Parkinson’s Disease

Here, we cover some of the more common parkinsonisms.

• Vascular (arteriosclerotic) parkinsonism – caused by reduced blood flow to the brain, which may be as a result of health conditions such as diabetes or stroke, and leads to symptoms such as incontinence and mobility problems

• Drug-induced parkinsonism – caused by reactions to medication and is mostly a temporary condition which is rectified once medication is stopped

• Multiple system atrophy (MSA) – a rare condition that causes nerve cell deterioration in the brain and symptoms similar to Parkinson’s; for more information on MSA, visit the Multiple System Atrophy Trust website

• Progressive supranuclear palsy (PSP) – a rare condition caused by damage to brain cells, which mostly affects people aged 60 or over; for more information on this condition, visit The PSP Association website

• Normal pressure hydrocephalus – caused by fluid building up in the brain which can lead to damage, and requires surgery to drain the fluid

• Tremors, including essential tremor, dystonic tremor, indeterminate tremor and atypical tremor

It can be difficult to diagnose which type of Parkinson’s disease (or parkinsonism) a person has, because symptoms are often very similar in each. A specific diagnosis may come later, as the person’s condition progresses. Often, a Parkinson’s specialist may prescribe treatments for Parkinson’s and see if these have an effect – if they do not reduce symptoms, they may reconsider the diagnosis and explore other parkinsonism's.

If you are concerned about any of the symptoms you read below, visit your GP in the first instance. Many of these symptoms are also symptoms of other health conditions or minor illnesses, but it is advisable to have these checked by a medical expert.

Symptoms of Parkinson’s disease include:

• Tremors, or shaking, which usually affects hands and which occurs when you are resting, or trying to do something with your hands. Some people with Parkinson’s do not have tremors at all, whilst some have them frequently, including internal tremors

• Bradykinesia (slow movements) e.g. coordination may become difficult, and actions such as standing up from a chair and walking short distances may take much longer

• Rigidity (stiff muscles), which may affect mobility, daily tasks such as getting dressed (if hands become stiff), and cause musculoskeletal pain and discomfort. Some people experience stiff facial muscles, which can sometimes cause difficulty with eating, drinking, speaking etc.

• Incontinence and sexual problems e.g. lack of sex drive, erectile dysfunction, etc

• Dysphagia (difficulty swallowing and eating)

• Eye problems e.g. blurred vision or blepharospasm

• Falls due to muscle weakness, or ‘freezing’ whilst moving

• Fatigue

• Low blood pressure

• Pain, including muscle pain, muscle cramps, shooting pain from trapped nerves, dystonia (muscle contractions)

• Foot problems

• Sleep problems e.g. insomnia

• Mental health problems e.g. depression, anxiety, etc

• Speech problems e.g. slurred speech or inability to control speed or volume of your speech

• Mild concentration and memory problems e.g. finding it hard to follow conversations or becoming easily confused

For more details about various symptoms of Parkinson’s disease, what causes them, and possible treatments, see the Parkinson’s UK website.

If you or someone you know are concerned you may have symptoms of Parkinson’s disease, it is important to visit your GP to discuss your concerns. Your GP will examine you and your movement. They will likely refer you to a neurologist if they suspect you have Parkinson’s and make further assessments to determine whether you should have a brain scan. They may prescribe Parkinson’s disease medication for you, to see if this helps alleviate your symptoms, and they will work with you to find the right Parkinson’s disease treatment plan.

For more detailed information about the process of being diagnosed with Parkinson’s disease, visit the NHS website.

If you are given a Parkinson’s disease diagnosis, you may feel a whole range of emotions and have concerns about how your daily life will be affected. Read on to find out more about living with Parkinson’s disease.

Having a health condition like Parkinson’s disease will likely impact a person’s life to some degree, but everybody experiences their condition differently. Many people continue to live independently with Parkinson’s disease. Some people need more support from family or friends, or professional carers to assist them. It is likely your needs will change over time.

It can be helpful to hear about how other people with the condition deal with day to day challenges. Parkinson’s UK has put together a leaflet with Tips and Hints for People with Parkinson’s , which includes lots of advice from people with the condition, or their carers.

If you have a family member with Parkinson’s disease, or are providing care for someone close to you with the condition, you may find that the disease also impacts their daily life in lots of ways. Carers UK provides a range of advice and support services for people providing care to family members.

Parkinson’s disease is more common in older people, but younger people can also develop the condition. Parkinson’s UK provides a wealth of information for young onset Parkinson’s disease.

Scientists have not yet found a cure for Parkinson’s disease but there are many treatments available, including medication and therapies, to help reduce the symptoms and ensure a person lives well with the condition.

You are likely to be prescribed medication to help improve symptoms, which help the brain function better and ensure it has enough dopamine. It may take some time to find the right drug and dosage to help you. The most common types of drug treatments for Parkinson’s disease are levodopa, dopamine agonists and monoamine oxidase-B inhibitors.

Because Parkinson’s disease symptoms sometimes include difficulties with mobility, you may benefit from physiotherapy. This may help if you have difficulties walking or moving around due to stiff or sore muscles and joint pain. Physiotherapists can provide exercises to help you build strength. Speak to your GP or specialist if you feel you may benefit from physiotherapy, or visit the Charted Society of Physiotherapy website.

Some people with Parkinson’s disease report that they experience benefits from alternative therapies, such as reflexology, chiropractic and acupuncture.

Some people with Parkinson’s disease also require help with their speech, eating or swallowing, and may be referred to a speech and language therapist who can assist in this area.

If you find that your symptoms are affecting what you can do or if you feel that your condition is stopping you from doing everyday tasks, working or undertaking hobbies, you may benefit from an assessment from an occupational therapist (OT). An OT can help find ways for you to adapt your home environment or alter how you approach daily tasks. To find out how to apply for an OT assessment, visit the GOV.UK website.

There is a surgical intervention which can be used to treat Parkinson’s disease in some cases, called deep brain stimulation. Surgery is not a suitable solution for everybody, and is only usually an option if drug treatments are not helping to reduce symptoms. Surgery does not reverse the condition, or stop it, but it can help alleviate symptoms where medication cannot. For more information, download the Parkinson’s UK leaflet Surgery for Parkinson’s.

For more information on Parkinson’s disease treatments, visit the NHS website.

At NRS Healthcare, we are experts in daily living aids, which are products designed to support people who are living with health conditions or disabilities. Daily living aids help you to stay as independent as possible, and provide support so you can continue with everyday tasks or stay mobile.

Here, we suggest some daily living aids for Parkinson’s disease that may help with some common challenges and tasks that some people find difficult.

• Help with mobility – some people may find that getting around becomes more difficult as their symptoms progress, and that they need support to help them walk and move around safely. There are a huge number of mobility aids available, and here are some that may help:

Walking stick, Rollators, Wheelchairs, Grab rail

• Safer bathing, showering and toileting – if you are experiencing stiffness and problems with coordination, using the toilet, bath or shower can become difficult. In order to make these tasks easier and safer, the following aids can help:

Bath lift, Toilet frame with seat, Shower seat

• Getting out of chair or bed – stiffness and movement difficulties can sometimes make it difficult to push yourself up out of a chair, or manoeuvre yourself out of bed. These aids can help:

Rise and recline chairs, Lifting seats, Bed rails

• Help with eating & drinking – tremors and muscle rigidity sometimes make it difficult to eat and drink with standard tableware. There are many solutions available to help such as:

Large handled cutlery, Weighted cutlery for tremors, Large handled mugs, Spill resistant mugs

• Memory, medication and safety aids – some people experience cognitive impairments such as mild memory problems, or are at risk of falls. These aids may be able to help:

Automatic pill dispenser, Simple mobile phone, Alarm telephone

If you are unsure what Parkinson’s disease aids may help you, contact our Occupational Therapist Product Advice team:

Telephone: 0345 121 8111

Email: [email protected]

Parkinson’s UK provides a leaflet ‘Daily Living Equipment for People with Parkinson’s’ which you may also find helpful.

Exercise for Parkinson’s disease

It is important for a person with Parkinson’s disease to remain as active as possible, to keep themselves healthy. Exercise helps the muscles and joints to stay strong and function as they should. A physiotherapist may be able to recommend a suitable programme of exercise for Parkinson’s disease that takes into account physical abilities and symptoms.

Parkinson’s disease diet

It is important for everybody to eat a healthy, balanced diet. Some people with Parkinson’s may find they have difficulties eating due to poor coordination or physically being unable to grip cutlery, cups etc. Parkinson’s disease eating difficulties may be caused by rigidity or tremors and include eating slowly, problems with chewing motion and keeping food in the mouth, or finding it hard to swallow. If you are having difficulties such as these, a dietician or speech and language therapist may be able to help you. There are also many Parkinson’s disease aids that might assist you.

Parkinson’s UK provides a leaflet called ‘Diet and Parkinson’s’ which provides lots of advice about healthy eating for Parkinson’s disease.

Some people choose to take supplements for Parkinson’s disease, such as calcium, vitamin D, antioxidants and co-enzymes. There is no conclusive evidence that taking Parkinson’s disease supplements reduces symptoms. Speak to your GP or specialist if you are interested in taking supplements.

Parkinson’s disease and employment

Many people with a Parkinson’s disease diagnosis are able to work and do work, in a variety of occupations. Some people are unable to continue in the same job, or prefer to work less due to their symptoms. You will find the right solution for you. To find out more about financial support if you feel you are unable to work, visit the Money Advice Service website.

Communities

Parkinson’s UK forum

Life with Parkinson’s Facebook Group

Resources

Brain and Spine Foundation – a UK charity for people affected by neurological problems, which provides information and expert nurse-led advice helplines

NHS – the essential guide to medical conditions, their diagnosis and symptoms

Parkinson’s UK – the leading UK charity that researches cures and treatments, whilst providing information on all aspects of living with Parkinson’s

The Cure Parkinson’s Trust – a charitable organisation dedicated to finding a cure for Parkinson’s, with lots of information about research projects and findings

The Michael J Fox Foundation for Parkinson’s Research – an American site created by the famous actor who has the disease, created to fund research and support patients

Antioxidants

- found naturally within the body and in foods, these substances counteract the damaging effects of oxidants in the body (which come from toxins, chemicals, pollution)

Blepharospasm

- a condition where the eyelids close involuntarily

Bradykinesia

- a symptom of nervous system disorders that causes movements to be slow and the body difficult to adjust into position

Co-enzymes

- found naturally in the body and available as a supplement, co-enzyme Q10 is a natural antioxidant that helps protect the body from free radicals

Cognitive impairments

- difficulties with thought process, decision making, concentration, memory

Deep brain stimulation

- a surgical procedure to treat Parkinson’s, which involves implanting a ‘brain pacemaker’ type device into the head to change electrical signals in the brain and ultimately attempt to reduce symptoms

Dopamine

- a chemical released by nerve cells (neurons) which helps control movement and emotion

Dopamine agonists

- a drug that stimulates nerve cells in the brain

Dystonia

- contracted muscles and spasms, which cause jerky, repetitive or twisted movements

Idiopathic

- occurs without reason or where the cause is not known

Insomnia

- sleep disorder that causes a person to be unable to fall asleep or stay asleep

Internal tremors

- a symptom that causes a feeling of tremor inside the body, which might not be visible to others

Levodopa

- a drug that changes to dopamine in the body and encourages more dopamine to be produced by nerve cells

Monoamine oxidase-B (MAO-B) inhibitors

- drugs that block MAO-B, which is an enzyme in the body that breaks down dopamine, in order to reduce symptoms of Parkinson’s

Motor skills

- actions we do with our bodies that involve using muscles e.g. running, walking, jumping, etc

Musculoskeletal

- the bones and muscles in the body

Neurologist

- a specialist doctor who is an expert in treating conditions of the brain, nervous system, spinal cord

Neurons

- nerve cells that form the basis of the body’s nervous system, which transmit messages or information through the body to the brain and vice versa

Progressive condition

- an illness where symptoms become worse over time

Substantia nigra

- part of the brain that produces dopamine, located in the midbrain area in the basal ganglia

Tremors

- caused by a variety of conditions, including Parkinson’s, tremors are involuntary and repetitive movements of the body, which may feel and appear as a shaking or juddering action