Parkinson's disease, sometimes referred to as "shaking palsy," affects approximately half a million people in the United States. It is a disorder that results from the degeneration of certain brain cells, and its most characteristic feature is defective message transmission from the brain to various portions of the body. This results in uncontrollable movement, which may be manifested as tremor, muscular rigidity or sluggishness.
The most common form of the disease is called idiopathic parkinsonism and has no known cause. It has no known hereditary component, nor is it contagious. Parkinsonism affects women and men in equal proportions.
There is also drug-induced parkinsonism, which is caused mostly by drugs to treat severe mental illness. This form of parkinsonism is usually reversed when the drug is discontinued or its dosage decreased. Parkinsonism also may be caused by disorders such as encephalitis and hardening of the arteries (arteriosclerosis), or following certain brain injuries, including those caused by a stroke.
Mechanism of Parkinsonism
Parkinsonism is believed to be related to the substantia nigra (black substance) of the nerve cells, which produce and store a chemical substance called dopamine--one of several neurotransmitters. (A neurotransmitter relays messages from the brain across a small open space--or synapse--at the junction of the nerves.) Parkinson's disease apparently interferes with dopamine storage and/or production, which causes disturbances in nerve message transmission. This, in turn, leads to shaking or other defective motor responses. In addition to dopamine depletion, parkinsonism also seems to involve an excess of cholinergic activity. Treatment, therefore, entails either increasing the concentration of dopamine or decreasing the concentration of acetylcholine, another neurotransmitter that causes symptoms of Parkinson's disease when dopamine levels are reduced. Both treatments are often used.
Symptoms of Parkinson's Disease
Parkinson's disease usually starts very gradually. Early symptoms, which may go unnoticed for years, include stiffness of the hands, fatigue or weakness, depression and a slight limp or changes in posture. The symptoms increase and eventually may develop into full-blown parkinsonism, exhibiting muscular rigidity, tremor and slowness of movement. Other symptoms vary from patient to patient and may include soft, monotonous or slow speech, difficulty in swallowing, trouble in walking, shuffling, a change in bowel habits, slow urination, excessive sweating or drooling. Symptoms often are limited to one side of the body. Diagnosis is sometimes assisted by analysis of the patient's handwriting, which may show evidence of tremor, is typically small and tends to decrease in size with the passage of time.
Treatment of Parkinson's Disease
A short while ago, a diagnosis of parkinsonism was a lifelong condemnation. But parkinsonism has become a very treatable condition, and many patients are able to function normally for many years.
Since the cause of the disease is still unknown, therapy is aimed at relieving symptoms. Treatment usually consists of drug therapy, physical therapy and the use of devices (such as a typewriter, instead of writing by hand, or a speech amplifier) that permit patients to lead productive lives. Treatment does involve trial and error, and both doctor and patient must persevere in an attempt to find the best individual combination of drugs and dosages. Drug treatment usually entails supplying the brain with the missing neurotransmitter, dopamine. These drugs are called dopamine precursors. Some patients react best when the excessive acetylcholine is inhibited through the use of anti-cholinergic drugs.
Exercises
Exercises are usually prescribed by the doctor, who may refer the patient to a physical therapist.
General physical condition is also important, and patients are encouraged to develop general exercise routines for home practice.
General Tips
Summing Up
Parkinsonism is a serious but treatable disease. As with most chronic illness, patients may be depressed, anxious and fearful. Parkinson's disease patients and their families may contact a voluntary health agency for support and information.
Hospitalization - Admission Procedures
The procedures you follow on admission to a hospital vary from one hospital to another, but basically the process is the same in most institutions in the United States.
Care of the Dying - Role of Friends
The friend can show appreciation of the work being done by the family and offer to stay with the patient if the family needs a little time away from home.
Care of the Dying - Death of an Older Child or an Adolescent
From the age of three years onward, a child begins to understand the concept of death and dying. The dying child feels protective toward his or her parents. Although the child desperately needs to talk about what is going to happen, he or she may never get close to the subject. The child may attach himself or herself to a nurse or physician while still relying on the parents. By doing this, the child is sharing the emotional responsibility. The parents may find this difficult to accept, but must realize that someone else can perhaps give more help by listening dispassionately to the child's fears and anxieties.
