Parkinson's Disease

Parkinson’s can be diagnosed by your primary care physician or by a neurologist. Either physician will begin by asking questions about your symptoms and your past health. If Parkinson’s disease is suspected, you will also have a neurological exam to evaluate how well your central nervous system is working. While there are no lab or blood tests that can diagnose Parkinson's, you might have these tests to rule out other possible causes for your symptoms.

If the diagnosis is Parkinson’s, your doctor will monitor your symptoms and provide education about the disease, including the various stages of Parkinson’s.

Early stage

Tremor is usually the first symptom of the disease. It appears in just one arm or leg, or only on one side of the body. With time, the tremor usually — but not always — spreads to both sides of the body. Joint pain, weakness and fatigue may occur.

Moderate stage

As the disease gets worse, individuals may experience slower movement, stiff muscles and poor coordination. Everyday tasks such as writing, shaving or brushing teeth can become quite challenging. Changes in handwriting are common.

Problems develop with posture and balance. A person with Parkinson's tends to walk in a stooped manner with quick, shuffling steps.

Advanced stage

After several years, as muscle stiffness and tremor increase, individuals may become unable to care for themselves. At this point, a person may use a wheelchair or be confined to their bed.

Dementia may develop in up to one-third of people who have late-stage Parkinson's disease. These symptoms may include disorientation at night, confusion and memory loss.

At this time, Parkinson's disease can't be cured. However, if symptoms are affecting your daily activities, treatment can help you manage these symptoms. There are also steps you can take at home that can help you stay as independent and healthy as possible.

Medication

Medications are the most common treatment for Parkinson's disease. The goal is to correct the shortage of the brain chemical dopamine, which causes the symptoms of Parkinson's.

Medication is usually started when your symptoms become disabling or disrupt your daily activities. Although medicines often improve symptoms, they also may cause side effects. It may take some time to find the best combination of medicines for you.

Several medicines may be used at different stages of the disease. They include:

• Levodopa and carbidopa
• Dopamine agonists
• COMT inhibitors
• MAO-B inhibitors
• Amantadine
• Anticholinergic agents
• Apomorphine

Because symptoms change as the disease progresses, your doctor will adjust your medication to deal with symptoms as they appear.
 

Physical or occupational therapy

A physical therapist can help you learn exercises and stretches to do at home to improve your posture, strength, flexibility and endurance.

A physical or occupational therapist can also help you to:

• Plan more efficient movements for activities you do every day, such as bathing and dressing, so that these activities are easier and less tiring.
• Improve your balance and walking.
• Use walking aids (such as canes or walkers) correctly.
   

Surgery

Brain surgery to treat Parkinson's disease may be considered when medications:

• No longer control symptoms.
• Cause severe or disabling side effects.

Like other treatment options, surgery isn't a cure. Surgery should not be considered a replacement for medications either. Medications are usually still needed after surgery, although you likely would not need as much medicine as before. This means you may have fewer side effects.

The types of surgery include:

• Deep brain stimulation, which uses electrical impulses to stimulate a target area in the brain. It's the preferred surgery for treating most cases of late-stage Parkinson's.
• Pallidotomy and thalamotomy are procedures that involve precisely altering a very small area in a deep part of the brain that causes symptoms.

Not everyone is a good candidate for surgery. People who have very advanced Parkinson's or who have other serious health problems usually aren't good candidates for surgery. Your physician will discuss all treatment options to help you determine the best treatment for you.

There are many things you can do at home that can help you stay as independent and healthy as possible.

• Take your medicines exactly as prescribed. For some people who have taken medicine for several years, they may start to have other movement-related problems. These changes in motor function can be managed by adjusting your medication.
• Keep up your normal activities as much as you can.
• Get plenty of rest and find ways to manage stress, which can make symptoms worse.
• Spend time with family and friends.
• Watch for signs of depression, which can accompany Parkinson’s. Tell your doctor if you have trouble sleeping, are eating too much or are not hungry, or feel sad or tearful all the time.
• Eat a balanced diet. If you are taking Levodopa, do not eat protein at the same time you take your medication. Levodopa may not work as well if you take it at the same time you eat protein.
• If you have problems swallowing, change how and what you eat:
  • Try thick drinks, such as milk shakes. They are easier to swallow than other fluids.
  • Do not eat foods that crumble easily. These can cause choking.
  • Use a blender to prepare food. Soft foods need less chewing.
  • Eat small meals often so that you do not get tired from eating heavy meals.
  • Drink plenty of water and eat a high-fiber diet to prevent constipation. Parkinson’s—and the medicines that treat it — may slow your intestines.
• Get exercise on most days. Work with your doctor or physical therapist to set up a program of walking, swimming or other exercise that you can do.

Benefits of exercise

Exercise is an important part of home treatment for people with Parkinson's disease. It has benefits in both early and advanced stages of the disease. Regular exercise can help you:

• Keep and improve your muscle strength and endurance.
• Control your weight and improve your cardiovascular fitness.
• Improve your balance, coordination, flexibility and range of motion.
• Reduce the likelihood of becoming constipated.
• Reduce your fear of falling and improve your quality of life.
• Promote a sense of well-being and improve your mood. For those who have mild Parkinson's symptoms, exercise can also reduce the chance of falling.

Make sure your home is safe

• Place furniture so that you have something to hold on to as you walk around the house.
• Use chairs that make it easier to sit down and stand up.
• Group the things you use most, such as reading glasses, keys and the telephone, in one easy-to-reach place.
• Tack down rugs so that you do not trip.
• Put no-slip tape and handrails in the tub to prevent falls.
• Use a cane, walker or scooter if your doctor suggests it.

Call your doctor now or seek immediate medical care if:

• You think your medication needs to be adjusted.
• You continue to have difficulties eating or swallowing.
• You notice your tremors are stiffness are getting worse.
• You can’t do your everyday activities because of your tremors
• You have symptoms of depression.