Parkinson’s Disease
There are new information, support and treatment guidelines for this distressing disease
Parkinson’s Disease (PD) causes longterm cell damage and reduces levels of the chemical messenger dopamine in brain areas that control movement. It can start in mid-life but gets more common with age, affecting 130,000 people in the UK each year. The cause isn’t known, but genes and toxins, possibly pollution/ pesticides, may play a role. However, it rarely runs in families. It can occasionally be triggered by other neurological conditions, strokes or medication, especially some drugs used for mental health disorders.
Symptoms
The three main symptoms usually develop slowly and unpredictably. Shaking (tremor) occurs when resting and improves with movement; it may affect the hand, arm or head on one side first. Movements slow down (bradykinesia) and muscles become stiff (rigidity); this can lead to cramps, difficulty ‘getting going’ or with finer movements, a shuffling walk, reduced arm-swinging, balance problems, and/or loss of facial expressions.
Other problems can include losing your sense of smell, urinary, bowel and sexual difficulties, dizziness/ faints/falls, sweating, excess saliva/difficulty swallowing, sleep disturbance and pain.
Anxiety and/or depression may develop, and memory and thinking can be affected, sometimes leading to hallucinations or dementia.
PD usually progresses slowly, and people who have it may be able to continue working, driving and so on for many years. But as immobility increases, active treatment helps to reduce falls, pressure sores, bowel and urinary problems, and chest infections.
Tests
There’s no specific test; PD is mainly diagnosed from your symptoms and your doctor’s examination. However, you may need a brain scan or other tests to rule out other conditions. If PD is suspected, NICE (National Institute for Health and Care Excellence) guidelines say you should be referred, without treatment, to a neurologist or geriatrician specialising in PD, within six weeks (nice.org.uk/ guidance/ng71).
Treatment
The new guidelines stress the importance of good written and oral communication for patients and their loved ones and carers, including an understanding of their personal needs and goals, a regular point of contact, and a comprehensive care plan that can be adjusted when things change. PD teams may include a doctor, nurse, physiotherapist, occupational therapist, psychologist, counsellor and/or social worker. (Also see ‘Sources Of Support’.)
Medication (levodopa) can replace lost dopamine and improve movement/ daily activities, while dopamine agonists, such as ropinirole can mimic
its effects. Other types of tablet/injections may also be tried. However, they can have side-effects such as excessive sleepiness, suddenly ‘wearing off’, hallucinations and impulse control disorders with irresistible urges to gamble, shop or be sexually active. The new guidelines specify pre-treatment counselling and access to advice, and the dose or drug may need to be changed.
If medication causes excessive problems, deep-brain stimulation (a wire inserted into the brain) at a specialist centre may help. But researchers hope that stem cell injections into the brain could eventually compensate for damaged nerve cells and improve movement.