PARKINSON'S DISEASE 1

ABSTRACT

When "Parkinson's disease" is mentioned the majority of people will

automatically think about the physical symptoms associated with the condition such as
the tremors, the loss of mobility and other motor impairments. However coping with
Parkinson's disease also takes a tremendous toll on the emotional well being of the
patient; something that many people do not consider. Certain mental health problems,
like depression and disturbances such as hallucinations, delusions, and paranoia, are also
possible complications of Parkinson's disease and/or its treatment. This paper will
discussion the signs and symptoms of Parkinson's disease, psychological affects on both
the patients and his or her loved ones and current treatments and therapies available.
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Parkinson's disease is a progressive neurological disorder that results in the death

of dopamine-producing cells in the brain. The loss of dopamine affects movement, both
of skeletal muscle and the smooth muscle of the gastrointestinal tract. Parkinson’s disease
afflicts about one to one and one-half million people in the United States (Weiner 2008).
The disease usually appears around the age of 60, although there are some rare young-
onset cases, for example, the famous child star Michael J. Fox (mihaeljfox.org). Contrary
to popular belief, Parkinson's disease is rarely inherited and less than one per cent of all
cases are thought to have a genetic component. Idiopathic (of no known cause)
Parkinson's disease affects about one percent of the population over the age of 60 years in
the United States (Weiner 2008). It is more common among men than among women and
also seems to be more widespread in northern countries. Most people can recognize a
Parkinson's patient by the slow, shuffling gait and resting hand or arm tremor.

The actual cause of the disease is still unknown, however, environmental factors
such as pollution and pesticides have been considered. There is still considerable debate
regarding the potential for the disease to be genetic, especially in early on-set cases. It is
estimated that the characteristics of Parkinson's disease symptoms develop once 70 per
cent of the dopamine producing neurons in the midbrain have been destroyed (Ahlskog
2005). Parkinson's disease is the most common cause of chronic progressive
parkinsonism, a term which refers to the syndrome of tremors, rigidity, bradykinesia and
postural instability. Among the non motor symptoms are autonomic dysfunction,
cognitive and neurobehavioral problems including dementia, and sensory and sleep
difficulties. About 30 per cent of Parkinson's disease victims eventually develop
Alzheimer's disease or other forms of dementia (Weiner 2008). At this time there is no
medical cure for the condition, but drugs that alleviate the symptoms and slow the
progress of the disease are available.

The main symptom of Parkinson's disease is a pronounced tremor affecting the

extremities notably the hands, chin or lips. The tremor is most noticeable at rest and
disappears with movement (pdf.org). Other characteristic symptoms of Parkinson's
disease are stiffness or slowness of movement, a shuffling walk, stooped posture, and
difficulties in performing simple tasks. Memory impairment and cognitive dysfunction
PARKINSON'S DISEASE 3

are rarely encountered in early stage Parkinson's disease. Cognitive disturbances,

however do occur in the initial stages of the disease in some cases. A very high
proportion of people with Parkinson's disease will have mild cognitive impairment as the
disease advances. The most common cognitive deficits in non-demented patients are the
inability to problem solve and fluctuations in attention. Patients may also experience
slowed cognitive speed, memory problems; specifically in recalling learned information,
visuospatial skills difficulties (the cognitive skill that allows one to put together a puzzle).
Muscles and nerves that control the digestive process may also be affected by Parkinson's
disease therefore, it is common to experience constipation and gastroparesis.

Depression is a common side effect of Parkinson's disease. The disease causes

neuropsychiatric and cognitive disturbances. Mood and behavior problems may also
occur and can be as disabling as the motor symptoms.

Depression can actually increase the physical effects of Parkinson's disease and
possibly cause a progression of the disease (Weiner 2008). Feelings of anxiety,
frustration and embarrassment at not being able to perform the activities of daily living
can have a huge effect on Parkinson's patients. These psychological symptoms occur as a
result of the physical symptoms and can have a very negative effect on a persons self-
esteem and motivation to participate in and adhere to treatment. Depressive episodes are
seen in an average of 50% of patients and these episodes often alternate with anxiety
attacks so the patient may exhibit the symptoms of a manic-depressive (Weiner 2008).

A person suffering from Parkinson's disease is also at an increased risk of

suffering dementia. Studies suggest that Parkinson's disease dementia (PDD) is common
among patients with Parkinson's disease. The dementia symptoms should follow the
diagnosis of Parkinson's Disease by at least two years. Eighty percent of patients with
Parkinson's Disease will develop PDD over time (Ahlskog 2005). The prevalence of
dementia increases in relation to the duration of the disease, the lack of care being
received and/or admittance to a nursing home.

Impulse control behaviors such as craving, binge eating, hypersexuality and

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pathological gambling among others, can also appear in patients suffering from
Parkinson's disease, and have been related to the medications for the disease (Ahlskog
2005). Psychotic symptoms are common in the later stages of Parkinson's disease. Visual
& auditory hallucinations may also occur.

In Parkinson's disease, depression may be treated with psychological therapy, as

well as with medications. People seem to do better when they receive both psychological
and drug treatments. There are many antidepressant medications available, each with
their own advantages and disadvantages. The choice of antidepressant for patients with
Parkinson's disease depends on their overall condition and specific needs. Most people
with Parkinson's disease should not take Ascendin (amoxipine) because this medication
could temporarily worsen the Parkinson's disease symptoms (pdf.org).

Psychological therapy can also help a patient with Parkinson's disease suffering
from depression by re-establishing a sense of self-worth in the face of declining
functional abilities (Zid 2007). It also can help the person maintain good relationships
with caregivers and family members, despite increasing dependency.

Another controversial therapy, electroconvulsive therapy (also known as ECT or

electroshock therapy) is a procedure in which a brief application of electric stimulus is
used to produce a generalized seizure. ECT can be a valuable treatment for depression
associated with Parkinson's disease (Ahlskog 2005). A major advantage of ECT is that it
works very quickly, unlike medications that may take several weeks before they become
fully effective. The primary motor symptoms of Parkinson's disease often improve with
ECT as well. The downside of ECT is that some people may have trouble tolerating the
pain associated with it, so it is important for a patient to speak with their doctor before
considering this treatment.

In addition to the common therapies provided there are now multiple medications
that can be prescribed. A commonly prescribed topical medication called the Exelon
Patch is a prescription medicine for patients with mild to moderate Parkinson's disease
dementia (pdf.org). In a recent study of Parkinson's disease dementia, parkinsonian
PARKINSON'S DISEASE 5

symptoms, particularly tremor, occurred or worsened in some people using the Exelon
patch or Excelon capsules. Other medications known as dopaminargenics, which either
convert to dopamine once they are absorbed or mimic the effects of dopamine as
commonly prescribed. In newly diagnosed patients, doctors are prescribing enzyme
inhibitors such as COM-T and MAO-B to prevent the breakdown of dopamine.

It is also helpful for a Parkinson's sufferer to participate in physical or mental

activities that reflect their interests. Having happy experiences can quickly fend off not
only any depressive feelings but mental and physical exercises will also help to keep the
brain and body functioning normal for longer (Zid 2007). Any activity can be enjoyed
with the support of a loved one so for example daily exercises can be made fun if they are
performed to music with a partner or loved one. For example, a grandfather suffering
from Parkinson's disease may benefit from taking his grandson to the park and showing
him how to throw and hit a baseball.

A balanced diet is recommended to help improve digestion. Diet should include

high-fiber foods and plenty of water. In the early stages of the disease foods high in
antioxidants should be increased because they reduce free radicals, which have a
tendency to damage the cells that produce dopamine (michaeljfox.org/living). Foods high
in antioxidants are also said to slow down the progression of the disease and even prevent
it. Some studies have also shown that caffeine can lower ones risks of developing
Parkinson's disease. Levodopa, a dietary supplement synthesized from amino acids is
commonly prescribed to assist in the production of dopamine (Zid 2007). However,
levodopa can interact with some proteins therefore excessive protein consumption
should be discouraged. To minimize interaction with proteins, levodopa should be taken
30 minutes before meals. Some regimens for Parkinson's disease may restrict proteins
during breakfast and lunch and are usually taken at dinner instead.

Parkinson's disease does not just affect the person suffering from it, family
members, loved ones and friends are also affected. Roles are often reversed when a child
becomes the caregiver for a parent suffering from Parkinson's disease. A person in the
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later stages of Parkinson's disease will require around the clock care. Tension, fatigue,
irritability and even resentment in some cases will quickly mount if no respite is given
(pdf.org). The lack of sleep and worries not only about the patient but also about coping
with life in general and the daily responsibilities can cause tremendous stress. Caregiver
support groups and forums exist throughout the country and are highly recommended.

The links between Parkinson's disease and factors such as genetics, aging,
environmental toxins, and free radicals are still being investigated. Although these studies
are beginning to provide some answers, experts do not know the exact cause of the
disease. Doctors attribute regular exercise and diets high in omega 3's, antioxidants and
folic acids as the best ways to prevent the disease. Recent studies also show that people
who use nicotine and consume high amounts of caffeine have lower chances of
developing Parkinson's (Zid 2007). While researching this topic I discovered many
different studies discussing the links between caffeine and the prevention of Parkinson's
and they all varied drastically and non of them have produced solid evidence at this time.

Although Parkinson's is a devastatingly disabling disease physically I would

imagine that the psychological effects are the most severe, especially among men. I can
only imagine how frustrating it must be to not have control over your own body. Even in
today's society, men are still heavily considered the provider and to not be able to
perform that role must greatly affect one's self-esteem. I'm a firm believer that prevention
is the key to living a long healthy life and diet and exercise play a huge role in
maintaining health. Foods rich in antioxidants and omega 3's are very easily accessible
and affordable these days and can be easily incorporated into the diet. Physical activities
such as yoga and pilates have also become more popular and can be performed with
friends and loved ones. In addition to diet and exercise, communication is important.
Diseases are rarely suffered alone and affect the entire family, sometimes event the entire
community. Incorporating daily communication sessions, I feel, will help regulate stress
levels and feelings of tension. There is still so much to be learned of this disease and only
time will tell.
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References

Ahlskog, J.E. MD Ph.D. (2005) The Parkinson's Disease Treatment Book:

Partnering with Your Doctor to Get the Most from Your Medications.
New York: Oxford University Press.

The Michael J. Fox Foundation for Parkinson's Research (2010)

Retrieved October 28, 2010, from
http://www.michaeljfox.org/living.cfm

Parkinson's Disease Foundations (2010)

Retrieved November 1, 2010 from
http://pdf.org

Weiner, W.J., MD, Shulman, L.M. M.D. & Lang, A.E. M.D. (2008).
Parkinson's Disease: A Complete Guide for Patients and Families,
Second Edition.

Baltimore: John's Hopkins University Press.

Zid, D. (2007) Delay the Disease - Excercise and Parkinson's Disease.

Columbus, Ohio. Columbus Health Works Productions.