Parkinson’s disease: Early detection and treatment leads to better quality of life.

Parkinson’s disease is one of the most prevalent diseases among seniors after Alzheimer’s disease and is more common in individuals aged 60 and above. This disease is complex and intricate, requiring appropriate care and proper treatment.

Many believe that it can only be manageable with medication and that the dosage needs to follow a spiral path upward. However, the most effective treatment of this disease requires a comprehensive approach. In this article, Dr Yuwadee Thongchuam, a neurology specialist in movement disorders, will provide information and enhance understanding of this condition for the readers.

One of the Common Diseases among the Elderly

Parkinson’s disease is a neurodegenerative disorder that affects part of the brain, specifically the neurons responsible for producing dopamine. The reduction of dopamine levels leads to abnormal movements. Symptoms often manifest when around 50% of these brain cells have degenerated.

Despite ongoing investigation, the complex factors that trigger Parkinson's disease remain under study. However, certain risk factors are associated with its occurrence, such as:

• Repetitive Head Trauma: Prolonged exposure to head injuries or repetitive trauma to the head.
• Exposure to Certain Chemicals: Contact with specific chemicals, such as pesticides or insecticides.

The precise mechanisms precipitating Parkinson's disease are not yet fully understood despite the identification of these risk factors. Ongoing research aims to deepen our understanding of the condition and explore potential preventive measures or treatments.

Tremor’ is not the sole symptom of Parkinson’s disease.

“Subtle signs of Parkinson's might appear a decade before tremors or stiffness, emphasizing the importance of vigilance and ongoing monitoring. Early detection is crucial as the disease is diagnosable from its initial stages.”

“Many patients seek medical attention after the disease has progressed significantly, often under the misconception that Parkinson's disease manifests solely with tremors. However, tremors are just one symptom and may occur concurrently or follow other symptoms. Crucially, some patients may not experience tremors but present predominantly with slow movements and stiffness. This misunderstanding can lead to delayed diagnosis and treatment for some individuals.”

Observable symptoms of Parkinson’s disease are classifiable into two main categories:

1. Motor Symptoms: Consisting of four symptom manifestations.
   • Bradykinesia: Bradykinesia is a must-have symptom for diagnosing Parkinson's disease, which needs to be present in every case. It manifests as slow movements or a gradual reduction in motion, such as walking with a swaying of the arms or diminished arm swing, as well as writing with smaller or closely spaced letters.
   • Tremor: Tremors can occur in the chin, hands, legs, or feet at rest.
   • Rigidity: Rigidity observable in the neck, arms, and legs, leading to abnormal postures, such as hunched shoulders, bent elbows, stiff knees, or a twisted torso.
   • Postural Instability: This results in unsteady posture due to walking with a narrow base, short shuffling steps, frequent tripping, and a forward-leaning posture of the trunk and head, increasing the risk of falls.
     
     In the early stages of the disease, symptoms may manifest on one side of the body before gradually affecting the other as the disease progresses. However, symptoms on the side affected first tend to be more pronounced. Some individuals may experience changes in facial expression, vocal volume, or speech quality. including a neutral or expressionless face and speaking with a soft or hoarse voice, among others.
2. Non-motor Symptoms:
   Some symptoms, known as prodromal symptoms, may predate motor abnormalities for many years, including:
   • Hyposmia/Anosmia: A diminished sense of smell or the complete loss of the ability to smell.
   • REM Sleep Behavior Disorder (RBD): Involves vivid dreams and acting out dreams during rapid eye movement (REM) sleep, such as shouting, punching, kicking, etc.
   • Chronic Constipation: Persistent and long-term difficulty with bowel movements.
   • Depression: Prolonged feelings of sadness or a persistent low mood.
     
     Some symptoms may emerge after the disease has progressed for several years, such as abnormalities in the autonomic nervous system, including difficulties in urination, inability to control urination, fainting or blackout episodes due to low blood pressure upon standing, and cognitive impairment affecting emotions, thinking, decision-making, and memory impairment.

Noting the stages of Parkinson’s disease is beneficial for planning treatment.

“The clinical staging of Parkinson's disease facilitates clearer communication among healthcare professionals, patients, and their families. It also proves beneficial in planning appropriate care for individuals at different stages.”

The overall symptoms of the disease are categorized into 5 stages, ranging from mild to severe, as follows:

• Stage 1: Unilateral abnormal movement.
• Stage 2: Symptoms become more noticeable and affect both sides.
• Stage 3: Postural instability issues arise, particularly during directional changes, turning, or slight impacts, increasing the likelihood of falls.
• Stage 4: Self-reliance decreases, significant postural issues emerge, requiring assistance in daily activities such as changing positions, standing, and walking.
• Stage 5: Patients often become wheelchair-bound, bedridden, or experiencing severe rigidity, joint deformities, inability to swallow food, and requiring constant assistance, posing a risk of infectious complications.

Parkinson's disease is not curable, but treatment can improve quality of life.

At present, no cure or treatment can halt the progression of Parkinson's disease. The treatment focus is to enable patients to perform daily activities and maintain the best possible quality of life at each stage of the disease.

Medications

Medications come in various forms and act through diverse mechanisms to increase dopamine levels in the brain. Examples include oral medications such as Levodopa, COMT Inhibitors, Dopamine Agonists, and MAO-B Inhibitors. Additionally, there are skin patches and subcutaneous injections.

“Some people worry that taking medication may worsen their symptoms, leading to a continuous need for increased dosage. This concern is based on a misunderstanding because Parkinson's disease is a neurodegenerative condition, and symptoms naturally progress over time. It is not a result of the medication.”

“Starting the appropriate medication early in the disease and maintaining a disciplined medication schedule can significantly improve the quality of life for individuals with Parkinson's disease.”

“Many patients find that their symptoms do not improve despite taking medication. Often, this is due to improper administration. It is crucial to take the medication on an empty stomach, at least 30 minutes before meals, and adhere to a consistent daily schedule. Avoiding taking medication with milk or high-protein foods is also important, as it can hinder absorption.”

Surgery for patients with indications

Surgery for implanting deep brain stimulation (DBS) devices is suitable for Parkinson's disease patients who have been treated with medication but experience inconsistent responses or medication-related side effects. However, surgery is not a cure for the disease and may not be appropriate for every patient. The choice of treatment approach will depend on individual suitability.

Exercise and physical therapy are integral to the overall treatment at all stages.

Engaging in exercises that promote muscle relaxation, Tai Chi, Qigong, and dance activities, combined with physical therapy practices such as walking and posture training, joint range of motion exercises to prevent stiffness, speech therapy for those with soft speech, and swallowing training for individuals with eating difficulties, are all beneficial components of the treatment plan.

“The management of Parkinson's disease requires a holistic approach, incorporating medications, physical therapy, optimizing the daily living environment, and reducing the risk of accidents for patients. It involves collaborative care from multidisciplinary professionals, including neurologists, physical medicine and rehabilitation physicians, psychiatrists, nurses, physiotherapists, occupational therapists, pharmacists, and the active involvement of family members and the patients.”