is to maintain the patient on conservative levels of medication whilemaintaining mobility. As the disease progresses, patients become less responsive tomedications and experience end of dose failure, peak dose dyskinesias, and painfuldystonic cramps. They are also more prone to developing de@um and hal-ludnations.(13,14)Levodopo TherapyLevodopa is the drug of choice for treatment of PD. It is marketed as acombination drug called Sinemet and is composed of carbidopa and levodopa. The-------------------------------------------------------------------------------------------------------------------Table 3. SUMMARY OF MEDICATIONS USED IN PARKINSON'S DISEASE-------------------------------------------------------------------------------------------------------------------Type Drug Name Indications Side Effects-------------------------------------------------------------------------------------------------------------Anticholinergics Tdhexyphenidyl Tremor, rigidity, Dry mouth,(Artane), drooling constipaflon,benztropine blurred vision,(Cogentin) confusion, visualhallucinationsAntihistamine Diphenhydramine Tremor, rigidity, Dry mouth, lethargy,(Benadryl) insomnia confusionDopaminergics Amantadine Rigidity, Leg edema, livedo(Symmetrel), bradykinesia, reticularls,carbidopa/ tremor hallucinations,levodopa orthostatic(sinemet) hypotension,nausea, confusionDopamine agonists Bromocriptine Motor fluctuations in Hallucinations,(Parb"), Parkinson's mental cloudinesspergolide (Permax) disease orthostatichypotension,confusion-------------------------------------------------------------------------------------------------------------action of carbidopa is to block the breakdown of levodopa in the peripheral organsand allows more levodopa to cross the blood-brain barrier. Levodopa is convertedto dopamine. in the brain through a series of enzymatic reactions.(13)Levodopa therapy is responsible for promoting quality of life for the vastmajority of patients with PD. Levodopa therapy has lin-dtations, however. Early intreatment, patients are maintained on low doses of levodopa to preserve thetherapeutic window for the future. Typically patients respond well to levodopa andonly experience mild side effects such as nausea and orthostatic hypotension. Asthe illness progresses, patients require higher levels of levodopa, a@d'response totherapy is less predictable.(13)Levodopa has a relatively short half-life. It has a rapid onset of actions andpatients report getting a surge of energy with each dose. Similarly, patients com-plain of "wearing off" symptoms as levodopa is metabolized and PD featuresreturn. When levodopa is at therapeutic levels, the patient's functioning mayappear quite normal. As the medication "wears off," however, patients may be-come akinetic and rigid. Like the on-off phenomenon, wearing off can be frustrat-ing for the patient and family. In contrast to the on-off phenomenon, however, thewearing-off symptoms are predictable and are associated with declining levodopalevels. When levodopa alone is not maintaining symptomatic control, the physicianmay add a dopamine agonist such as bromocriptine (Parlodel) or pergofide (Per-max). There agents act to smooth out levodopa levels and help to control the rapidrise and fall of levodopa levels.(13,14)With progression of symptoms, patients with PD may experience peak-dosedyskinesias. The term "dyskinesia" describes the development of extra movementsof the head, neck, trunk, and extremities as levodopa doses rise and peak rapidly.Most patients find that these extraneous movements limit social activities. Al-though dyskinesias can be devastating, patients can function within the limitationof the movement disorders.(13)ComplianceCompliance in taking prescribed drugs is essential to successful managementof PD. Patients with PD often verbalize feelings of being chained to the clockbecause they require levodopa to maintain mobility. Levodopa dosage schedulescan be prescribed as frequently as every 2 hours during the waking day. The needfor levodopa can overshadow all other aspects of the patients life because he or sheis unable to function without it. If medications are late or missed, the patient canexperience dystonic pain, increased tremor, rigidity, and personality changes. Com-pliance can also be an issue when patients with PD take extra doses of levodopa toboost their levels of energy and function. This behavior should be discouraged, andany change in treatment plan should be discussed with the physician. Alarm clocksor pill boxes with alarms can assist the patient with remembering to take themedication on time.Cost of medication can also affect compliance. It is not uncommon for patientsto spend approximately $300 per month on medications for PD. The financialimpact of medications can preclude physicians from ordering additional therapy.Nurses can assist in deterring the cost of therapy by investigating drug-cost-sharing programs sponsored by drug companies or pricing mafl-order pharmaciesto find lower Cost medications.Side Effects of Delirium and HallucinationsMedications used in the management of PD often need to be titrated. Usually,the higher the dose of drug, the more frequently side effects are encountered. (13) Theside effect of delirium is a constant danger with all medications usld in PD. Theprobability of delirium is determined by each patient's tolerance to the medicationand predisposing factors such as age and general health. Living with a drug-induced delirium is a difficult issue for many patients and families. Families areoften asked to make a choice between clear mentation and motor functioning. Itmay be easier for a family to care for a mobile patient with PD who is cognitivelyimpaired.The occurrence of hallucinations is well documented in the management ofpatients with PD. Amantadine, a dopaminergic medication, is notorious for causingvisual hallucinations. Other medications in which hallucinations have been docu-mented as a side effect include anficholinergic medications such as trihexyphenidyl(Artane) and benztropine (Cogentin), levodopa in the form of carbidopa/levodopa,and dopan-dne agonists such as bromoctiptine and pergolide. All of these drugs actto increase the levels of dopamine in the brain through different mechanisms ofaction. (13)Patients frequently are able to tolerate continued use of medications knowingthat hallucinations are a side effect of therapy. Typical treatment-induced halluci-nations in PD are visual and may consist of seeing small children or animals. Thesehallucinations are seldom threatening. If hallucinations become auditory or threat-ening in content, patients should be evaluated for depression or dementia by aqualified psychiatrist.SUMMARYPD affects many dimensions of quality of life. This article has identified motorand nonmotor features of PD that are directly related to a patient's quality of life.Medication therapy can help to ameliorate some of the symptoms, yet side effectscan be as disabling as the symptoms of PD. Nursing care should include assess-ment, intervention, and evaluation of both physical and psychosocial aspects ofcare for patients with PD to assist them in achieving maximum functioning,References1. Brown RG, Jahanshahi M, Quinn N, et al: Sexual function in patients with Parkinson'sdisease and their partners. J Neurol Neurosurg Psychiatry 53:480-486, 19902. Bunting LK, Fitzsimmons B: Depression in Parkinson's disease. J Neurosci Nurs 23(3):158-164, 19913. Cummings JL, Benson DF: Dementia: Definition, prevalence, classification, and approachto diagnosis. In Dementia: A Clinical Approach. Massachusetts, Butterworth, 1992, p 14. Folstein MF, Ross C: Cognitive impairment in the elderly. In Kelly WN led); Textbook ofInternal Medicine. JB Lippincott, 1992, p 24085. Gentile KM: A review of the literature on interventions and quality of fife in the fradelderly. In Birren JE, Lubben JE, Rowe JC, et a] (eds): The Concept and Measurement ofQuality of Life in the Frafl Elderly. San Diego, Academia Press, 1991, p 746. Giovannini P, Piccolo 1, et al: Early onset Parkinson's disease. Movement Disorders6(l):36-42, 19917. Hickey J: Nervous system degenerative diseases. In The Clinical Practice of Neurologicaland NeUTOSurgical Nursing. Philadelphia, JB Lippincott, 1992, p 6518. Marttila Rj: Epidemiology. In Koller WC led): Handbook of Parkinson's Disease. NewYork, Marcel Dekker, 1987, p 359. McCance KL, Huether, SE: Alterations in neurologic function. In Pathophysiology: Thebiologic basis for disease in adults and children. St. Louis, CV Mosby, 1990, p 50910. Micoch AG: Diagnosis and treatment of patkinsonian dysarthria. In Koller WC (ed):Handbook of Parkinson's Disease. New York, Marcel Decker, 1987, p 181
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Labels: PD PRIMER FOR GP'S
PD HEARTOUT
Letter to My Family and Friends about Parkinson'sAuthor Unknown(please advise me if you know its author)I have Parkinson's Disease. It is not contagious or hereditary. No one knows what causes it, but some of the dopamine cells in the brain begin to die at an accelerated rate. Everyone slowly loses some dopamine cells as they grow older.If the cells suddenly begin to die at a faster rate, Parkinson's Disease develops. It is a slowly progressive disease usually occurring as people get older. Medicine can help. I'll take newer, stronger kinds over the years. Some make me sick and take lots of adjustments. Stick with me. I have good days and bad days.Emotions:Sometimes I cry and appear to be upset and you think you have done something to hurt my feelings. Probably not. It is the Parkinson's. Keep talking to me. Ignore the tears. I'll be OK in a few minutes.Tremors:You are expecting me to shake. Maybe I do, maybe I don't. Medicine today takes care of the tremors. If my hands, feet, or head are shaky, ignore it. I'll sit on my hands or put them in my pockets. Treat me as you always have. What's a little shakiness between friends?My Face:You think you don't entertain me anymore because I'm not grinning or laughing. If I appear to stare at you, or have a wooden expression, that's the Parkinson's, I hear you. I have the same intelligence; it just isn't easy to show facial expressions. If swallowing, I may drool. This bothers me, so I will mop it up.Stiffness:We are ready to go somewhere and I get up. I can hardly move. Maybe my medicine is wearing off. The stiffness or rigidity is part of Parkinson's. Let me take my time. Keep talking.Exercise:I need to walk each day. Two to three miles is good. Walk with me. Company makes walking fun. It may be a slow walk, but I'll get there. Remind me if I slump or stoop. I don't always know I'm doing this. My stretching, bending and exercises must be done everyday. Help me with them if you can.My Voice:As my deeper tones disappear, you'll notice my voice is getting higher and wispy. That's the Parkinson's I know you can talk louder, faster and finish my sentences for me. I don't care for that. Let me talk, get my thoughts together and speak for myself. I'm still there. My mind's okay. Since I'm slower in movement, my thoughts are slower too. I want to be part of the conversation. Let me speak.Sleeplessness:I may complain that I can't sleep. If I wander around in the middle of the night, that's Parkinson's. It has nothing to do with what I ate or how early I went to bed. I may nap during the day. Let me sleep when I can. I can't always control when I'm tired or feel like sleeping. Be patient, my friends. I need you. I'm the same person; I've just slowed down. It's not easy to talk about Parkinson's, but I'll try if you really want to know. I need my friends. I want to continue to be part of life.Please remain my friend.Posted by Kate Kelsall on July 13, 2008 in Parkinson's: General Permalink
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Sunday, June 8, 2008
parkinson's web site
the pakistan parkinsons society web site is up address www.parkinsons.org.pk
the red tulip... our symbol of hope
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Thursday, May 8, 2008
psique: Introduction to Parkinson's Disease
psique: Introduction to Parkinson's Disease
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Friday, March 21, 2008
i am all shook-up
Shaking Up Life: Parkinson's Diseaseby Janet M. Schneider -- Library Journal, 1/15/2003Although Parkinson's Disease (PD) is one of the most common neurological disorders, many Americans were unaware of the condition until actor Michael J. Fox revealed his diagnosis to the public in 1998. An estimated 1.5 million people in North America now have the disease, including other luminaries like Muhammad Ali and Janet Reno.It also is an expensive disease; according to the National Parkinson Foundation, each patient spends an average of $2500 per year on medications alone. The total annual cost to the United States exceeds $5.6 billion.First identified by physician James Parkinson in 1817, PD is a slowly progressing, degenerative disorder that manifests itself with tremors, stiffness, slowness of movements, slurred speech, and impaired balance and coordination. (PD patients, or Parkinsonians, are often mistaken by the public as being inebriated or mentally deficient.) The disease's progression varies from individual to individual. Some are so mildly affected that they are never diagnosed, while others become completely incapacitated. A small percentage eventually develop dementia. Although primarily found in people over the age of 50, the disease is increasingly affecting younger adults. Fox himself was 30 when he was diagnosed. Treatments but no cure What triggers the disease is still unknown; its physical cause—a loss of nerve cells in the substantia nigra part of the brain—was only recognized in 1960. It appears that heredity plays a minor part, if any, in its development. Some medications used in the treatment of mental illness can produce symptoms that mimic PD, and in the early 1980s a "designer drug," MPTP, was found to cause PD in its users. Scientists now theorize that currently unidentified environmental toxins or viruses may also be a factor; a recent report that three other people who worked in the same television studio as Michael J. Fox during the late 1970s also developed PD has excited interest among researchers. First approved for use in 1970, the drug levodopa is still the best avenue for replacing the brain's lost dopamine and alleviating symptoms. (Without dopamine, signals from the brain cannot "transmit" properly to the body, and movement is impaired.) Research in the last decade has resulted in a better understanding of the disease process and some new drug therapies to enhance levodopa's effectiveness and reduce its side effects. Complementary therapies such as exercise and fall prevention have only recently been added to the PD treatment regimen. And surgeons are now experimenting with fetal tissue transplants, neuroblation, deep brain stimulation, and pallidotomy as possible treatments. But despite these advances, there is still no known cure. Collection diagnosis Because Parkinson's can mimic other neurological disorders (there is no definitive test), it is frequently misdiagnosed by family physicians unfamiliar with the disease; some patients have gone for years before receiving a correct diagnosis. It's important, therefore, for consumer health collections to offer authoritative resources for anxious patients and families seeking reliable information.Consumer health information on the disease has only begun to emerge since the 1990s, and much of that is far more technical than the lay literature on other health topics. Still, a number of leading experts and pioneers in the field (Abraham Lieberman, William Wiener, and Curt Freed) have recently written authoritative medical guides specifically for PD patients, and libraries should make sure they have these titles in their collections. Because advances in treatments mean people are living longer than ever before with the disease, and therefore are experiencing more complications, look for books that address these factors as well as discuss psychosocial issues and life skills. Personal narratives that describe how the PD patient or family member cope are also necessary purchases. Supplement your collection with good texts that deal with chronic diseases in general, especially those that emphasize patient control and coping skills, since these volumes are often far more positive in tone than the sometimes grim PD guides.There are currently few consumer periodicals on PD (most newsletters are only available online via PD associations), and quality up-to-date videos are rare. Starred [* ] items are core purchases for consumer health and most public library collections.Medical Guides *Blake-Krebs, Barbara & Linda Herman. When Parkinson's Strikes Early: Voices, Choices, Resources and Treatment. Hunter House. 2001. 270p. illus. bibliog. index. ISBN 0-89793-340-0. pap. $15.95.The authors, who were diagnosed with PD in their mid-40s, met on an online discussion list and discovered that the disease was becoming increasingly common in a younger population. Their guide incorporates e-mailings from the members of the Parkinson's Information Exchange Network (PIEN), with detailed advice on diagnosis, treatment, and self-help options. The vivid essays, poetry, and stories personalize the disease's impact; the resources section is outstanding.Cram, David L., M.D. Answers to Frequently Asked Questions in Parkinson's Disease: A Resource Book for Patients and Families. Acorn Pub. 2002. 170p. bibliog. index. ISBN 0-9710988-8-3. pap. $19.95.Dermatologist Cram has suffered with PD for over 12 years. Drawing on his personal experience and the latest medical research, he answers commonly asked questions submitted to his online column on Agenet.com. Especially helpful is his advice on the importance of the PD patient using an advocate when he or she is hospitalized or is navigating the healthcare system. A glossary and resources listing are included.Duvoisin, Roger C., M.D & Jacob Sage, M.D. Parkinson's Disease: A Guide for Patient and Family. 5th. ed. Lippincott Williams & Wilkins. 2001. 195p. illus. index. ISBN 0-7817-2977-7. pap. $29.95.This instructive text updates the 1996 edition with the latest details on the progression of PD treatments, genetics, and molecular biology. The complications of advancing disease are particularly well described. While the reading level is high, the determined reader can find a great deal of detailed information not found in other guides. Duvoisin is a pioneer in the development of levodopa therapy.Hauser, Robert A. with Theresa A. Zesiewics. Parkinson's Disease: Questions and Answers. 3d ed. Merit Pub. Intl. 2000. 182p. illus. index. ISBN 1-873413-92-0. pap. $17.95.Although primarily aimed at general clinicians, this manual may be useful for patients wishing more in-depth knowledge than what the consumer guides offer. Hauser (neurology, Univ. of South Florida) covers tests, clinical characteristics, staging and classification, medical management, and issues frequently missed in the lay literature.*Lieberman, Abraham, M.D. with Marcia McCall. 100 Questions About Parkinson Disease. Jones & Bartlett. Feb. 2003. 160p. index. ISBN 0-7637-2057-7. pap. $16.95.The national medical director of the National Parkinson Foundation has compiled common questions asked by newly diagnosed Parkinsonians. Lieberman is particularly good at telling patients what they should expect from their physicians, how they can select a competent movement disorders specialist, how they can make the most of living with PD, and what they should know about the new advances in medical, alternative, and surgical therapies. An optimistic resource that should be much in demand.*Lieberman, Abraham, M.D. Shaking Up Parkinson Disease: Fighting Like a Tiger, Thinking Like a Fox. Jones & Bartlett. 2002. 250p. illus. ISBN 0-7637-1866-1. pap. $18.95.Lieberman's sympathetic, thorough book explains PD and its symptoms (with steps to alleviate them) and extensively covers treatment options such as drugs and surgery. A plus is the author's discussion of anxiety and depression as a biological rather than a psychological symptom of the disease. Disorders that mimic PD are listed, and questionnaires help readers measure their personal mobility, emotional status, quality of life, and more. Although nonreligious readers may be put off by the biblical quotes, this is still an outstanding text. (LJ 1/02)*Parkinson's Disease. DK. (ACP Home Medical Guides). 2000. 80p. ed. by David R. Goldman, M.D. & David A. Horowitz, M.D. illus. index. ISBN 0-7894-4169-1. pap. $6.95.This excellent entry in the American College of Physicians series features DK's typical lush full-color photos and illustrations. The concise text covers types of Parkinson's, causes and characteristics, signs and symptoms, and diagnosis, as well as standard medical and surgical treatments. Especially good are the clearly written evaluation scales for disease assessment.*Silverstein, Alvin & others. Parkinson's Disease. Enslow Pub. 2002. 128p. illus. bibliog. ISBN 0-7660-1593-9. $20.95.Although written for children, this reassuring guide is also excellent for adults with limited reading skills. Covering the basics (causes, treatment, symptoms, and progression), the volume also highlights ongoing research, the use of service dogs for Parkinsonians, and PD celebrities such as Michael J. Fox.Weiner, William J., M.D. & others. Parkinson's Disease: A Complete Guide for Patients & Families. Johns Hopkins. 2001. 272p. illus. index. ISBN 0-8018-6555-7. $45; pap. ISBN 0-8018-6556-5. $15.95.While somewhat clinical in tone, this guide by the director of the Maryland Parkinson's Disease Center offers excellent current information. Physical, behavioral, and psychiatric signs and symptoms exhibited during mild, moderate, and advanced stages are explained, as are diseases that can mimic Parkinson's. Emphasizing the questions to be asked and the tests that the patient should undergo before a diagnosis is made, the text also discusses the latest drug and surgical treatments, including alternative therapies. (LJ 5/15/01)Treatment & Therapy *Argue, John. Parkinson's Disease & the Art of Moving. New Harbinger. 2000. 220p. photogs. index. ISBN 1-57224-183-7. pap. $15.95.PD destroys the ability of patients to perform many routine physical skills necessary to daily living. Argue, who has taught movement and speech classes for Parkinsonians since 1985, presents ten exercise routines (clearly demonstrated in over 100 photographs) to improve flexibility, balance, coordination, speech, swallowing, and more.Hutton, J. Thomas, M.D. Preventing Falls: A Defensive Approach. Prometheus. 2000. 115p. illus. bibliog. ISBN 1-57392-761-9. pap. $19.Falls are a major concern for balance-impaired Parkinsonians as resulting injuries can cause even more disability or even death. Hutton, medical director of the National Parkinson Foundation Center of Excellence at Covenant Health System (Lubbock, TX), briefly explains major causes of falls and what the caregiver or patient can do to anticipate and minimize risks. He includes some assessment tools and a reassuring chapter on how to recover from a fall. A companion video is available.Leader, Geoffrey & Lucille Leader. Parkinson's Disease: The Way Forward!; An Integrated Approach Including Drugs, Surgery, Nutrition, Bowel and Muscle Function, Self-Esteem, Sexuality, Stress Control and Careers. Denor Pr. 2001. 301p. illus. index. ISBN 0-9526056-8-6. pap. $22.95.While the British viewpoint may not always translate well, this volume covers alternative treatments for PD, such as chelation therapy, Chinese medicine, electromagnetic therapy, and more. The authors also discuss sexuality and PD, pregnancy, and the role of other healthcare professionals such as osteopaths and physiotherapists in the treatment of the disease.Rosenstein, Ann. Water Exercises for Parkinson's: Maintaining Balance, Strength, Endurance, and Flexibility. Idyll Arbor. 2002. 244p. illus. index. ISBN 1-882883-49-7. pap. $18.In her introduction, water aerobics instructor Rosenstein argues persuasively that water exercises can significantly enhance mobility and ease the physical impact of PD, as well as ward off depression and improve self-esteem. She addresses pool safety, drugs, proper attire, equipment, and methods of entering the pool; her exercises are well illustrated.Coping Issues Biziere, Kathleen E., M.D. & Matthias C. Kurth, M.D. Living with Parkinson's Disease. Demos Medical. 1997. 160p. illus. index. ISBN 1-888799-10-2. pap. $24.95.While the first half presents a technical explanation of the etiology, symptoms, and medical and surgical management of PD, this book's real strength lies in the second-half discussion of clinical trials, including points to consider before participating in a clinical trial and lines of research being pursued. An extensive glossary is included.Caring for the Parkinson Patient: A Practical Guide. 2d ed. Prometheus. 1999. 251p. ed. by Thomas J. Hutton & Ray Lynne Dippel. illus. ISBN 1-57392-684-1. pap. $22.Sixteen contributed chapters address medical and surgical treatments, physical and occupational therapy to enhance the patient's daily living skills, psychological and cognitive changes caused by the disease, and caregiver issues. Also helpful are the photos and descriptions of adaptive equipment.Jahanshahi, Marjan, M.D. & C. David Marsden, M.D. Parkinson's Disease: A Self-Help Guide. Demos Medical. 2000. 392p. illus. index. ISBN 1-888799-38-2. pap. $24.95.This practical handbook gives essential information to PD patients and their families on how best to cope with the life changes brought about by the disease. The authors emphasize patient empowerment through information, resources, and assistive devices.* Parkinson's Disease and Quality of Life. Haworth. 2000. 223p. ed. by Lucien Cote. index. ISBN 0-7890-0763-0. $49.95; pap. ISBN 0-7890-0810-6. $19.95.Published simultaneously as an issue of Loss, Grief and Care (2000. Vol. 8, #3/4), this volume features 31 contributors (nurses, doctors, patients, speech therapists, etc.) who cover a wide array of topics about PD not found in other guides: dental health, shortness of breath, sexuality, incontinence, medical expenses and health insurance benefits, tax planning, and occupational therapy, among others. Some essays are more technical, but this is still a valuable resource.Schwarz, Shelly Peterman. 300 Tips for Making Life with Parkinson's Disease Easier. Demos Medical. 2002. 144p. index. ISBN 1-888799-65-X. pap. $18.95.Multiple sclerosis (MS) sufferer Schwarz has written similar books on MS and arthritis. Her new guide offers tips, techniques, shortcuts, and resources that can assist Parkinsonians adapt to their environment and maintain their daily personal living skills. She also gives advice to caregivers. While some suggestions are too simplistic to be actually useful, others are concrete and practical enough to help PD patients keep their independence.Research *Freed, Curt, M.D. & Simon LeVay. Healing the Brain: A Doctor's Controversial Quest for a Cell Therapy To Cure Parkinson's Disease. Times Bks. 2002. 288p. index. ISBN 0-8050-7091-5. $26.Freed's absorbing account details his initial involvement with neurology and his later specialization in Parkinson's studies. His use of stem cells in 1994, in which monkeys with Parkinson's-like disease had dopamine cells from embryos transplanted into their own brains, showed great promise for humans. Detailing the outcomes from the human clinical trials, Freed also discusses the ethical and legal issues involved in fetal tissue research, although his bias in favor of this controversial technique is obvious. (LJ 8/02)Personal Narratives Fox, Michael J. Lucky Man: A Memoir. Hyperion. 2002. 260p. photogs. ISBN 0-7868-6764-7. $22.95.Actor Fox hid his PD for seven years before announcing his illness in 1998. He recounts his life from childhood to stardom, his efforts to deny his disease to himself as well as his fans, and ultimately his decision to go public. In a down-to-earth style, Fox reveals his struggles to deal with and find meaning in his changed life.Grady-Fitchett, Joan. Flying Lessons: On the Wings of Parkinson's Disease. Forge. 1998. 240p. ISBN 0-312-86490-6. $17.95; pap. 2000. ISBN 0-312-86491-4. $12.95.A successful 47-year-old professional woman, Grady-Fitchett was diagnosed with PD in 1979. Refusing to allow the disease to dampen her positive attitude, she entered clinical trials, remarried, and maintained an independent lifestyle. Ultimately the disease progressed until, in 1996, she was accepted into the University of Colorado's experimental stem cell transplant program. Readers will be inspired by her attitude and disappointed that the book ends before knowing the surgery's outcome. (LJ 10/15/98)*Havemann, Joel. A Life Shaken: My Encounter with Parkinson's Disease. Johns Hopkins. 2002. 200p. bibliog. index. ISBN 0-8018-6928-5. $24.95.Los Angeles Times Senior Editor Havemann movingly chronicles the physical and emotional effects the disease has had on his life since his diagnosis in 1990. While he briefly discusses PD's history, possible causes, medical and surgical treatments, and research progress, it is the account of his personal struggle that is the heart of this book. Havemann realistically accepts his condition yet also resists its limitations; his appreciation of life in spite of disability is inspiring. (LJ 3/15/02)Kondracke, Morton. Saving Milly: Love, Politics, and Parkinson's Disease. Perseus. 2001. 288p. photogs. index. ISBN 1-58648-037-5. $25; pap. Ballantine. 2002. ISBN 0-345-45197-X. $14.Recounting his first reactions after his wife was diagnosed with PD at age 47, political journalist Kondracke honestly describes his denial and retreat from Milly and his eventual transformation into the role of caregiver and PD political activist. Readers will be moved by his account of Milly's struggle to achieve a decent quality of life through traditional and alternative therapies and later pallidotomy and deep brain stimulation. (LJ 7/01)Morgan, Eric. Defending Against the Enemy: Coping with Parkinson's Disease. QED. 1997. 122p. bibliog. index. ISBN 0-936609-36-2. pap. $12.95.A year after Morgan's wife, Audrey, was found to have PD, Morgan was diagnosed as well. His unique perspective as caregiver and patient offers insight into how the disease can manifest itself and progress differently in each affected person. Morgan also details the emotional strains that PD places on relationships. Chapters define medical terms and concepts, and the book ends with tips for the patient and the caregiver.Associations & Web Sites *American Parkinson Disease Association. 1250 Hylan Blvd., Staten Island, NY 10305-1946; 800-223-2732; e-mail: apda@apdaparkinson.org; www.apdaparkinson.org.With 65 chapters and over 800 support groups nationwide, the APDA seeks to "ease the burden and find the cure" for PD. Its web site offers full-text booklets, video rentals, news releases, and reports on current research and political efforts.Awakenings www.parkinsonsdisease.com This comprehensive site lists pertinent materials for patients (support groups and associations; book, audiotape, and video lists; tips for living with PD, etc.), primary care physicians, and PD specialists. The information on assistive technology and resources for caregivers is excellent. Michael J. Fox Foundation for Parkinson's Research, PO Box 4777, Grand Central Sta., New York, NY 10163; www.michaeljfox.org.Founded by the actor in 2000, the foundation strives to assist in the cure of PD through an "aggressively funded" research agenda. It also provides information for patients and caregivers about the disease, disability benefits, research, and advocacy efforts. On the web site, the organization's newsletter is available in PDF format, and readers can access excerpts of Fox's book (above) in English and Spanish.*National Institute of Neurological Disorders and Stroke. PO Box 5801, Bethesda, MD 20824; 800-352-9424; www.ninds.nih.gov.The National Institute of Neurological Disorders, a part of the National Institutes of Health, conducts and supports basic and clinical research on the causes, prevention, diagnosis, and treatment of neurological disorders and stroke. It provides a great deal of free information on the more than 600 disorders, including PD. The web site includes a link to clinical trials seeking volunteers.*The National Parkinson Foundation. Bob Hope Parkinson Research Ctr., 1501 NW 9th Ave., Bob Hope Rd., Miami, FL 33136-1494; 800-327-4545; www.Parkinson.org.NPF offers a wealth of information, from the basics to a multimedia library and chat groups. Online full-text pamphlets are available in English and Spanish. Listings and contact information for PD Research Centers of Excellence are noted, and the quarterly Parkinson Report can be downloaded in PDF format.Parkinson's Action Network. 300 N. Lee St., Alexandria, VA 22314; 800-850-4726; e-mail: info@parkinsonsaction.org; www.parkinsonsaction.org.Founded by a PD patient, the Parkinson's Action Network seeks to strengthen funding for PD research through grass-roots efforts, legislation, and promoting increased awareness of the disease. PAN's Advocacy Handbook can be downloaded from the web site, which also features a multimedia library.*Parkinson's Disease Caregiver's Information www.parkinsonscare.com Caregivers will find crucial information, including links to other caregiving resources, and online chat forums at this NPF-sponsored site. Parkinson's Disease Foundation. (PDF). William Black Medical Bldg., Columbia-Presbyterian Ctr., 710 W. 168th St., New York, NY 10032-9982; 800-457-6676; e-mail: info@pdf.org; www.pdf.org.Users of the organization's web site can find support groups, clinical neurologists specializing in PD, an Ask-the-Expert section to which they can submit questions, and a wide variety of other resources. They can also register to receive via e-mail select portions of the Parkinson's Disease Foundation's quarterly newsletter. [The merger between the PDF and the National Parkinson Foundation (NPF) is expected to be completed in early 2003; the new organization will be known as The Parkinson Foundation (TPF).—Ed.]The Parkinson's Institute. 1170 Morse Ave., Sunnyvale, CA 94089-1605; 800-786-2958; www.parkinsonsinstitute.org.Founded by neurologist J. William Langston in 1988 after his experience with heroin addicts who had developed PD after taking a designer drug (as he recounted in The Case of the Frozen Addicts, now out of print), the nonprofit organization conducts patient care as well as clinical and basic research. Other services include a Movement Disorders Clinic, a resource library, physical therapy, monthly seminars, and referrals to support groups and specialists. The semiannual newsletter is available online.The Parkinson's Web spauldingrehab.mgh.harvard.edu/parkinsonsweb/Main/Pdmain.html From Harvard Medical School's Department of Neurology, this web page provides links to PD national organizations, federal resources, clinical centers, support groups, advocacy groups, and more. Young Onset Parkinson's Associationwww.youngparkinsons.com Younger Parkinsonians, whose needs and concerns differ from older patients, will find here personal narratives, a reading list, message board, and chat room. --------------------------------------------------------------------------------Author Information Janet M Schneider is Patient Education Librarian, James A. Haley Veterans' Hospital, Tampa, FL, and has reviewed health books for LJ for ten years. 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Posted by haroon at 12:14 AM 0 comments Links to this post
Labels: shaking up life - PD
Saturday, January 5, 2008
parkinson's....useful info
Adult Medicine Children's Health Dental Health Emotional Well Being/Psychiatric Dysfunction Health,Prevention, & Care HIV Issues and Topics Nutritional Consultation Sexual Health Issues Parkinson's Disease Description What Is Parkinson's Disease?Parkinson's Disease is a chronic progressive nervous disease that is linked to decreased dopamine production in the substantia nigra (a layer of deeply pigmented gray matter situated in the midbrain and containing cell bodies of a tract of dopamine-producing nerve cells). It is marked by tremor, weakness of resting muscles, and by a shuffling gait. The disorder is named for British Physician James Parkinson, who first described the disease in a report called "An Essay on the Shaking Palsy", in 1817. Parkinson called the disorder paralysis agitans; Latin words meaning "shaking palsy".Dopamine is a neurotransmitter, a chemical that carries messages from one nerve cell to another. Loss of dopamine disrupts the communication pathways among the nerves that help control movement. Symptoms of Parkinson's may cause problems with walking or talking and sometimes may produce severe disabilities. Scientists do not know the cause of Parkinson's disease, and while there is no cure there are various treatments and therapies that may alleviate some of the more troubling symptoms.Parkinson' disease occurs in people worldwide, however the incidence is higher in men than in women, and Caucasians have a higher incidence than people of other races. In the United States and Canada more than 50,000 people are diagnosed with the disease each year. It is hard to estimate how many people have the disease, however, as the symptoms are often mistaken for the normal effects of aging, or are believed to be caused by other diseases. It most commonly develops around the age of 60, and the incidence rises with age. At least ten percent of cases occur in people under the age of forty, and there is a rare form that affects teenagers.Signs and SymptomsMotor Problems For the motor disorders, the four classic symptoms that Health Care Providers look for in assessing a person that is suspected of having Parkinson's are:Tremor (the involuntary shaking of limbs): Tremor often starts with the slight shaking in one hand that later spreads to the entire arm. In the beginning, tremors sometimes cause the hand to rub back and forth between thumb and forefinger (this is called pin rolling). Tremors may also develop in the head, lips or feet. These symptoms may occur on one or both sides of the body, and while they can be distressing, they are not usually disabling, and generally disappear during sleep. At least a third of people diagnosed with the disease do not develop this symptom. Rigidity (stiffness of limbs and joints): Rigidity usually occurs in the limbs and the neck. The stiffness in the joints is similar to arthritis. Often rigidity impairs the small muscles of the hands, making tasks such as buttoning a shirt, writing, or typing difficult. Bradykinesia (generalized slowness of movements): this is the most debilitating symptom and produces a physical and mental sluggishness. The slowness in the voluntary movements contributes to varied problems, such as a distinctive shuffling walk, stooped posture, indecipherable handwriting, and even simple tasks become difficult and time consuming. The slowness in the speech patterns makes communication difficult and frustrating for not only the patient but also for the patient's friends and family. In the later stages of the disease, the muscles may freeze up, making it difficult to resume normal movement. This sluggishness may also affect the digestive tract and can contribute to constipation, which is often a major problem for people with Parkinson's. Postural Instability (difficulty adjusting to changes in body positions): This impaired reflex appears as unsteadiness or lack of balance and contributes to falls and injuries for people with Parkinson's. A person without Parkinson's who trips and starts to fall is usually able to quickly move the trunk and limbs in such a way as to prevent or ease the fall. People with postural instability, on the other hand, are unable to respond as quickly, and cannot move in a way that stops or lessens their fall. Often just simple turning, or rising from a chair are difficult and can result in an imbalance that can lead to falling.Symptoms usually affect one side of the body more than the other side and there are always two primary symptoms present when a diagnosis of Parkinson's is made. According to the Hoehn and Yahr scale, Parkinson's disease has the following five stages:Stage I: Symptoms are only on one side of the body Stage II: Symptoms are on both sides of the body Stage III: Balance is impaired Stage IV: Assistance is required to walk and other symptoms are severe Stage V: Wheelchair bound There are several secondary symptoms that are caused by one or more of these four major symptoms. Many people have difficulty walking, resulting from a combination of postural instability and bradykinesia. The balance problems may cause them to stagger and add to a lurching gait. They may experience difficulty in turning or stopping as they walk, or they may inexplicably come to an abrupt stop. Loss of automatic movements may lead to a freezing of the facial muscles resulting in a "mask like" expression. They may also develop a fixed staring expression, and unblinking eyes. They may develop drooling, dizziness when moving from a seated to a standing position, difficult or frequent urination, difficulty speaking or swallowing, restlessness, eyelid closure, skin problems, excessive sweating, and sexual problems. Mental DisordersDepression: Due to the toll of living with their illness, and also due to the deficiencies of brain chemicals that are a part of the disease, many Parkinson's patients experience depression. Depression is marked by deep hopelessness and pessimism, and occurs in at least 40 percent of Parkinson's patients. A majority of patients experience anxiety that in turn may produce panic attacks. Panic attacks are overpowering fears, accompanied by breathlessness, sweating, chest pain, choking, and dizziness. Depression or anxiety that appears before motor symptoms develop are most likely caused by the disease itself, while depression or anxiety that occurs after the disease is diagnosed are usually due to the natural reaction to having a chronic and debilitating illness.(It should be noted here that many Parkinson's patients and their families have found much relief in dealing with this disease by joining support groups. By checking with your healthcare provider, or by contacting the Parkinson's Foundation, you should be able to find one in your area.) Dementia: At least thirty percent of Parkinson's patients develop dementia. Dementia is deterioration in intellect marked by memory losses, short attention span, impaired judgment, as well as personality changes. Twenty percent of People with Parkinson's experience cognitive impairment in which the information processes become slow. Planning or organizing skills, a decline in initiative and creativity may be compromised and completing simple tasks, such as balancing checkbook, becomes difficult. Dementia may be preceded by cognitive impairment.Sleep problems: Sleep problems are also a symptom of Parkinson's. The sleep disturbance may be caused by depression or anxiety, or the drugs that are used to treat the Parkinson's could cause it. These patients may wake up frequently during the night, and may also act out their dreams (REM sleep behavior disorder). The disease may also cause this sleep disorder, as the sleep centers are located near the substantia nigra and may be altered by the disease. CausesWhile scientists do not understand the mechanisms underlying nigral cell deterioration in Parkinson's disease, most researchers believe that it results from a combination of factors that involve genetics, environmental agents, and abnormalities in cellular processes. Although Parkinson's has been thought to be mostly a genetic disease, a report published in the January 27,1999 issue of the Journal of the American Medical Association (JAMA), stated that it is instead more likely to be caused by environmental factors. The genetic factor has been debated for more than a century. Researchers have noted, however, that the disease is more common in the developed Western nations, fueling speculation that a byproduct of industrialization is to blame. A new study, the largest ever undertaken to examine the role of genetic or environmental causes of Parkinson's disease, was conducted by researchers at the Parkinson's Institute in Sunnyvale, California. The six-year study drew on the health records of nearly 20,000 white male twins. The records were contained in a registry of twins who fought in World War II (1939-1945). It was found that among men who developed the disease after the age of 50, the chance that their twin brother would also have the disease was equal to that of an unrelated stranger. About ninety percent of all cases of Parkinson's were diagnosed in men aged 50 or older. In the rare instances where Parkinson's developed before the age of 50, the researchers determined that genetic factors were important. Having eliminated genetic factors as a primary cause of the most common form of Parkinson's, the researchers concluded that an environmental agent most likely triggers the disease. These agents are unknown, but scientists have speculated that they could include exposure to pesticides and other chemicals, or something in the diet. In an editorial accompanying the new study, neurologist Jeffrey Cummings at the University of California (UCLA), wrote that the study findings should help refocus research on Parkinson's.(It should be noted here, however, that scientists have yet to identify a particular drug or toxin that causes Parkinson's disease.) DiagnosisIt is difficult to diagnose Parkinson's in the early stages, as no definitive tests exist for the disease. Many of the symptoms may be dismissed as the effects of aging, particularly in older adults. Healthcare Providers sometimes miss Parkinson's disease in the young, precisely because they believe it mainly affects older patients. A diagnosis is based on a patient's medical history, observations of the symptoms, and a neurological examination. The neurological examination includes an evaluation of the patient's walking, coordination, and some simple dexterity tests. Subtle signs such as reduced facial expressions, or lack of gestures or a subtle tremor are also noted. Healthcare providers may use brain-imaging techniques to help in their diagnosis. Magnetic resonance imaging (MRI), which uses electromagnetic radiation to view soft tissues of the body, can help the healthcare provider exclude other medical conditions that produce symptoms similar to Parkinson's disease.TreatmentA person who suspects he/she might have Parkinson's should always contact their healthcare provider for a diagnosis and for treatment possibilities.Depending on the symptoms, one healthcare provider may first try lifestyle changes such as diet, exercise, and physical therapy, while another may begin drug treatment at the first signs of the disease. Although the symptoms may be controlled by use of various drugs, and in some cases by surgery, there is no treatment that prevents the progressive brain changes in patients who have the disease. Physical therapy can be helpful both in the early and later stages. It can help improve not only mobility, range of motion and muscle tone, it can also help improve gait and balance. Working with a speech pathologist can help improve problems with speaking and swallowing. Drugs are used primarily for managing problems with walking, movement, and tremors, by increasing the brain's supply of dopamine. Dopamine itself cannot pass from the bloodstream to the brain, therefore, the drugs used to treat Parkinson's disease, known as antiparkinson drugs, use other methods to temporarily restore dopamine in the brain or closely mimic dopamine's actions.Drugs Used IncludeLevodopa (laradopa): an oral drug introduced in 1967 that treats bradykinesia, rigidity, tremor, and difficulty walking. Levodopa enters the brain where it transforms into dopamine. The body breaks down about 95 percent of the drug into dopamine before it reaches the brain if the drug is taken by itself. Therefore, it is usually combined with a drug such as carbidopa, which enables more levodopa to enter the brain before it converts into dopamine. Carbidopa/levodopa (Atamet, Sinemet) lessens rigidity and bradykinesia but is less effective in treating temor or balance problems. A similar drug (Madopar) combines carbidopa and benserazide and is available in Canada. As the disease progresses, the drug works less evenly. As a result some people may experience involuntary movements (dyskinesias), especially when the medication is having its peak effects. This causes what is known as the "off-on" phenomenon. Therefore, it is very important to work closely with your healthcare provider who can monitor the progress, and the treatment. Drugs that sustain levodopa's effectiveness, such as a controlled-release form of carbidopa/levodopa (Sinemet CR) are often used. Side effects include hallucinations, a drop in blood pressure (especially when standing), and nausea.Dopamine Agonists: these are drugs that unlike levodopa are not changed into dopamine. Instead, they mimic the effects of dopamine in the brain and cause neurons to react as though sufficient amounts of dopamine were present. They are primarily used as adjuncts to levodopa therapy, but are also used in early therapy, and in younger adults. The side effects are similar to those of levodopa. This class of drugs includes bromocriptine (Parlodel) and pergolide (Permax) and the new drugs, pramipexole (Mirapex) and ropinirole (Requip). Only by working closely with the healthcare provider, however, can a person with Parkinson's receive the correct care for him/her.Selegiline (Carbex, Eldepryl, Atapryl): this drug is used as an adjunct to levodopa therapy and helps prevent the breakdown of both naturally occurring dopamine and dopamine formed from levodopa. This occurs by inhibiting the activity of the enzyme monoamine oxidase B (MAO-B); the enzyme that metabolizes dopamine in the brain. Toxic reactions have occurred in some patients who took selegiline with the narcotic drug, meperidine (Demerol).COMT inhibitors: are a newer class of drugs that work to prolong the effect of levodopa therapy by blocking an enzyme that breaks down dopamine in the liver and other organs. Tolcapone (Tasmar) is a potent COMT inhibitor that easily crosses the blood-brain barrier and doubles the time that levodopa is effective in the brain, and reduces the on-off effect. However, it has been linked to liver damage and liver failure and is normally used only in people who are not responding to other therapies. Entacapone (Comtan) is a milder COMT inhibitor that may help manage fluctuations in the response to levadopa.Anticholinergics: these were the main drugs used before the introduction of levodopa. They are mildly beneficial in the earlier stages of Parkinson's and may lesson tremor and drooling, but are not effective in treating bradykinesia or posture instability. Anticholinergics block the action of acetycholine, which is responsible for problems with motor skills.Amantadine (Symmetrel): this drug was originally developed as an antiviral drug. It is usually prescribed for people in the latter stages of Parkinson's disease, especially if they have problems with involuntary movements induced by levodopa (dyskinesias). Side effects include swollen ankles and a purple mottling of the skin.(If you are taking medications for Parkinson's disease, it is extremely important not to stop taking them on your own. Always talk to your healthcare provider.) Surgical TreatmentsSurgical procedures were commonly used in the 1950's and 1960's to treat tremor and rigidity in Parkinson's patients. The success rate varied and life-threatening complications often occurred. Surgical treatment fell out of favor with the introduction of levodopa and other drug therapies. However, the surgical approaches are being re-evaluated to be used for times when symptoms cannot be controlled with medications. These surgical procedures include:Thalamotomy: this procedure, used to reduce tremors in people with Parkinson's disease involves the destruction of small amounts of tissue in the thalamus - a major brain center for relaying messages and transmitting sensations. The surgery can cause extreme weakness and slurred speech if it is performed on both sides of the brain, and the benefits are usually confined to one side of the body. Pallidotomy: in this procedure, an electric current is used to destroy a small amount of tissue in the globus pallidus, a part of the brain responsible for many symptoms of Parkinson's disease. It may improve tremors, rigidity and slowed movement by interrupting the neural pathway between the globus pallidus and the thalamus. It has proven helpful for some patients, but it is not a cure, and the effects do not always last. The surgery includes certain risks such as slurred speech, disabling weakness and vision problems, especially when performed on both sides of the body. Deep brain stimulation: this is a device that helps control the disabling shaking and trembling caused by Parkinson's disease. A probe is inserted into the thalamus or globus pallidum and connects to a battery-powered generator outside of the body. When tremor or other uncontrolled movement starts, the patient turns the generator on and an electric signal sent to the brain halts the movement. In 1997, the Food and Drug Administration approved a new device that is implanted in the chest and transmits electrical pulses via a wire to an implant in the thalamus. Potential risks exist with the DBS, including infection caused by the wire connecting the electrode to the stimulator and the need to perform minor surgery to change the unit's battery. Experimental Treatments IncludeFetal cell transplantation: a procedure in which fetal cells are implanted into the brains of people with Parkinson's. This procedure is used to replace the dopamine-producing cells in the substantia nigra. However, a study, published in the March 8, 2001 issue of the New England Journal of Medicine, suggested that fetal cells implants only benefit people under the age of 60, and about 15 percent of the study participants later developed severe involuntary movements (dyskinesias) as a result of too much dopamine.Embryonic stem cells: these are the parent cells of all tissues in the body, and the hope is that they may one day be used to reproduce specific types of cells - such as dopamine-producing neurons - that can be used to treat disease. Stem cells can also be obtained from the discarded umbilical cord from healthy babies, and the bone marrow of adults. Using stem cells from these sources make this treatment more acceptable and may go far in alleviating the controversy surrounding the use of embryonic stem cells.(Both of these treatments are still in the research phase, and are not available to the public. At this time they are still experimental treatments.) Self-HelpIn addition to the various treatment procedures there are many things a person diagnosed with Parkinson's can do to help him/herself. While any and all treatments and therapies should be discussed with one's healthcare provider, the following may be of help:Nutrition/Diet: Because it is believed that Parkinson's may be associated with free radicals (potentially damaging molecules produced in cells as part of cell activity or in response to injury), it is important to eat foods that contain antioxidants. Foods that contain antioxidants are fruits, vegetables and whole grains. A balanced diet that contains these can help protect against free radical damage. They are also high in fiber, which is important for the Parkinson's patients that suffer from constipation. Your healthcare provider may advise taking a fiber supplement, such as Metamucil or Citrucel, however, it should be introduced slowly and it is imperative to drink eight to ten glasses of water daily. Limiting caffeine and alcohol is also helpful. Reducing the consumption of fat, especially saturated fats can be helpful in maintaining an acceptable weight. Because Parkinson's disease slows gastric motility, swallowing is prolonged, and therefore food absorption is slower. Eating small amounts of food throughout the day is better for the Parkinson's patient than three large meals. If a Parkinson's patient is taking Simemet, it should be taken on an empty stomach. Even taking it fifteen minutes before eating is preferable. If nausea is present, it may be taken with a non-dairy fluid and a small cracker, bite of fruit, even a pretzel. Ginger has been found to be helpful in offsetting nausea. Taking Simemet on an empty stomach allows it to be absorbed more easily and quickly. Some healthcare providers may recommend vitamin or antioxidant supplements. Talk to your healthcare provider about the benefit of adding these to your diet. Parkinson's patients often have trouble swallowing, especially in the latter stages of the disease, therefore it is important to remember to take small bites of food, chewing them completely and swallowing before taking another bite. Chopping food in a food processor may also be helpful, as would using a plate warmer under the plate to insure the food doesn't get cold, thus allowing you to take your time in eating.Exercise: Regular exercise is important for Parkinson's patients. It aids in mobility, balance, and range of motion. Your healthcare provider may recommend an exercise program for you, however, walking, swimming, and gardening have all proved beneficial. Studies have shown that activities such as walking, jogging, and even dancing may be more helpful than physical therapy. Making sure that your medicines are working well and you are feeling strong, as the energy level may go up and down, are important things to consider before beginning any exercise. In the case of fatigue, it may be helpful to do part of your exercise routine in the morning, and another part in the evening. Make sure and stretch before exercising as this helps to warm up the muscles and also helps to prevent stiffness. Stretching also improves balance and flexibility. Some healthcare providers are suggesting that their patients try Tai Chi, a Chinese form of exercise that uses slow, graceful movements to relax and strengthen the muscles and joints. It is also known to be beneficial in improving balance. It is imperative to always consult with your healthcare provider before starting any exercise program.Walking: Walking is difficult for the Parkinson's patients, especially in the latter stages due to the shuffling and foot drag that is common to this disease. Making sure to use proper posture and wearing the right shoes, such as a pair of good walking shoes can help. One of the problems that Parkinson's patients face is what is known as "freezing". This usually happens when a person with Parkinson's stops or tries to pivot in order to turn and their feet become "frozen" in place. Rocking gently from side to side, or pretending to step over an object on the floor can aid in this. Avoiding prolonged standing, using a large rubber tipped cane, using a forward facing wide U-turn rather than the usual pivoting and keeping distractions to a minimum can help the patient avoid falls. Also, standing with feet eight to ten inches apart instead of close together may be of help. There are many products on the market that can help the people who have Parkinson's disease. These would include handrails (especially on staircases) and grab bars for around the tub and beside the toilet. Removing area rugs can also help. Music Therapy, a therapy that uses music and rhythm to help improve the patient's mobility and balance has been used with some success. You can check with your healthcare provider to find this therapy in your area.Dressing: As dressing can become an ordeal for a person who has Parkinson's, it might be helpful not only to allow plenty of time for dressing, but also to choose clothes that slip on easily or that have Velcro fasteners rather than buttons or zippers.Speaking: A person who has Parkinson's often speaks with a soft of hoarse voice. In order to communicate more easily, face the person you are talking to and speak deliberately and more loudly than you think necessary. Reading or singing out loud while focusing on breathing aids in strengthening the vocal cords and the throat muscles which in turn aid in swallowing. Consulting with a speech pathologist that is trained to treat Parkinson's patients can also be beneficial.Parkinson's is a progressive disease, and while none of these tips can eliminate or cure any of the problems associated with Parkinson's, making certain lifestyle changes can help make living with the disease easier.The information in this or any article should never be used to diagnose oneself. If Parkinson's or any disease is suspected, a healthcare provider should be contacted as soon as is possible, in order to detect early symptoms and begin treatment.Additional ResourcesAmerican Healthcare Association (202) 842-4444 Americans with Disabilities Act Regional and Technical Assistance Centers (800) 949-4232 The National Council On the Aging, Inc. (202) 479-1200 National Council on Disability (202) 347-1234 The National Parkinson's Foundation encourages all patients to request a Parkinson's Medical Alert card if they don't already have one. This card alerts anyone rendering assistance that the individual has Parkinson's disease. It provides emergency contact numbers so that the family and/or healthcare provider may be contacted, as well as important medical information. To request your card call: 1 (800) 327-4545. /em> post
Wednesday, January 2, 2008
the secret...........by Rhindo Byrne
Disease is held in the body by'thoughts' and by the attention given to it.By talking about you add energy to it......
Posted by haroon at 11:33 PM 0 comments Links to this post
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parkinson's web site
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parkinson's....useful info
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what caused PD
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About Me
haroon
retired CEO and Banker now working as ombudsman financial services View my complete profile
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Sunday, July 13, 2008
pd primer for GP'S
Parkinson's Disease
Quality of Life Issues
Barbara Fitzsimmons, RN, MS
Lisette K. Bunting, RN, MScN
--------------------------------------------------------------
Individuals who develop Parkinson's disease (PD) are confronted not only
with the physical manifestations of the disorder but with the psychosocial issues
that impact on quality of life. Psychosocial aspects of PD may present as subtle
changes with progression of the disease. Many patients with PD are reluctant to
discuss these concerns with health care providers, however. Unfortunately, these
unvoiced concerns have a negative effect on acceptance of the disease state, corn-
phance with treatment, and response to therapy, and they can significantly affect
quality of life.
Current nursing literature has focused on management of mobility in PD, and
little attention has been devoted to psychosocial issues. This paucity of literature is
attributed to the belief that if motor symptoms are treated, psychosocial aspects of
the disease will spontaneously improve. Quality of life has been reported to be the
primary concern of patients with PD and their famidy members.(12) Medicine is
learning to recognize and accept quality of life as a major criterion in evaluation of
health interventions. "The concept of quality of life then goes beyond the dimen-
sions of health functioning to performance of social roles, mental acuity, emotional
states, subjective well-being, and interrelationships."(5) Life satisfaction, self-esteem,
and physical health have also been identified as key elements of quality of fife.
This article briefly reviews salient points regarding PD as a degenerative
neurologic process and focuses primarily on the motor and nonmotor features that
impact on quality of life. In addition, nursing care is presented and reviewed to
assist the reader in facilitating the development of goals with the patient and family
that are congruent with achieving maximum quality of life (Table 1).
HISTORY OF PARKINSON'S DISEASE
James Parkinson, a London general practitioner, first described Parkinson's
disease in a monograph entitled "An Essay on the Shaking Palsy" in 1817. It was
--------------------------------------------------------------------------------------
Table 1. NURSING PLAN OF CARE
-----------------------------------------------------------------------------------------------------------
Nursing Diagnosis Expected Outcomes Nursing Interventions
Impaired physical mobility Patient will demonstrate Consult with physical
related to rigidity, maximal independence therapy for exercises and
bradykinesia, and/or with performing activities assistive devices to
postural instability of daily living. maximize independence
with self-care activities.
Plan for patient to
participate in care when
medications are at peak
level.
Provide for safety in
environment.
Impaired verbal Patient will communicate Facilitate consultation with
communication related to effectively with others. speech therapy.
softening of voice Provide opportunities for
patient to practice speech
exercises.
Encourage patient not to
hurry to complete speech.
Refrain from completing
sentences for patient.
Altered self-esteem related Patient will actively Incorporate patient into
to dependency on participate in decisions decision-making process
spouse/significant other related to care prior to about taking medication,
discharge, participating in diversional
activities, and so on.
Offer suggestions for
patient to have
opportunities to socialize
in the community.
Altered thought processes Patient will state that Provide reality orientation to
related to hallucinations hallucinations are not real patient as needed.
and confusion prior to discharge. Be calm and offer
reassurance if patient
becomes fearful.
Umit environmental stimuli.
Promote restful sleep-wake
cycle.
-----------------------------------------------------------------------------------------------------------
here that Dr. Parkinson described the classic parkinsonian symptoms of resting
tremor, propulsion, and stooped posture. Parkinson wrote that he found that
11 senses and intellect" were "uninjured;" however, he went on to describe patients
as "unhappy," "dejected," and "melancholic."(2)
PD is a chronic, progressive disease of the central nervous system. The classi(-
triad of symptoms is resting tremor, rigidity, and bradykinesia. PD has been de-
scribed as a collection of symptoms rather than one distinct clinical picture. Thus,
diagnosis can be difficult in the early stages of the disease. Typically tremor or
rigidity are noted on one side of the body, although they may progress to bilateral
involvement. (13)
Physicians often refer to PD as the "waiting room diagnosis." This refers to the
classic signs of pill-rolling tremor, stooped posture, bradykinesia, and masked face
that are easily observed in the clinical setting. Patients typically seek consultation
with a neurologist to confirm or rule out a diagnosis of PD. Frequently patients will
request testing to substantiate the diagnosis. No such test exists, however. PD is a
diagnosis made by history and physical. In today's technologic health care environ-
ment, patients are often frustrated with the fact that PD is a clinical diagnoSis.13
EPIDEMIOLOGY
Approximately 1 million Americans are currently diagnosed with PD. Men
have a slightly higher incidence of the disease, and whites are disproportionately
affected when compared with other races. PD is typically considered to be a disease
of the aged. The mean age of onset is 60 years of age, although cases have been
identified in individuals as early as 30 years of age.
With increased incidence of PD in young patients, that is, in those diagnosed
before the age of 50, a new set of quality-of-life issues has emerged.(6,8) For example,
an older patient, a more "traditional Parkinson's patient," has probably planned
for retirement. Facing a degenerative disease in what had been hoped to be the
"golden years," elderly couples are often confronted with not being able to travel
and thus change their focus to planning for long-term care. On the other hand, the
concerns of the younger patient with PD focus on raising children, managing a
career, and maintaining a home. These two age groups have distinct differences in
issues affecting their quality of life.
CAUSE
The cause of PD is unknown. However, the following theories are the focus of
current research: genetic, viral, and environmental toxins. Genetic research is fo-
cusing on mitochondrial defects and family linage.'-' Twin studies have failed to
demonstrate any clear inherited trait, however. The viral theory was first suggested
with the outbreak of encephalitis lethargica, which occurred worldwide from 1918
to 1926. This viral epidemic resulted in postencephalitic parkinsonism killing more
than 2000 Americans. The mortality rate approached 40%, and only 15% of
patients fully recovered. As survivors of this viral epidemic die, fewer individuals
with this form of PD are seen. Environmental toxin theories have continued to be a
focus of epidemiologic studies. (13)
PATHOLOGY
The hallmark pathologic feature of PD is the degeneration of the dopaminergic
nigrostriatal pathway. It has been shown that 80% of the dopan-dne-producing
cells must be lost before manifestations of the disease can be seen. The severity of
PD is associated with the degree of neuronal loss in the midbrain at the level of the
substantia nigra.11
Dopamine, a neurotransn-titter, is the primary neurocheniical responsible for
the signs and symptoms of PD. The balance of dopamine and acetylcholine are
responsible for normal motor function. The development of symptoms is explained
by an imbalance of dopaminergic (inhibitory) and chohnergic (excitatory) activity in
the caudate and putamen of the basal ganglia. When degeneration of the dopamin-
ergic nigrostriatal pathway occurs, there is depletion of dopan-dne and relative
excess of cholinergic activity in the feedback circuit involving the cerebral cortex,
basal ganglia, and thalamus. This change in neuronal activity is responsible for the
classic manifestations seen in PD.(9)
MOTOR FEATURES
The Motor features of PD include the classic triad of tremor, rigidity, and
bradykinesia. In addition, there is postural instability and disordered gait as well as
disorders in fine motor movement. A brief description of each motor feature
follows.
Tremor
Resting tremor is the most classic and visible sign of PD. Seventy percent of
patients present with resting tremor as their chief complaint for seeking diagnosis
and treatment. Parkinsonian tremor has been described as having a pfll-rolling
quality and can affect all four limbs and the head.(13)
Many patients express feelings of embarrassment related to their tremor.
Tremor is the most difficult symptom to treat but the least disabling. It subsides
with action and is thus described as a resting tremor. The resting quality of the
Parkinson tremor allows patients to maintain activities of daily living within some
lin-titations. Unfortunately, patients will restrict social activities due to fear of social
stigma and being labeled as ill. In addition, stress can intensify tremor, which
further restricts the patient's willingness to participate in social life,
Rigidity
Rigidity is often described as a plastic resistance to passive movement. Patients
often describe this characteristic as stiffness. On examination, rigidity can be de-
tected as a coglike release of muscle resistance in the wrist, elbows, neck, and knees
as the limb is moved through passive range of motion.(13)
Rigidity can cause the face of the patient with PD to take on a masklike quality.
The face appears fixed and rigid, and previously recognizable nonverbal messages
are misinterpreted or lost in communication. Fanifly members find this change to
be most disturbing because the patient no longer has a change of facial expression.
Bradykinesis
Bradykinesia refers to difficulty with initiating and continuing movement.
Movements are slowed and are performed with conscious effort. Patients have
described bradykinesia as feeling as if "My brain is sending the message to the
body, but the body won't listen."(7)
Postural Instability and Gait Disorders
As PD progresses, patients may demonstrate difficulty maintaining erect pos-
ture. Typically, there is forward flexion of the neck, hips, knees, and elbows.
Postural abnormalities greatly reduce the patients' ability to be ambulatory and
places them at high risk for injury.(7) This may also lead to reliance on assistive
devices.
Because of rigidity and postural changes, patients also develop a shuffling
quality to their gait and use small steps. Another abnormal gait characteristic is
propulsion, a disturbance in which the patient goes from a slow walking pace to
runnin with an inability to stop. Patients are only able to stop themselves by
grabbing stationary objects such as a door frame. It is important to note that
patients who develop an unsteady festinating gait may appear to be under the
influence of drugs or alcohol.
The inability to be freely ambulatory restricts the independence of the patient
with PD. The use of a cane, walker, or wheelchair gives the patient a message that
the disease is progressing. Resistance to the use of assistive devices is often an
attempt to maintain self-esteem as the patient is dealing with declining health.
Limitations of mobility further restrict social fife, and many patients express an
inability to maintain pace with friends or family members. Often patients will
express embarrassment due to their gait disturbance and verbalize a realistic fear
that others will assume they have a substance abuse problem.
On-Off Phenomenon
As the disease advances, patients enter a narrow therapeutic window. Re-
sponse to treatment is less predictable, resulting in what is termed the "on-off"
phenomenon. This phenomenon refers to a syndrome in which patients are freely
ambulatory one n-tinute and then find they are "frozen" and unable to move the
next. Patients also describe "off" periods as if someone has turned off the switch
and their feet have sprouted roots. The cause of the on-off phenomenon is un-
known but may be associated with years of therapy compounded with continued
loss of dopan-tine-producing cells.(13)
Because the on-off phenomenon is unpredictable, it can play a major role in
family dynan-dcs. The concept of a person exhibiting a behavior that is severely
disabling, sudden in onset, and resolving without intervention is a difficult concept
for patients and health professionals to grasp. Understanding that on-off phenom-
enon behavior is not intentional and is not psychogenic in origin is essential.
Patients and farnfly members need education about this feature of the disease
process to assist the patient with PD to maintain a sense of control.
Swallowing and Speech Defects
Dysphagia is a common disorder that affects patients with PD and was first
recognized by James Parkinson. He described patients as having significant weight
loss with complaints of difficulty swallowing solid foods as compared to liquids. As
the disease progresses, patients report difficulty with chewing or moving food to
the back of the mouth. This may lead to choking episodes and places the patient at
high risk for aspiration. Management of dysphagia in PD may be difficult. Consul-
tation with a dietitian and swallowing therapist may be beneficial in providing
optimal nutrition. In addition, meals should be eaten when levodopa dosages are
reaching maximum effectiveness. (10,16)
The motor disturbances responsible for swallowing deficits can also lead to
disorders of speech in the patient with PD. Dysarthria, a form of speech distur-
bance, is characterized by deviations in phonation, prosidic disturbances in which
speech may be slow or extremely fast, and an articulatory disorder in which vocal
sounds are distorted. Dysarthria is a common problem for patients with PD and can
have a dramatic and devastating effect in a patient's interpersonal communication
and self-image. Management of dysarthria involves the use of medication and
speech therapy. Levodopa has been shown to improve speech intelligibility, and
speech therapy can assist the patient in using techniques to enhance projection. To
gain maximum benefit from speech therapy, the patient must be invested in
practicing the exercises assigned by the speech therapist. (10)
Handwriting
Difficulty with handwriting can be an early sign of PD. Patients with PD
typically will initiate handwriting with normal-sized penmanship and trail off
words and sentences with smaller illegible handwriting. This small writing is
referred to as "n-dcrographia." Patients with micrographia can have difficulty sign-
ing checks, and banks frequently request patients to sign a new bank card because
of the dramatic change in signature. The inability of patients to spontaneously
write can also inhibit communication. (14)
NONMOTOR FEATURES
Depression
Depression in PD has been the focus of numerous studies. Research indicates
that 20% to 90% of patients with PD will experience a major depressive episode as
compared to 7% of the general population. Depression accounts for the majority of
psychiatric referrals in patients with PD and can be the initial feature of PD. It has
been hypothesized that the shared neurochemistry of these two disorders accounts
for the high incidence of depression in PD.(2)
Depression can be viewed in two ways. Some patients may become demora-
lized with the diagnosis of PD and experience a "reactive depression." Reactive
depressions are linked to external events and are short in duration. Typically the
patient experiencing a reactive depression is able to resolve the issue and accept the
diagnosis. Individuals experiencing a reactive depression may benefit from sup-
portive psychotherapy, however.(2)
The most typical depression experienced by the patient with PD is endogenous
depression. Endogenous depression is caused by a biochemical imbalance in the
brain and can be life-threatening if not treated. The difficulty in diagnosing depres-
sion in patients with PD lies in the shared clinical features of the two disorders
(Table 2).
Dementia
Dementia is also a common feature of PD. It is estimated that 20% of patients
with PD will become demented.(11,14) Dementia can be defined as an acquired,
-------------------------------------------------------------------------------------------------------------
Table 2. COMPARISON OF CLINICAL FEATURES ASSOCIATED WITH PARKINSON'S
DISEASE AND DEPRESSION
Features Parkinson's Disease Depression
Motor manifestations Stooped posture, bradykinesia, Slumped posture, psychomotor
masked face retardation, diminished facial
affect
Sleep disturbances Insomnia, sleep fragmentation Insomnia, early morning
awakening
Gastrointestinal Constipation, weight loss Constipation, weight loss
Concentration Bradyphrenia Poor concentration
Hallucinations Visual, usually nonthreatening Visual, auditory, olfactory and
tactile
Adapted from Bunting LB, Fitzsimmons, B: Depression in Parkinson's disease. J Neurosci Nurs
23(3):160, 1991; wwith permission.
-------------------------------------------------------------------------------------------------------------
persistent impairment of intellectual function with compron-dse in at least three of
the following areas of mental activity: language, memory, visuospatial skills, emo-
tionality and personality and cognition in the presence of clear consciousnesS.3,4
The retention of long-term memory permits the patient to maintain aspects of
normal social behavior early in the disease. The severe loss of ability to learn new
material and the limitations of short-term memory result in episodes of frustration
that can escalate into agitation, however. In addition, individuals with dementing
illnesses may have enough insight to experience a clear sense of loss, thus leaving
patients and families demoralized and dispirited.(4) Nursing management of demen-
tia care should encompass the principles of preservation of dignity and provision of
safety.
Sleep Disturbances
Sleep disorders are a frequent complaint in patients with PD. Disorders of
sleep initiation, sleep fragmentation, early morning awakening, excessive daytime
somnolence, and parasomnias represent the disorders of sleep seen in PD. A
detailed history of the sleep complaint, validated by a bedpartner, is the best
method of establishing the cause of sleep disturbances.(11)
Patients may complain of initiation insomnia as, "I can't get to sleep." C)nce
asleep they are able to sleep soundly through the night, however. Researchers have
concluded that sleep initiation insomnia in PD is related to anxiety, agitated de-
pression, or levodopa therapy.
The more typical sleep disorders seen in PD are sleep fragmentation and early
morning awakening." Sleep fragmentation can be related to the inability to turn
over in bed. Rigidity compounded by the wearing off of medication reduces pa-
tients' ability to reposition themselves in bed. Patients state that they must wake up
to change sleeping positions and then are unable to return to sleep. One solution to
this problem is the use of satin sheets to decrease friction and facilitate turning.
Early morning awakening typically represents onset of a depressive episode, and
the nurse should evaluate the patient for other vegetative symptoms such as
decreased appetite, psychomotor retardation, and constipation. Early morning
awakening may be related to focal dystonic cramping in the calf and feet, however.
Focal dystonia is related to diminished levels of levodopa.(11)
Excessive daytime somnolence is the most frequent sleep complaint made by
family members of PD patients. In some individuals, daytime somnolence is related
to a disturbance in the circadian control of sleep. These patients are up at night and
take multiple naps throughout the day. Families report that daytime sonuiolence is
disruptive to normal family life. Families should discourage day time napping in an
attempt to correct the circadian clock. Patients who are described as sleeping all
day, however, should be screened for metabolic abnormalities that may cause
disturbances in the sleep-wake cycle.
Parasomnias are the most debilitating and difficult of the sleep disorders to
manage. Sleep talking, sleep walking, vivid dreams, and nightmares are the most
frequently reported parasomnias experienced by patients with PD. Most typically,
these occur as a side effect of levodopa therapy. Unfortunately, treatment for
parasomnias is limited.(11)
Sexual Dysfunction
Sexual functioning in patients with PD has received inadequate attention. The
paucity of literature can be attributed to the assumption that patients with PD are
elderly and therefore have a diminished interest in sex. Research indicates that
frequency of sexual intercourse decreases with age; however, sexuality continues to
play a role in the lives of the elderly. Sexual dysfunction has a significant impact on
patients who are diagnosed with PD in their midadult years when an active sex life
is the norm.(1)
Dysfunction of the autonomic nervous system, depression, medications, and
interpersonal issues all play a role in sexual dysfunction in PD. Autonomic dys-
function in the urogenital system resulting in impotence is the primary reason for
sexual dysfunction in male patients with PD. Secondary issues affecting sexual
function include motor fluctuations, fatigue, medications, sleep disorders, depres-
sion, and interpersonal issues.(1)
The motor fluctuations and fatigue can be related to antiparkinsonian drugs,
primarily levodopa. Patients with PD find that they are better able to function in
the morning, after their initial dose of medication, and become more fatigued with
greater motor fluctuations as the day progresses. Numerous reports document
hypersexuality with the use of levodopa. This may result in a problem when one
partner has heightened sexual interest that is not shared by the other partner. To
adapt to these changes in their sexual life, couples may need to change their daily
routine to accommodate morning sexual activity and take advantage of optimum
energy levels and motor functioning. Unfortunately, sleep disorders experienced in
patients with PD may result in bedpartners sleeping in separate beds, which
diminishes opportunity for spontaneous sexual activity.(1)
Depression can also have a significant impact on sexual activity in patients
with PD. As discussed earlier, depression is common in patients with PD and can
produce a markedly decreased libido. Sexual partners may also experience depres-
sion and fatigue as they struggle with the caregiving role in the relationship; thus,
they also may not have the energy or interest to engage in sexual activity. In
addition, autonon-dc dysfunctions that result in droohn& diaphoresis, and excessive
facial oiliness may interfere with perceived attractiveness of the patient by the
sexual partner.(1)
The issues surrounding sexuality in PD are complex. Patients should be rou-
tinely questioned regarding satisfaction of their sexual life. A referral to a urologist
or sex therapist can assist in identifying issues affecting sexuality. Open conununi-
cafion regarding sexual issues can be limited by the patient's reduced facial expres-
sion and altered speech pattern. The ability of the couple to communicate their
sexual needs within the liniitafions of the disease state can have a significant impact
on the couple's marriage and sexual life.(1)
Driving Performance
When a patient is seen for the management of PD, no discussion would be
complete without addressing driving. Motor manifestations of the disease as well as
a decline in cognition may impair the pafient's ability to function safely behind the
wheel. Some patients may willingly retire their driver's license, whereas others may
view this as giving up valued independence. Evaluation of driving skills by a
professional driving instructor may provide a nonthreatening avenue to assess auto
safety. Family members should be involved in the evaluation of driving to arrange
alternate transportation if the patient's driving is found to be unsafe.
Employment
PD can be a disability and liability in the work place. Many patients ask,
"Should I tell my boss?" There is no clear answer to this question because each
situation is different. Patients should be encouraged to have a frank and open
discussion with their health professionals regarding the limitations imposed by
their symptoms and the effect of these lin-dtations on their job responsibilities. This
discussion should include the benefits and potential disadvantages of revealing this
information to their supervisor. Frequently, coworkers have suspected that a prob-
lem exists. By sharing the diagnosis, an empathefic supervisor may facilitate a
pafient's medical appointments and make environmental adjustments to expedite
an optimum working relationship. Unfortunately, the risk of sharing the diagnosis
of PD can have a negative impact on job security. It has been the experience of
these authors that patients have been reassigned to other job responsibilities or
pressured into early retirement. Physicians and nurses should strive to provide
strategies and guidance for handling this difficult situation.
DRUG THERAPY
Drug therapy is the mainstay of management of PD. The primary medications
used in PD are classified as anticholinergics, antihistamines, dopaminergics, and
dopamine agonists (Table 3). (17) Unfortunately, all drugs used in the treatment of PD
have potential for side effects that impact on quality of life. Indication for medica-
tion is determined when the patient develops deficits in activities of daily living or
is expressing embarrassment from tremor or gait disturbances. The approach to
drug therapy is to maintain the patient on conservative levels of medication while
maintaining mobility. As the disease progresses, patients become less responsive to
medications and experience end of dose failure, peak dose dyskinesias, and painful
dystonic cramps. They are also more prone to developing de@um and hal-
ludnations.(13,14)
Levodopo Therapy
Levodopa is the drug of choice for treatment of PD. It is marketed as a
combination drug called Sinemet and is composed of carbidopa and levodopa. The
-------------------------------------------------------------------------------------------------------------------
Table 3. SUMMARY OF MEDICATIONS USED IN PARKINSON'S DISEASE
-------------------------------------------------------------------------------------------------------------------
Type Drug Name Indications Side Effects
-------------------------------------------------------------------------------------------------------------
Anticholinergics Tdhexyphenidyl Tremor, rigidity, Dry mouth,
(Artane), drooling constipaflon,
benztropine blurred vision,
(Cogentin) confusion, visual
hallucinations
Antihistamine Diphenhydramine Tremor, rigidity, Dry mouth, lethargy,
(Benadryl) insomnia confusion
Dopaminergics Amantadine Rigidity, Leg edema, livedo
(Symmetrel), bradykinesia, reticularls,
carbidopa/ tremor hallucinations,
levodopa orthostatic
(sinemet) hypotension,
nausea, confusion
Dopamine agonists Bromocriptine Motor fluctuations in Hallucinations,
(Parb"), Parkinson's mental cloudiness
pergolide (Permax) disease orthostatic
hypotension,
confusion
-------------------------------------------------------------------------------------------------------------
action of carbidopa is to block the breakdown of levodopa in the peripheral organs
and allows more levodopa to cross the blood-brain barrier. Levodopa is converted
to dopamine. in the brain through a series of enzymatic reactions.(13)
Levodopa therapy is responsible for promoting quality of life for the vast
majority of patients with PD. Levodopa therapy has lin-dtations, however. Early in
treatment, patients are maintained on low doses of levodopa to preserve the
therapeutic window for the future. Typically patients respond well to levodopa and
only experience mild side effects such as nausea and orthostatic hypotension. As
the illness progresses, patients require higher levels of levodopa, a@d'response to
therapy is less predictable.(13)
Levodopa has a relatively short half-life. It has a rapid onset of actions and
patients report getting a surge of energy with each dose. Similarly, patients com-
plain of "wearing off" symptoms as levodopa is metabolized and PD features
return. When levodopa is at therapeutic levels, the patient's functioning may
appear quite normal. As the medication "wears off," however, patients may be-
come akinetic and rigid. Like the on-off phenomenon, wearing off can be frustrat-
ing for the patient and family. In contrast to the on-off phenomenon, however, the
wearing-off symptoms are predictable and are associated with declining levodopa
levels. When levodopa alone is not maintaining symptomatic control, the physician
may add a dopamine agonist such as bromocriptine (Parlodel) or pergofide (Per-
max). There agents act to smooth out levodopa levels and help to control the rapid
rise and fall of levodopa levels.(13,14)
With progression of symptoms, patients with PD may experience peak-dose
dyskinesias. The term "dyskinesia" describes the development of extra movements
of the head, neck, trunk, and extremities as levodopa doses rise and peak rapidly.
Most patients find that these extraneous movements limit social activities. Al-
though dyskinesias can be devastating, patients can function within the limitation
of the movement disorders.(13)
Compliance
Compliance in taking prescribed drugs is essential to successful management
of PD. Patients with PD often verbalize feelings of being chained to the clock
because they require levodopa to maintain mobility. Levodopa dosage schedules
can be prescribed as frequently as every 2 hours during the waking day. The need
for levodopa can overshadow all other aspects of the patients life because he or she
is unable to function without it. If medications are late or missed, the patient can
experience dystonic pain, increased tremor, rigidity, and personality changes. Com-
pliance can also be an issue when patients with PD take extra doses of levodopa to
boost their levels of energy and function. This behavior should be discouraged, and
any change in treatment plan should be discussed with the physician. Alarm clocks
or pill boxes with alarms can assist the patient with remembering to take the
medication on time.
Cost of medication can also affect compliance. It is not uncommon for patients
to spend approximately $300 per month on medications for PD. The financial
impact of medications can preclude physicians from ordering additional therapy.
Nurses can assist in deterring the cost of therapy by investigating drug-cost-
sharing programs sponsored by drug companies or pricing mafl-order pharmacies
to find lower Cost medications.
Side Effects of Delirium and Hallucinations
Medications used in the management of PD often need to be titrated. Usually,
the higher the dose of drug, the more frequently side effects are encountered. (13) The
side effect of delirium is a constant danger with all medications usld in PD. The
probability of delirium is determined by each patient's tolerance to the medication
and predisposing factors such as age and general health. Living with a drug-
induced delirium is a difficult issue for many patients and families. Families are
often asked to make a choice between clear mentation and motor functioning. It
may be easier for a family to care for a mobile patient with PD who is cognitively
impaired.
The occurrence of hallucinations is well documented in the management of
patients with PD. Amantadine, a dopaminergic medication, is notorious for causing
visual hallucinations. Other medications in which hallucinations have been docu-
mented as a side effect include anficholinergic medications such as trihexyphenidyl
(Artane) and benztropine (Cogentin), levodopa in the form of carbidopa/levodopa,
and dopan-dne agonists such as bromoctiptine and pergolide. All of these drugs act
to increase the levels of dopamine in the brain through different mechanisms of
action. (13)
Patients frequently are able to tolerate continued use of medications knowing
that hallucinations are a side effect of therapy. Typical treatment-induced halluci-
nations in PD are visual and may consist of seeing small children or animals. These
hallucinations are seldom threatening. If hallucinations become auditory or threat-
ening in content, patients should be evaluated for depression or dementia by a
qualified psychiatrist.
SUMMARY
PD affects many dimensions of quality of life. This article has identified motor
and nonmotor features of PD that are directly related to a patient's quality of life.
Medication therapy can help to ameliorate some of the symptoms, yet side effects
can be as disabling as the symptoms of PD. Nursing care should include assess-
ment, intervention, and evaluation of both physical and psychosocial aspects of
care for patients with PD to assist them in achieving maximum functioning,
References
1. Brown RG, Jahanshahi M, Quinn N, et al: Sexual function in patients with Parkinson's
disease and their partners. J Neurol Neurosurg Psychiatry 53:480-486, 1990
2. Bunting LK, Fitzsimmons B: Depression in Parkinson's disease. J Neurosci Nurs 23(3):
158-164, 1991
3. Cummings JL, Benson DF: Dementia: Definition, prevalence, classification, and approach
to diagnosis. In Dementia: A Clinical Approach. Massachusetts, Butterworth, 1992, p 1
4. Folstein MF, Ross C: Cognitive impairment in the elderly. In Kelly WN led); Textbook of
Internal Medicine. JB Lippincott, 1992, p 2408
5. Gentile KM: A review of the literature on interventions and quality of fife in the frad
elderly. In Birren JE, Lubben JE, Rowe JC, et a] (eds): The Concept and Measurement of
Quality of Life in the Frafl Elderly. San Diego, Academia Press, 1991, p 74
6. Giovannini P, Piccolo 1, et al: Early onset Parkinson's disease. Movement Disorders
6(l):36-42, 1991
7. Hickey J: Nervous system degenerative diseases. In The Clinical Practice of Neurological
and NeUTOSurgical Nursing. Philadelphia, JB Lippincott, 1992, p 651
8. Marttila Rj: Epidemiology. In Koller WC led): Handbook of Parkinson's Disease. New
York, Marcel Dekker, 1987, p 35
9. McCance KL, Huether, SE: Alterations in neurologic function. In Pathophysiology: The
biologic basis for disease in adults and children. St. Louis, CV Mosby, 1990, p 509
10. Micoch AG: Diagnosis and treatment of patkinsonian dysarthria. In Koller WC (ed):
Handbook of Parkinson's Disease. New York, Marcel Decker, 1987, p 181
PD HEARTOUT
Letter to My Family and Friends about Parkinson's
Author Unknown
(please advise me if you know its author)
I have Parkinson's Disease. It is not contagious or hereditary. No one knows what causes it, but some of the dopamine cells in the brain begin to die at an accelerated rate. Everyone slowly loses some dopamine cells as they grow older.
If the cells suddenly begin to die at a faster rate, Parkinson's Disease develops. It is a slowly progressive disease usually occurring as people get older. Medicine can help. I'll take newer, stronger kinds over the years. Some make me sick and take lots of adjustments. Stick with me. I have good days and bad days.
Emotions:
Sometimes I cry and appear to be upset and you think you have done something to hurt my feelings. Probably not. It is the Parkinson's. Keep talking to me. Ignore the tears. I'll be OK in a few minutes.
Tremors:
You are expecting me to shake. Maybe I do, maybe I don't. Medicine today takes care of the tremors. If my hands, feet, or head are shaky, ignore it. I'll sit on my hands or put them in my pockets. Treat me as you always have. What's a little shakiness between friends?
My Face:
You think you don't entertain me anymore because I'm not grinning or laughing. If I appear to stare at you, or have a wooden expression, that's the Parkinson's, I hear you. I have the same intelligence; it just isn't easy to show facial expressions. If swallowing, I may drool. This bothers me, so I will mop it up.
Stiffness:
We are ready to go somewhere and I get up. I can hardly move. Maybe my medicine is wearing off. The stiffness or rigidity is part of Parkinson's. Let me take my time. Keep talking.
Exercise:
I need to walk each day. Two to three miles is good. Walk with me. Company makes walking fun. It may be a slow walk, but I'll get there. Remind me if I slump or stoop. I don't always know I'm doing this. My stretching, bending and exercises must be done everyday. Help me with them if you can.
My Voice:
As my deeper tones disappear, you'll notice my voice is getting higher and wispy. That's the Parkinson's I know you can talk louder, faster and finish my sentences for me. I don't care for that. Let me talk, get my thoughts together and speak for myself. I'm still there. My mind's okay. Since I'm slower in movement, my thoughts are slower too. I want to be part of the conversation. Let me speak.
Sleeplessness:
I may complain that I can't sleep. If I wander around in the middle of the night, that's Parkinson's. It has nothing to do with what I ate or how early I went to bed. I may nap during the day. Let me sleep when I can. I can't always control when I'm tired or feel like sleeping. Be patient, my friends. I need you. I'm the same person; I've just slowed down. It's not easy to talk about Parkinson's, but I'll try if you really want to know. I need my friends. I want to continue to be part of life.Please remain my friend.
Posted by Kate Kelsall on July 13, 2008 in Parkinson's: General Permalink
Author Unknown
(please advise me if you know its author)
I have Parkinson's Disease. It is not contagious or hereditary. No one knows what causes it, but some of the dopamine cells in the brain begin to die at an accelerated rate. Everyone slowly loses some dopamine cells as they grow older.
If the cells suddenly begin to die at a faster rate, Parkinson's Disease develops. It is a slowly progressive disease usually occurring as people get older. Medicine can help. I'll take newer, stronger kinds over the years. Some make me sick and take lots of adjustments. Stick with me. I have good days and bad days.
Emotions:
Sometimes I cry and appear to be upset and you think you have done something to hurt my feelings. Probably not. It is the Parkinson's. Keep talking to me. Ignore the tears. I'll be OK in a few minutes.
Tremors:
You are expecting me to shake. Maybe I do, maybe I don't. Medicine today takes care of the tremors. If my hands, feet, or head are shaky, ignore it. I'll sit on my hands or put them in my pockets. Treat me as you always have. What's a little shakiness between friends?
My Face:
You think you don't entertain me anymore because I'm not grinning or laughing. If I appear to stare at you, or have a wooden expression, that's the Parkinson's, I hear you. I have the same intelligence; it just isn't easy to show facial expressions. If swallowing, I may drool. This bothers me, so I will mop it up.
Stiffness:
We are ready to go somewhere and I get up. I can hardly move. Maybe my medicine is wearing off. The stiffness or rigidity is part of Parkinson's. Let me take my time. Keep talking.
Exercise:
I need to walk each day. Two to three miles is good. Walk with me. Company makes walking fun. It may be a slow walk, but I'll get there. Remind me if I slump or stoop. I don't always know I'm doing this. My stretching, bending and exercises must be done everyday. Help me with them if you can.
My Voice:
As my deeper tones disappear, you'll notice my voice is getting higher and wispy. That's the Parkinson's I know you can talk louder, faster and finish my sentences for me. I don't care for that. Let me talk, get my thoughts together and speak for myself. I'm still there. My mind's okay. Since I'm slower in movement, my thoughts are slower too. I want to be part of the conversation. Let me speak.
Sleeplessness:
I may complain that I can't sleep. If I wander around in the middle of the night, that's Parkinson's. It has nothing to do with what I ate or how early I went to bed. I may nap during the day. Let me sleep when I can. I can't always control when I'm tired or feel like sleeping. Be patient, my friends. I need you. I'm the same person; I've just slowed down. It's not easy to talk about Parkinson's, but I'll try if you really want to know. I need my friends. I want to continue to be part of life.Please remain my friend.
Posted by Kate Kelsall on July 13, 2008 in Parkinson's: General Permalink
Sunday, June 8, 2008
parkinson's web site
the pakistan parkinsons society web site is up address www.parkinsons.org.pk
the red tulip... our symbol of hope
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