Causes

PD is a relentlessly progressive neurodegenerative disorder of the brain. Lack of dopamine produces the symptoms of Parkinson’s disease.

Parkinsonism may be caused by a number of conditions, such as :

• Dementia with Lewy bodies
• Progressive supranuclear palsy
• Multiple system atrophy
• Corticobasal degeneration
• Shy-Drager syndrome
• Wilson’s disease
• Benign essential tremor
• Dystonic tremor
• Huntington’s disease.
• Creutzfeldt-Jakob disease (CJD or “Mad Cow Disease”)
• Pick’s disease
• Alzheimer’s disease
• Encephalitis
• Meningitis
• Brain tumors
• Stroke
• Head injury, particularly repeated head trauma, as in boxing
• Drugs- pharmaceutical and narcotic
• Other toxins – manganese, carbon monoxide, methanol

Drug-Induced Parkinsonism

The onset of drug induced Parkinsonism is more rapid than that of PD. On withdrawal of the offending drug the symptoms often improve but some percentage of patients develop persistent and progressive Parkinsonism. In these cases it is believed that the drug did not cause the Parkinsonism but rather unmasked a latent condition.

Many medicines have been implicated in producing parkinsonism, including :

• Antiemetics – metoclopramide
• Antidepressants – selective serotonin-reuptake inhibitors (SSRI)
• Antipsychotics (used to treat severe paranoia and schizophrenia) – chlorpromazine, haloperidol. Atypical antipsychotics are less likely to cause secondary Parkinsonism
• Anti-seizure medication – valproic acid.
• Antihypertensives – methyldopa, reserpine
• Brain damage caused by anesthetic drugs

MPTP seems to be selectively toxic to the cells in the substantia nigra, producing not only sudden irreversible Parkinsonism but all other associated features of PD too. Inadvertent synthesis and use of MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine) while trying to manufacture MPPP (1-methyl-4-phenyl-4-propionpiperidine), an illicit narcotic compound, led to symptoms of PD.

Use of MPPP contaminated with MPTP, which was sold in the street as synthetic heroin, led to similar symptoms with toxicity and death.

Symptoms

PD and Parkinsonism may have similar symptoms. Tremor, rigidity, slowness of movements, postural instability, slow shuffling gait, unilateral involvement (symptoms only on one side of the body) or other associated symptoms of PD such as dementia, difficulty with speech, swallowing difficulties and other features may also be present with secondary Parkinsonism.

Diagnosis

Differentiation between Parkinsonism due to some other cause and that due to PD may become difficult in patients presenting with early symptoms, especially in the elderly.

• A thorough history, noting other signs and symptoms, and a neurological examination may help to arrive at a diagnosis.
• There are no definite tests to confirm the diagnosis of PD, which is often diagnosed by eliminating other causes of Parkinsonism.
• Investigations, including a CT scan and MRI, may be done as indicated.
• A dramatic improvement of symptoms with levodopa can sometimes support the diagnosis of Parkinson’s disease.

Treatment

Treatment of PD is usually with a combination of anti-Parkinson drugs, including levodopa, and auxilliary therapies like physical therapy.

In Parkinsonism, treatment will be directed the cause, once it is identified. Parkinsonism caused by drugs or toxins often improve on stopping the drugs or eliminating the toxins. Specific treatment may be undertaken for other diagnosed conditions.

In most cases, Parkinsonism due to other causes does not respond, or responds only moderately, to anti-Parkinson drugs.

Early Signs and Symptoms of Parkinson’s Disease

Although tremor, rigidity, bradykinesia (slowness of movement), and loss of postural reflex are considered to be the characteristic features of Parkinson’s. However, not all these symptoms are likely to be present in all patients in the early stages of Parkinson’s disease. Symptoms vary from person to person, and the onset may be so slow as to remain unnoticed for several years.

Some of the very first signs and symptoms likely to be observed are :

• A change in facial expression may be one of the earliest signs. Others may notice the expressionless face and fixed staring gaze without blinking of the eyes (“masked face”). Loss of animation is sometimes mistaken for depression.

• A barely noticeable tremor, usually on one hand, when the hand is at rest is among the first sign noticed by a person or their loved ones. It is also the first symptom which prompts many patients to seek medical help. The tremor may get worse when the person is agitated or stressed. Tremor of the lips, tongue, or chin may also be present. The typical “pill-rolling” tremor of Parkinson’s disease (repeated rolling of the thumb over the fingers) may be observed.

However, some PD patients may not suffer from tremor, which may cause a delay in diagnosis or even misdiagnosis of the condition. Other features that may be noticed include :

• The symptoms are initially present on one side of the body.
• A feeling of internal trembling.
• A general feeling of fatigue and ill-health.
• Loss of arm swing while walking.
• Walking with short shuffling steps and a tendency to lean forwards or backwards while walking.
• Unsteady gait.
• Frequent falls.
• Unnatural posture.
• Walking in a stooped position.
• Slowness of movement, especially in initiating a movement, such as getting up from a chair and walking.
• Sudden freezing of movement while walking, with the person being unable to go forward without assistance.
• Soft, hesitant, slurred speech. The person may speak in a monotone.
• The handwriting may gradually become smaller and end off in a scrawl (micrographia).
• Muscle stiffness, often leading to pain, which may be mistaken for arthritis.
• Irritability, depression, or decreased concentration level may be noticed.
• Memory problems.
• Evidence shows that mood disorders and sleeping problems can start many years before the typical symptoms of PD become evident.

Detection of early symptoms of Parkinson’s disease can help to slow progression of the disease by starting treatment as soon as possible. However, many Parkinson’s patients are either embarrassed or in denial about the first signs and symptoms and often wait till they are unable to cope or pressurized by a loved one to seek medical help.

Preparing for your Trip

• Plan your trip well in advance. This will give you time to consult with your doctor regarding various aspects of your trip. An assessment of your condition will allow him to suggest how far you should be able to travel comfortably – whether to the next state, across the border, or to a overseas destination.
• Your doctor can recommend which form of travel (air, road or sea) will be best suited for you.
• If your drug regimen has changed, it is better to start it well before your trip so that the effect of the drug can be monitored and any necessary adjustments in dosage can be made prior to your journey.
• It is advisable that you carry with you a summary of your illness, present disabilities, and current medication with dosage written by your doctor.
• Enquire from your doctor about other drugs that you might need during your trip, such as for fever, diarrhea, motion sickness, and vomiting. Your doctor will ensure that none of these medicines will result in drug interactions with your PD medicines.
• If traveling by air, request for special meals as recommended by your doctor.
• Find out about medical insurance coverage when traveling abroad.

Travel

• Usually a road trip by car is easier because it gives you the flexibility of traveling at your own pace.
• Consideration of travel time is important too. With PD, you may tire easily, so long journeys are best avoided.
• Plane journeys of more than 3 hours are not recommended since movement becomes difficult after sitting for a long time. However, air travel is often the best option these days so you should try walking around in the plane or if you can afford it, opt for a business class seat.
• Using a wheelchair at the airport will prevent you from getting tired due to unnecessary walking.
• Travel light. Check in most of your baggage.
• Request an aisle seat, as near to the exit as possible.
• Bathrooms in the plane may be uncomfortable to maneuver in, so use the bathroom before getting on the plane.
• Taking a cruise may be a relaxing way of traveling.
• It is a good idea to travel with a companion. Not only does the trip become more enjoyable, but a person by your side may be of help in case of any unforeseen difficulties.
• Remember to keep all your medication on you whenever you are traveling. In the event of lost luggage, you still have your essential medicines with you.
• Some PD medicines may cause drowsiness. Be careful about driving if you are on such drugs.
• Use a watch alarm or alarm pillbox for remembering to take your medicines on time if you are traveling in different time zones.

Other Considerations

• Take extra medicines with you during your travels. While there are options available in every country, you do not want to fall prey to unscrupulous vendors supplying counterfeit medicines.
• When considering accommodation at your destination, be sure that your room is conveniently located, preferably on the ground floor or near the elevator and accessible by wheelchair. Rooms with handicap installments in the bathroom will be additional features to look for.
• Use a backpack when traveling so that both your hands are free.
• Keep in hand the contact details of doctors and hospitals that you may need in case of emergency.

Energy Therapies

Energy therapies are based on the presumption of the existence of energy fields (universal life force) in and around the body. Treatment aims at balancing this energy by various means.

• Magnet Therapy. Magnets have been used for various symptoms, especially for pain relief, but effectiveness of treatment is yet to be proved. Treatment may carry certain risks, particularly in pregnancy, people on pacemakers or those using medicine patches, and people using insulin pump.

• Reiki. This is an ancient form of healing which uses universal energy to heal the body by balancing the 7 chakras (energy points) in the body. A Reiki healer channels “life force energy” to the patient through the hands, which are placed either on the part to be healed or slightly above it, without touching the body. A mild tingling sensation or a sense of warmth or coldness may be felt over the part being treated. Reiki may improve physical as well as emotional well being. Reiki can be self-administered after learning and taking initiation from a Reiki Master.

• Therapeutic Touch. This is similar to Reiki where the healer moves their hands back and forth over the patient to promote a feeling of well being. Actual touching of the patient may not be necessary.

• Yoga. Originating in India, yoga embraces both physical and mental concepts. It is a system of exercise which aims to control both body and mind by meditation, breathing exercises, and physical postures. It is a system of healing encompassing the person as a whole.

• Tai Chi. Having originated in ancient China, tai chi is a form of gentle physical exercise, done in a rhythmic, flowing pattern, which helps to bring the mind and body together, thereby healing both in the process.

Yoga and Tai Chi can improve muscle strength, balance, flexibility and range of motion in PD patients. As a result, the risk of falls and injury are greatly reduced. Reduced joint pain can help to increase mobility. Stress reduction and emotional well-being are added advantages.

Manipulative and Body Based Therapies

Certain illnesses are treated by manipulation of different parts of the body.

• Chiropractic. Spinal manipulation is the basis of this form of therapy since it is believed that the body’s structure (especially the spine) and its function are related. Pain relief is the main domain of this type of treatment.

• Massage. Different forms of therapeutic massage may be effective in relieving stiffness, rigidity and pain. An overall feeling of relaxation is evident too. Massage therapy works by increasing blood flow to the muscles.

• Reflexology. Various areas of the foot are supposedly related to different organs or systems of the body. By applying pressure on these areas, without the use of oils or lotions, changes are brought about that eliminate the blockage of energy believed to be responsible for pain or disease of that particular part.

• Physical therapy. While physical therapy is an established medical science, some therapists practice alternative techniques in conjunction with scientific therapies for a holistic approach to treatment.

• Postural re-education. Abnormalities in posture and balance are common in PD. This method uses movement and touch to help patients become aware of their body to improve posture and gait.

• Alexander technique is a practice to improve posture and movement and to use muscles efficiently. It may be used by osteopaths, chiropractors and some physical therapists.

Mind Body Techniques

Physical health and illnesses are dependent upon mental and emotional factors. This forms the basis of mind body techniques, which aim to improve physical health by improving mental and emotional status of a person by some of these methods :

• Meditation.
• Relaxation techniques.
• Hypnosis.
• Biofeedback – unconscious biologic processes, such as heart rate, blood pressure, and muscle tension are brought under conscious control by making a person aware of them. Understanding the reasons for the changes may help people to regulate them.
• Guided imagery – mental images, such as a happy and healthy situation is conjured up, often with the help of a practitioner, to overcome certain illnesses and stress.
• Music therapy.

Biologically Based Therapies

Naturally available substances are used in this type of therapy either in the food or as separate supplements.

Nutrition

• Altering the type of diet taken or including certain substances in the diet have often been claimed to provide relief from various symptoms of Parkinson’s disease. Of these, vitamin E (found in whole grains, seeds, and green leafy vegetables), vitamin C, and Coenzyme Q10 may have certain benefits, although this has not been definitively proven.
• Research has shown that broad beans (fava beans) are a natural source of levodopa. Varying doses and metabolism of fava beans may however impact on the therapeutic benefit.
• Proteins may interfere with the action of levodopa hence it is best to restrict protein intake two hours before and one hour after taking levodopa. Proteins are best taken with the evening meal.
• Caffeine may lower the risk of PD.

Herbal Remedies

Herbal medicine (phytotherapy) makes use of plants and their extracts to treat diseases. These may be prescribed according to the whole systems of medicine described below or based on the action of the pharmacologically active ingredients which have been scientifically verified.

• Herbs such as Ginkgo biloba and Bacopa monniera (brahmi) may be effective in PD by improving blood circulation in the brain.
• Mucuna pruriensis is an herb that contains levodopa
• Hypericum perforatum (St. John’s wort), a herb that has been used extensively in Europe for many years, may be helpful in treating depression and insomnia that is often associated with PD.
• Aromatherapy can be considered as part of herbal therapy, where essential oils of plants are used for treatment. Passion flower or oil of evening primrose has been claimed to be helpful in alleviating various symptoms of PD.

Whole Medical Systems

Ayurveda

Considered by many as the oldest healing science, ayurveda is an age old method of treatment practiced in ancient India since nearly 5000 years. The body is treated as a whole, with equal emphasis on diet, herbs, enema, meditation, massage, and exercise (yoga). PD has been mentioned in old ayurvedic texts as Kampa (tremor) vata (energy controlling body functions). Mucuna pruriens is an herb used in ayurvedic medicine for treating PD that has effects similar to levodopa but with less side effects.

Traditional Chinese Medicine

Acupuncture, Chinese herbs, massage, diet, and exercise comprise traditional Chinese medicine which has been practices for over 2000 years in China. It includes the concept that two opposite principles, yin and yang, is in balance within our body. Illness occurs whenever there is imbalance of yin and yang due to improper flow of life force and this balance needs to be restored to achieve health. In acupuncture, very fine sterile needles are inserted into specific points of the body. These are presumed to realign energy flow through the body and help in healing.

Homeopathy

The homeopathic system of medicine was developed in Germany over 200 years ago. The basic principle of homeopathy is “like cures like”, meaning that a disease can be cured by a substance which produces similar symptoms in healthy people. The body’s ability to heal itself is utilized by giving tiny doses of highly diluted substances known as potentized remedies. These remedies are derived from natural substances originating in plants, animals, or minerals. It may be effective in alleviating certain symptoms of PD. Medication will depend upon the individual symptoms.

Naturopathy

This is a system of therapy which relies almost totally on natural remedies such as air, water, and sunlight, along with diet and massage. The belief is that a healthy environment will cause the body to heal naturally. These days, homeopathic remedies, herbs and even acupuncture are often used by naturopaths in conjunction with traditional naturopathic principles.

]]> http://pdring.com/parkinsons-disease-natural-treatment-remedies-and-foods.htm/feed 2 http://pdring.com/complementary-alternative-treatment-for-parkinsons-disease.htm http://pdring.com/complementary-alternative-treatment-for-parkinsons-disease.htm#comments Tue, 24 Aug 2010 23:57:03 +0000 Dr. Chris http://pdring.com/?p=246 When considering any type of alternative treatment for Parkinson’s disease, one very important point needs to be kept in mind – there is as yet no cure for Parkinson’s disease. The various treatment options available can only help to treat the symptoms of the disease and provide some degree of relief.

Treatment by means other than conventional Western medicine (allopathic medicine) falls under the banner of complementary and alternative medicine (CAM). These are considered as natural therapies. Many natural forms of treatment are based on ancient systems of healing as were practiced in India, China, Africa, Tibet, and the Americas.

The basic difference between conventional and alternative medicine lies in the understanding of disease. Conventional medicine considers health as absence of disease. Disease may be caused by aging, pathogens, or biochemical imbalances in the body and is normally treated by medication or surgery. Alternative medicine, however, considers health as a perfect balance between the physical, emotional, and spiritual aspect of a person. Any disturbance that upsets this balance results in ill health. Alternative treatment aims to restore this balance by enhancing the body’s own defenses.

Reasons for Trying Complementary Treatments for Parkinson’s Disease

When faced with a chronic, progressive, and debilitating illness such as Parkinson’s disease, which requires lifelong treatment with drugs, many people will consider alternatives. Some of the reasons for this include :

• Natural treatments are thought of as being safe.
• The considerable side effects due to conventional medicines.
• Conventional treatment is not providing much relief.
• Unwillingness to continue with long term treatment as is necessary in PD.
• The expense involved in long term drug treatment.
• The mistaken belief that drugs stop providing relief from PD symptoms when continued for too long.
• Unjustifiable claims in advertisements about the ability of natural products to cure the disease.

Caution in Treating Parkinson’s Disease with Natural Therapies

• Stopping conventional PD drugs to try natural therapies is never advisable. Refer to Quitting Parkinson’s Disease Drugs.
• Natural treatments may be tried along with conventional therapy only after consultation with the doctor.
• Treatment should be done only under the guidance of trained and experienced professionals in complementary medicine.
• Herbal and natural preparations should be taken with caution as they may contain toxic substances or ingredients which may cause interaction with the PD drugs.
• Some herbal preparations may contain natural forms of levodopa but this will not be in the purified form, neither can the exact dose be controlled.
• Contrary to belief, certain natural remedies do have side effects.
• Natural therapies that involve manipulation of the body may result in injury.
• Many claims made about complementary therapies have not been substantiated with reliable clinical trials. The possibilities of side effects and long term complications from using these natural remedies have therefore not been verified.

Types of Natural Treatments for Parkinson’s Disease

• Biologically based therapies include diet and herbal therapy.
• Energy therapies include Reiki, Therapeutic touch, yoga, tai chi, and magnet therapy.
• Mind body medicine and techniques include meditation, relaxation techniques, hypnosis, biofeedback, and guided imagery.
• Manipulative and body based therapies include chiropractic, massage, reflexology, physical therapy, and postural re-education. While physical therapy and chiropractic are based on sound medical principles, there are practitioners within these disciplines who practice alternative techniques that have not been scientifically verified.
• Whole medical systems include Ayurveda, Traditional Chinese medicine, Homeopathy, and Naturopathy.

Parkinson’s Disease (PD)

Parkinson’s disease is a neurodegenerative disorder where there is degeneration of the cells of a part of the brain known as the substantia nigra, resulting in dopamine deficiency. Dopamine is a chemical transmitter which is involved in transmitting signals within the brain that help to coordinate movements. Loss of dopamine produces problems with movement and coordination that is the characteristic of PD.

PD usually affects older persons, usually over the age of 60, but it can also occur in younger people. The typical symptoms are tremor, rigidity, bradykinesia (slowness of movement), and loss of postural reflex, which develop gradually over time. Other associated features may develop as the disease progresses and may include an expressionless face, drooling, soft indistinct speech, short shuffling steps, difficulty in performing fine rapid movements such as writing, or fastening buttons. Memory loss, dementia, sleep problems, difficulty with speech, eye problems, and a host of other complications may follow.

Although there is no definite cure, medicines are the mainstay of treatment in PD and help to control symptoms. Of these, levodopa, in combination with a peripheral acting dopa-decarboxylase inhibitor, seems to give best results. The other commonly used drugs are pramipexole, ropinirole, rotigotine, selegiline, entacapone, benztropine, and amantadine.

Alzheimer’s Disease (AD)

Alzheimer’s disease is an age-related, slow but relentlessly progressive disease of the brain cells for which there is no cure. It usually occurs after the age of 60, but the risk increases as a person gets older. It is the most common form of dementia in the elderly. Destruction of the brain cells result in problems with memory, thinking and behavior.

Initially, a person with AD has problems with remembering recent events or names of known people. As the disease progresses, they may have difficulty in recognizing family members and forgetting how to do normal activities such as brushing their teeth. There may be behavioral and personality changes, inability to take simple decisions, and loss of mental functions.

Drugs such as donepezil, rivastigmine, galantamine and memantine are used in AD patients to treat symptoms but this cannot slow down the progression of the disease.

Multiple Sclerosis (MS)

Multiple sclerosis is an autoimmune disease where there is damage to the protective covering of the nerve fibers (myelin sheath) of the central nervous system. This can result in damage to the fibers itself and conduction of electrical impulses through the nerve fibers is hampered. MS usually starts at a young age, often between 20 and 40 years of age, with women being more often affected than men. Age should not be the only criteria in trying to identify a degenerative neurological condition because in early-onset Parkinson’s disease, the condition may begin in the 40’s or rarely, even younger.

Muscle weakness, difficulty with balance and coordination, visual problems, numbness or “pins and needles” sensation, problems with thought and memory may be some of the symptoms. The symptoms are unpredictable and may vary from person to person and from time to time. In most cases the symptoms may be mild and often remit spontaneously. A person’s ability to speak or walk may become impaired in severe forms of the disease.

There is no cure for MS but drugs such as beta interferon, glatiramer and corticosteroids may help to slow down the progress of the disease or control some of the symptoms.

When other factors are involved, such as the side effects of some anti-Parkinson medicines or other drugs, depression and other psychosocial factors which may be unique to a patient suffering with a disease like Parkinson’s disease, substance abuse can become a real possibility.

The question as to whether Parkinson’s disease is related to substance abuse is discussed below. Parkinson’s patients who are abusing any substance, whether a pharmaceutical drug or other illicit substance, should realize that the misuse and their addiction could negatively impact upon their condition. Apart from drugs interactions with Parkinson’s disease medicines, may drugs can contribute to or exacerbate the signs and symptoms of Parkinson’s disease or possibly even accelerate the progression of Parkinson’s disease.

For information on other forms of addiction – gambling, sex and so on, please refer to the article on Compulsive Behavior in Parkinson’s Disease.

Cigarette Smoking

There seems to be an inverse proportion to the number of cigarettes smoked and the development of Parkinson’s disease. It has been seen that patients with Parkinson’s disease are less likely to have ever smoked. Current smokers, in relation to ex-smokers, show this inverse relation better. The neuroprotective effect of cigarette smoke may be the reason for this, but should not prompt one to start smoking.

Caffeine Intake

Research also shows a decreased incidence of Parkinson’s disease in people consuming large amounts of caffeine, indicating that caffeine may have a neuroprotective effect too. Consuming 2 cups or more of tea per day, or 2 or more cola drinks per day may play a role in reducing the risk of Parkinson’s disease.

Alcohol Consumption

While it has been suggested that alcohol consumption may protect against Parkinson’s disease, there is no clear evidence to support this theory. Moderate beer consumption may lower the risk of developing Parkinson’s disease, but wine or liquor do not seem to offer any protection.

Drug Addiction

Research has shown a relationship between Parkinson’s disease and drug addiction. Parkinson’s disease patients sometimes become addicted to the drugs they are taking or develop various addictions as a result of their medication.

Parkinson’s disease patients lack dopamine, a neurotransmitter in the brain (a chemical messenger) which is responsible for motor movements as well as the ability to experience pleasure and pain. Dopamine is also involved with the reward pathway of the brain. Patients with drug addictions, on the other hand, have an excess of dopamine in their brain. This can explain how Parkinson’s disease patients, when treated with dopamine agonists (which increase the dopamine levels in the brain) start to show personality traits such as addiction which are normally alien to the patient. Treatment with levodopa does not usually produce such side effects.

Narcotics

Narcotics such as morphine are sometimes given to Parkinson’s disease patients to alleviate pain not responding to any other treatment. Narcotics are often prescribed in combination with other drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs). Although not usually dangerous in prescribed doses, the potential danger of addiction remains in such patients.
MPPP (1-methyl-4-phenyl-4-propionpiperidine), is an analogue of meperidine (a synthetic opioid), a street drug. During its illicit manufacture, MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine) was inadvertently synthesized, whose use rapidly produced symptoms of Parkinson’s disease in the users, with toxicity leading even to death.

Methamphetamine

Methamphetamine is closely related to amphetamine but its effects on the central nervous system seem to be greater than those of amphetamine. Methamphetamine causes release of dopamine in the brain and there may be long-term impairment in dopamine function following abuse of this drug.

Cocaine

Studies show that cocaine-users may be more at risk of developing Parkinson’s disease. Pregnant women abusing cocaine could be at increased risk of giving birth to children who will develop Parkinson’s disease later in life.

Related Article

1. Compulsive Behavior in Parkinson’s Disease

References

1. Alcohol Consumption and the Incidence of Parkinson’s Disease
2. Parkinson’s Disease Risks Associated with Cigarette Smoking, Alcohol Consumption and Caffeine Intake

]]> http://pdring.com/substance-abuse-and-addiction-in-parkinson%e2%80%99s-disease.htm/feed 0 http://pdring.com/bedsores-in-parkinsons-disease-patients.htm http://pdring.com/bedsores-in-parkinsons-disease-patients.htm#comments Tue, 18 May 2010 22:52:59 +0000 Dr. Chris http://pdring.com/?p=207 Parkinson’s disease can be very demanding on the caregivers, especially in the end stages of Parkinson’s disease, when the patient is wheelchair bound or absolutely bedridden. This is the time when extra precautions have to be taken to prevent bedsore formation. Bedsores (also called pressure sores or decubitus ulcers) can be extremely painful and usually develop as a result of prolonged immobilization. It is better to take precautions to prevent bedsore formation because once they develop they can progress very fast and then become extremely difficult to heal.

How and why do Bedsores form?

Due to restricted movements towards the end stages of the disease, there is constant pressure (as a result of the patient’s own body weight) on certain areas of the body such as the buttocks, hips, back of thighs or heels. This constant pressure causes loss of blood circulation to those areas and as a result the tissues die and decubitus ulcers are formed.

Quite often, the friction caused by bed sheets when a bedridden person is moved causes the delicate and thinned-out skin (especially in the elderly patient) to break leading to bedsore formation in these areas. Furthermore, as a result of the various causes of weight loss in a Parkinson’s disease , the normal cushioning of the body by fat and muscles is lost. Chronic moistness of the skin due to inability to control the bladder in later stages also predispose to bedsore formation.

Symptoms of Bedsores in Parkinson’s Disease

In the early stage, there is persistent redness of the skin with slight pain or itching. If treated at this stage, bedsores usually heal rapidly. If not detected early enough, blisters or open sores may form with reddish discoloration of the surrounding skin, which may soon progress to a crater-like ulcer which gradually becomes more painful. In extreme cases, very deep ulcers are formed which involve the deeper structures such as muscles, bones and nerves and can be excruciatingly painful.

Prevention of Bedsores in Parkinson’s Disease

Caregivers have to be extremely alert to the first signs of a bedsore such as persistent redness of the skin, especially at pressure points of the body. Relieving of pressure by turning the patient on his side frequently will prevent formation of bedsores or their further progression. Eating a healthy balanced diet, keeping the skin clean and dry, and physiotherapy and exercises for a Parkinson’s disease patient help to prevent bedsores.

Complications of Bedsores in Parkinson’s Disease

Infection of the skin and adjoining tissues and deeper structures such as muscles, bones and joints. Extreme pain due to involvement of the nerve is another complication.

Treatment of Bedsores in Parkinson’s Disease

• Relieving of pressure by changing positions often, such as by turning the bedridden patient frequently.
• Using special cushions or mattresses.
• A healthy nutritious diet.
• Controlling incontinence of urine or using incontinence pads.
• Proper cleaning of the wound.
• Removal of dead or damaged tissue.
• Regular dressing of the bedsore.
• Use of local antiseptic creams.
• Antibiotics.
• Pain relievers.
• Surgical treatment is the last option in later stages.

Dysphagia can lead to shorter survival time in a patient with Parkinson’s disease, not only because the affected muscles of the throat may make swallowing difficult – hence less food intake and increased chances of under-nutrition of the patient – but also because it increases the possibility of aspiration pneumonia.

How does dysphagia occur?

The act of swallowing can be divided into 3 phases – oral, pharyngeal and esophageal. Parkinson’s disease patients usually have problems with the first 2 stages of swallowing, which means that their dysphagia is of the oropharyngeal type. Weak tongue or cheek muscles make moving food around in the mouth difficult and can hamper chewing. Along with that, the weak throat muscles cannot sufficiently move the food towards the esophagus.

Causes of Dysphagia in Parkinson’s Disease

A number of factors may contribute to swallowing problems in Parkinson’s disease.

1. Motor impairment of the throat muscles as a result of Parkinson’s disease.
2. Dysphagia can be made worse by lack of saliva or dry mouth. This is common in Parkinson’s disease patients, frequently related to anticholinergics medication. Refer to Parkinson’s Disease Drugs.
3. Since Parkinson’s disease is more common in the elderly, associated features such as poor dentition can play a role.

Diagnosis of dysphagia in Parkinson’s Disease

When a person with Parkinson’s disease has problems with swallowing, a proper history and examination of the patient will help to determine the severity of dysphagia and evaluate the risk of aspiration. This is usually done by the doctor as well as a speech-language pathologist. Certain tests may also be done such as :

1. Video-fluoroscopy.
2. Endoscopy.
3. Barium swallow.

Complications of dysphagia in Parkinson’s Disease

• Food and saliva which cannot be swallowed may collect in the mouth or back of the throat and cause choking, coughing or drooling.
• Aspiration pneumonia – due to food or liquids being inhaled into the lungs.
• Weight loss – this can be an indicator of the severity and duration of dysphagia.
• Malnutrition.
• Shorter survival time in a patient with Parkinson’s disease.
• Apart from the physical problems faced due to dysphagia, certain psychosocial problems may also occur. Difficulty in swallowing can make patients dread meal times. The fear of choking is very real in some people. There is less enjoyment of food, especially due to the adjustments needed regarding the type of food that can be easily swallowed. Social adjustments, such as avoiding guests during meal times or going out to dinner can take its toll, both on the patient as well as the care-giver.

Treatment of dysphagia in Parkinson’s Disease

• Intensive swallowing therapy by a speech-language pathologist can help to overcome the weakness in the swallowing apparatus by strengthening exercises or compensatory maneuvers.
• Sitting up straight and keeping the head slightly forward while eating may help.
• Modifications in diet, such as eating soft and pureed food can help.
• Gastric feeding tube in end stages of the disease may become necessary.