May 2000 Parkinson's Disease Dr. Paul Fry, Radiologist Parkinson's disease or paralysis agitans is a disease that will affect approximately 1% of our Americans over the age of 50. Several celebrities including Michael J. Fox and Muhammad Ali are affected with this or related conditions. The disease begins insidiously and progresses over 10-12 years to eventual full incapacitation. The basis pathology involves melanin containing cells in the brain stem, primarily the neurons of the substantia nigra and the locus coeruleus. These neurons are involved in the dopaminergic pathway of the basal ganglia and primarily regulate movement. There is a loss of cells, reactive gliosis, and the formation of distinctive inclusions in the cytoplasm, Lewy bodies. Though one might not be able to recognize the pathologic findings, most everyone can recognize the clinical findings. A characteristics tremor is the usual the presenting symptom. This is a resting, rhythmic tremor that improves with purposeful movement. It usually begins with one hand but becomes bilateral and may involve the legs, neck, and facial muscles. Ambulation is with a stooped posture using a short, shuffling gait. This is primarily due to the loss of balance control. Retropulsion and pulsion is seen where one when put off balance will continue to ambulate at an increasing pace until balance is lost altogether and the person falls. The Parkinson's afflicted individual also suffers from muscular rigidity, which combined with the tremors, and loss of balance control eventually renders the patient incapacitated. He/She is unable to perform the most rudimentary task and becomes bedridden. In the end stages dementia becomes more apparent and auditory and visual hallucinations become common. Though there is no known cure for Parkinson's disease, there are many drugs to alleviate all but the most advanced symptoms. These drugs include Levodopa, which helps increase the neurotrausmitter dopamine. Used be those affected with Parkinson's disease. Other medications include anticholinergic drugs, amantidine and bromocriptine. The course of symptoms previously discussed progress over several years of time. The symptoms are aggravated by anxiety, tension and unhappiness and minimized when one is in a content frame of mind. Ones with Parkinson's disease will generally be happiest at home. Until the most advanced stages of Parkinson's disease there is no reason one can't live at home taking care of most of their needs. Home health aids should be utilized to assist in these needs. Since one with Parkinson's is prone to falls, assists, like grab bars, etc., should be available in high-risk areas such as the bathroom. The goal is to maximize life in a familiar environment such as the home. Though Parkinson's disease is progressive in nature a meaningful, contented life may be achieved with good medical management and optimizing safety in the home. |