Depression often is unrecognised as people do not come out with the problem as they fear the social stigma attached to it.
How It All Started
When my aunt was diagnosed with Parkinson’s disease a few years back, we were really shocked because we had met her a few days back and she was perfectly healthy, joking and smiling. She was a happy go lucky person who made everyone laugh with her silly jokes and banter. On probing further with my cousin told the facts. From a few days, she seemed listless, sad, did not respond properly to questions. When she lost her balance and was unable to stand on her own, her son got very concerned and took her to a specialist. By then she had developed tremors in her right hand and was not able to do her routine work. The doctor explained that she had stage three Parkinson’s disease. It was then that my cousin and I sat and researched about this disease. The doctor on his part described in detail the facts of the case. So here is a list of the things we learned about Parkinson’s disease which might be helpful to others who may have to deal with it or with their loved ones.
What is Parkinson’s disease?
The doctor indicated the following facts about Parkinson’s disease: It is a neurodegenerative disease and occurs due to the loss of brain cells that produce dopamine. Dopamine is a neurotransmitter or in other words one of those chemicals required to produce smooth, controlled movements in the body. The causes of this disease or why the dopamine-producing cells deteriorate are unknown but researchers believe that genetic and environmental factors are responsible for the disorder. It is a progressive disease and may be difficult to recognise early. It cannot be reversed or cured but with medication and lifestyle changes, the symptoms can be controlled and a good quality of life can be maintained.
Signs and Symptoms of Parkinson's Disease
Symptoms of Parkinson's Disease start gradually and are hardly noticed in the initial stages and that was what happened to my aunt. The tremor was hardly noticeable. Later came stiffness and slowing of movement. Her face showed no expression. The impaired balance was the biggest hurdle. She needed support and could not walk by herself. The doctor listed the early symptoms as follows:
Early symptoms include
- Stiffness in limbs
- Slowness of movement
- Impaired balance
- Postural Instability
- Shuffling gait
Other secondary symptoms include:
- . Anxiety, insecurity and stress
- . Confusion
- . Memory loss
- . Depression
- . Dementia
- . Difficulty swallowing
- . Decreased sense of smell
- . Urinary incontinence
- . Skin problems
- . Increased sweating
- . Slow speech and monotone voice
Progression and Stages of development
As symptoms worsen it may become difficult to walk, talk and complete simple tasks. It mostly occurs in older people, usually 60 and above but can occur earlier also. My aunt was sixty-five when she developed the symptoms. The progression of the disease and the degree of impairment varies from person to person. Many people diagnosed with Parkinson’s seem to manage the disease with treatment and live productive lives whereas some succumb to disabilities faster. The complications associated with Parkinson’s disease are, falling related fractures and pneumonia. Adult-onset of Parkinson’s is common but early-onset (between ages 21-40) and juvenile(before 21 years) onset Parkinson ‘s disease also can occur. British doctor James Parkinson first described the disorder in detail in 1817. He called it ‘Shaking Palsy’.
Stages of Development of the Disease
Stages of the disease: The Parkinson’s disease foundation supports 5 stages of the disease
State 1- Symptoms are mild and do not interfere with the patient’s quality of life
Stage 2- Symptoms worsen and daily activities become more difficult and take more time
Stage 3- The individual loses balance, moves slowly and falls are common. Symptoms impair daily activities like dressing, eating and brushing teeth.
Stage 4- Symptoms become severe and the patient needs help walking and performing daily tasks.
Who are more at risk at getting the disease?
- Age is the largest risk factor for the development and progression of Parkinson’s disease. Most of the patients are older than 60 years.
- Men seem to be more often affected, almost twice than women.
- Genetic- People with a family history of the disease are at an increased risk.
- Head trauma, illness, and certain drugs like anti psychosomatic drugs are more at risk.
- Exposure to pesticides and herbicides and other toxins constantly also seem to be a risk factor though research is not conclusive about it.
- Research suggests that stressful events may increase the risk of getting the disease.
Prognosis Treatment and Life Expectancy
Early and accurate diagnosis is important in Parkinson’s disease for the correct treatment and for maintaining a better quality of life for the patient. However, there is no test to diagnose Parkinson’s disease accurately. A diagnosis in the early stages can be challenging and is sometimes misdiagnosed due to the similarity in symptoms related to movement with other conditions. It is therefore important to re-evaluate individuals in the early stages on a regular basis to rule out other conditions that may be responsible for the symptoms. A CT scan or MRI may be used to help physicians to rule out other medical problems like stroke and brain tumors. A neurologist who specialises in movement disorders will be able to make an accurate diagnosis based on medical history, neurological exam, and symptoms. For the medical history, it is important to know whether other members of the family had Parkinson’s disease, the medication given to them, whether the individual had any sort of exposure to toxins and had been subjected to head trauma at any time. The severity of the symptoms and signs vary from person to person and it is difficult to predict how quickly the disease will progress in the particular individual.
Parkinson’s disease itself is not fatal but the secondary complications such as pneumonia, falling related injuries, choking can lead to death. Many treatment options can reduce some of the symptoms and prolong the life and improve the quality of life of the patient.
Levodopa and Carbidopa which help in increasing the dopamine levels are the most commonly prescribed drugs for Parkinson’s disease. Coenzyme Q 10 is also prescribed. The doctor may also recommend some lifestyle changes like healthy eating, aerobic exercise and physical therapy that focuses on balancing and occupational therapy for daily living activities such as eating, dressing, bathing, writing. A speech pathologist may be recommended for improving speech problems. In advanced stages, deep brain stimulation may be suggested for patients that don’t respond to medicines like Levodopa, but it does not keep the disease from progressing.
Alternate therapies like massage therapy, Tai chi, yoga, meditation and Pet therapy also help to ease some of the complications and symptoms of the disease such as pain, fatigue and depression
Diet, Lifestyle Changes And Things To Avoid
- Increasing fiber intake and whole-grain foods such as brown rice, pasta, whole wheat bread, and oatmeal is very beneficial. Organic fresh fruits and vegetables free from pesticides or insecticides should be used
- Sugary foods and drinks can negatively affect the immune system and should be avoided. It is better to opt for naturally sweetened food and reduce sugar intake.
- Avoid consuming a lot of beef, fish, and cheese as it may hinder the effect of certain Parkinson’s medications.
- Plan on having more vegetables and carbohydrates during the day and more proteins at dinnertime.
- Avoid consuming too much sodium, Trans fat, cholesterol, and saturated fats.
- Avoid Citrus juices such as orange, or grapefruit, instead opt for anti-oxidant rich, non-citrus fruits such as berries, mangoes, papaya and watermelon
- Drink plenty of water, at least eight glasses a day green tea and limit beverages like coffee, tea as they can hamper the effect of medicines.
Other Lifestyle Changes
- Avoid stress and anxiety, try massage therapy, reiki, yoga and meditation to soothe your mind and body
- Avoid sleep deprivation as it can have consequences and medicines may appear to be less effective and symptoms may get aggravated.
- Avoid cramped spaces and loud noises as they can cause discomfort and uneasiness
- Avoid extreme physical activity that causes a strain like lifting, pushing or pulling heavy stuff
- Plenty of rest is very essential for Parkinson’s patients as exertion can cause fatigue
- Conserve energy-using less energy to do daily tasks can help the patient to do more activities during the day.
- Avoid alcohol as it hinders the effect of medicine.
- Prevent falls as falls can cause fractures and other dangerous complications. The physical therapist can help in assisting devices and equipment for exercises to improve safety.
- Maintain a healthy weight as malnutrition and weight loss are common problems faced by Parkinson patients. Ask your doctor for nutritional supplements if there is drastic weight loss.
The ability to drive safely can be affected in patients with Parkinson’s disease, hence it is advisable to get assessed by the concerned authorities, and better to get the doctor's consult also as he can assess correctly depending on the symptoms at that point of time.
Living With Parkinson’s Disease
Living with Parkinson’s disease is very tough and the patient, as well as his caretaker, should learn to manage by making proper changes and maintaining a positive frame of mind. Having a well-balanced diet, proper exercise, medication, joining support groups, and a strong emotional bonding with family and friends can make a big difference and enhance the quality of life of a Parkinson’s patient. An active lifestyle and interactions with fellow PD members go a long way in conquering the obstacles associated with Parkinson’s disease. It is a chronic disease and one cannot wish away the difficulties that it brings, but one has to stay strong and overcome them. Parkinson’s disease not only affects the life of the patient himself but also his partner or caretaker. They have to make changes in their lifestyles and routines while taking care of the person affected. They should ensure that it does not affect their health while taking care of their loved ones. But there are many assisting devices today which can help the patient in walking, getting dressed, eating, writing, etc. Many home adaptations can make it easier for a person with Parkinson’s disease in their daily life as some of the modifications reduce the risk of falls which are common for these patients.
Drug Induced Parkinsonism
Some people develop Parkinsonism after taking certain drugs and people with Parkinson’s may also find their symptoms worsen after taking certain medications. This is called drug-induced Parkinsonism. These medicines block the action of dopamine in the brain. These drugs include neuroleptic or antipsychotic drugs used to treat schizophrenia, Prochlorperazine used to treat dizziness and nausea, Metoclopromide to treat nausea and indigestion. The symptoms of drug-induced Parkinsonism rarely progress as in Parkinson’s and most people recover after the drug causing it is stopped
The development of modern therapy forms has increased the life expectancy of Parkinson’s patients so that they can have the same life expectancy as a healthy person of the same age. Being diagnosed with Parkinson’s disease is not a death sentence and one must learn to make some changes and adjust to a new life but never lose hope and live joyfully in spite of the difficulties. My aunt did the same. She never complained, tried everything possible. Not wanting to be a burden on her son, she tried all therapies and made adjustments until the end with the support of family and had also joined a support group and attended the sessions regularly. I really admired her grit and the patience and determination of my cousin who took such good care of his mother. But the sad fact is that she passed on. First, the diagnosis was late, next, it was wrong. Hers was a case of drug-induced parkinsonism which later on progressed to Parkinson's disease. We later came to know that she was on depression drugs for many years, which brought on the disease. It was really very difficult to believe that such a joyful person from outside was actually battling depression inside, which made me think as to what makes people fall prey to depression when everything seems to be going well for them and many people neither show any signs of the disorder nor seek help for it. So I have decided to research on this subject now.
VIDYA D SAGAR (author) on November 20, 2019:
Thank you so much for the comment. Yes it is very tough for both the sufferer and the families. But with grit and a positive approach and support one can try to overcome the difficulties and lead a better quality of life.
Liz Westwood from UK on November 20, 2019:
Parkinsons is a terrible disease for both the sufferers and their families as well. You have made some interesting points in this article.