Parkinson's Disease - Research Paper Example

?Parkinson’s Disease Introduction Parkinson’s disease is d after James Parkinson who wrote about the condition he called “the shaking palsy” in 1817. It is described as a chronic, progressive neurological disease which affects the substantia nigra’s ability to produce dopamine, a chemical messenger which facilitates muscle movement (Christensen, 2005). The earliest known record of the study of Parkinson’s Disease is mentioned in James Parkinson’s “Essay on the Shaking Palsy”. The article describes the most common features of the disease which remain as the standard by which other types of parkinsonism are compared. The disease is mainly characterized by trembling of the limbs, muscular stiffness, and slow body movement. In addition, individuals suffering from the disease exhibit the following: standing in a stooped posture; walking in short, shuffling steps, and speaking softly in a rapid and even tone (Duvoisin & Sage, 2001). In most cases, 60 to 80 percent of an individual’s dopaminergic neurons – dopamine-producing cells of the body – are already non-functional by the time Parkinson’s disease has been diagnosed (Christensen, 2005). The mechanism which causes Parkinson’s disease remains unknown. Its pathological classification describes it as a systemic degeneration of the brain which targets specific cells in the brain. In 1908 Dr. Frederick Lewy discovered abnormal structures in the brain associated with Parkinson’s Disease. Called Lewy bodies, these structures are not found in other forms of parkinsonism. It has been theorized that a premature aging process, unknown nutrient deficiency or toxin may be causing the deterioration of the substantia nigra (Duvoisin & Sage, 2001). Tremors (300) Tremors are the most common of Parkinson’s disease, as observed in 50 percent of reported cases. It is the involuntary rhythmic movement of a body part which may occur during rest or when an individual performs a certain movement or action. When the trembling occurs in the middle of a movement, it is classified as an action tremor. However, this does not show as a sign of the disease (Christensen, 2005). Body tremors usually affect the arms and legs, but may also be observed on the lips, tongue, jaw, abdomen, and chest. The trembling action only occurs when the body part concerned is at rest, thus it is described as a resting tremor (Duvoisin & Sage, 2001). In its advanced stages, Parkinson’s disease may also cause postural or action tremors (Schapira, 2010). Rest tremors usually start at the hands or feet, progressing until all four limbs are affected. Since rest tremors disappear once the body part affected starts to move, it does not interfere with an individual’s ability to perform usual activities such as walking or holding objects (Sharma & Richman, 2005). Jankovic’s (2008) review of existing literature on Parkinson’s disease show that 69% of patients had rest tremor at the onset of the disease. Meanwhile, 9% of the patients lost their tremors at later stages. On the other hand, 11% of patients reported not experiencing tremors. However, another study involving autopsies among victims of Parkinson’s disease revealed that all patients had experienced tremors at some point. Minen and Louis (2008) performed a study on clinical correlates among 53 patients diagnosed with Parkinson’s disease. Analysis of the data collected revealed that 100% of the patients had rest tremors. In addition, the data also show that majority of patients with rest tremors were male. Muscular Rigidity Muscular stiffness among patients with Parkinson’s disease is characterized by a constant and uniform resistance to limb manipulation. This type of stiffness in the muscles is called plastic rigidity wherein the patient’s muscles lose their ability to go back into a relaxed state even when the muscle is at rest (Duvoisin & Sage, 2001). Normally, muscle action involves the contraction and relaxation of specific muscle pairs. One muscle contracts while the other muscle relaxes. However, in cases of Parkinson’s disease, the muscle which is supposed to relax fails to do so, resulting to the contraction of both muscles. This condition can affect movement in the neck, back, arms, or legs. In addition, it may become evident on one side of the body only, known as hemiparkinsonism. The rigidity of motion which results impairs an individual’s ability to perform fluid, graceful movements and can cause a significant amount of pain (Christensen 2005). Patients normally complain of difficulty standing from a seated position or rolling over in bed (Schapira, 2010). Muscle rigidity may be categorized as proximal or distal. Proximal muscle rigidity involves muscles in the neck, shoulders, and hips. On the other hand, distal muscle rigidity involves muscles located in the wrists and ankles. Pain may be associated with muscle rigidity, with most patients complaining of shoulder pain. Rigidity-induced pain is being identified as a risk indicator of contracting Parkinson’s disease (Jankovic, 2008). A review conducted by Maetzler, Liepelt and Berg (2009) on the progression of Parkinson’s disease show that symptoms such as muscle rigidity and bradikinesia progress faster at the onset of the disease. This pattern is evident based on the decline in functional presynaptic dopaminergic activity. The authors suggested that treat progression of Parkinson’s disease symptoms should be consider in the development of future interventions. Slowness of Movement / Bradikinesia Meanwhile, bradikinesia or slow body movement is characterized by the patient having difficulty in: (1) initiating; (2) sustaining; and (3) repeating body movements. This condition also affects automatic movements such as eye blinking, and hand/facial expressions (Duvoisin & Sage, 2001). Patients suffering from Parkinson’s disease observe that activities which they normally do take more time than usual and require mental effort and concentration. Repetitive and reflex movements are likewise affected. Moreover, patients find difficulty in doing multiple, simultaneous tasks. Impaired eye reflexes can cause dry eyes. In addition, slowed swallow reflex compounded with excess saliva can cause choking (Christensen, 2005). Freezing or start hesitancy is described as the inability to initiate a movement. Patients encounter difficulty performing motor actions because the brain is unable to process the idea to perform an activity. This condition makes it necessary for patients to follow visual, auditory, or verbal cues to circumvent these physical impediments (Christensen, 2005). Patients usually encounter difficulty walking through hallways, entering doors, changing direction, and making way through tight spaces. Medical intervention normally attempt to assess whether freezing occurs during specific activities, environment, time of day, or medication taken. Patients may need to have their medications adjusted because freezing can be caused by undermedication or wearing off (Tuite, 2009). Jankovic (2008) enumerated other manifestations of bradikinesia such as impaired ability to make spontaneous movements and gestures, drooling caused by inability to swallow, loss of facial expression, reduced arm movements while walking, and decreased blinking. Bradikinesia is described to be dependent on a patient’s emotional state, as shown in immobile patient who suddenly perform movements when in an excited state. Moreover, patients are observed to have the usual motor programs but find it difficult to perform specific actions without the help of an external trigger such as sound and visual cues. Problems Encountered Patients suffering from Parkinson’s disease encounter several difficulties induced by symptoms as the disease progresses. Some of the most common problems include anxiety, apathy, compulsive behavior, constipation, depression, drooling, dyskinesia, dystonia, fatigue, freezing, hallucinations, leg swelling, micrographia, numbness/tingling, orthostatic hypotension, pain, postural instability, psychosis, seborrheic dermatitis, sexual dysfunction, and shortness of breath (Tuite, 2009). Anxiety occurs in 40% of patients and may present itself together with depression. Patients normally experience anxiety when medications start to wear off and could be addressed by adjustment of medication. Internal tremors may also be observed when patients start to feel anxious (Tuite, 2009). The depression and fatigue associated with Parkinson’s disease can affect patient motivation and interest, leading to episodes of apathy. Patients become demotivated and lose interest in life, which could also affect members of the family and other social contacts. In addition, patients become less inclined to take care of themselves (Tuite, 2009). Individuals afflicted with Parkinson’s disease may start to exhibit compulsive behavior such as gambling, eating, shopping or sex. These behaviors may be attributed to dopamine levels affecting reward and pleasure centers of the brain. Pre-existing addictive behavior is seen as a risk factor, but cases exist where patients had no history of addiction (Truite, 2009). Constipation and changes in bowel habits such as appetite loss, nausea, vomiting, bowel obstruction, and hemorrhoids are attributed to gastric and bowel slowdown. In addition, medications used to treat Parkinson’s disease may also affect bowel movement. Moreover, lack of exercise, poor diet, and inability to eliminate body waste could also contribute to the problem (Tuite, 2009). Patients may experience hallucinations which could affect one or more senses: visual (seeing things or persons); auditory (hearing voices); tactile (skin sensations); odorous (smelling non-existent odors); and gustatory (non-existent tastes). This may be caused as a side effect by medications, toxins, or infections. If left unchecked, hallucinations may lead to delusions (Tuite, 2009). Diagnosis and Treatment The diagnosis of Parkinson’s disease is based on clinical criteria. There is no definitive diagnostic test for the disease. Histopathological confirmation of the existence of Lewy bodies in brain autopsy has been a standard diagnosis criterion. In a clinical setting, diagnosis is based on the confirmation of cardinal signs, associated and exclusionary symptoms, and response to levodopa (Jancovic, 2008). Testing for Parkinson’s disease also involves a complete neurological examination to evaluate nervous system function, vision, hearing, sensation, movement, reflexes, balance, and coordination. In addition, CT scans and MRI can be utilized to rule out conditions which may be mistaken for Parkinson’s disease (American Medical Association, 2004). Up until now there is no cure for Parkinson’s disease. The medications currently being used only help alleviate the symptoms and slow down the progression, not cure the disease itself. Doctors usually utilize combination treatments of levodopa and carbidopa, which stimulate the production of dopamine by the brain. However, the effectiveness of this treatment regimen lasts only for a few years. The next step involves the use of dopamine agonists to enhance the effect of dopamine as a means of prolonging the treatment period. To reduce trembling, anticholinergic drugs may also be prescribed (American Medical Association, 2004). Surgical options are taken into consideration when symptoms increase in severity and when a patient becomes unresponsive to treatment regimens. Electrical stimulation of the brain through implanted wires may be recommended to help stop the tremors. In some cases, pallidotomy or thalamotomy may be performed to destroy brain tissues affected by the disease. Another treatment option involves the use of stem cells harvested from the patient’s adrenal glands or human embryos. The stem cells are transplanted into the brain and allowed to mature into dopamine-producing cells (American Medical Association, 2004). Conclusion Parkinson’s disease is shown to create a negative impact on the quality of life among patients. This is primarily attributed to the cognitive impairment and depression associated with the symptoms of the disease. In a study conducted by Rahman, Griffin, Quinn, and Jahanshahi (2008) on quality of life indicators among 130 patients with Parkinson’s disease, the most common symptoms which patients complain about are: unpredictable on/off states, difficulty in dressing, walking impediments, falls, depression, confusion, start hesitation, shuffling gait, freezing, festination, propulsion/retropulsion, and difficulty in turning. Parkinson’s disease remains a scourge to the elderly. Its personal and social implications show that patients suffering from the disease need to face the inevitable. As of the moment, science still has to uncover the exact mechanisms which cause the disease, as well as the risk factors which contribute to the susceptibility of certain populations. Modern pharmacological and surgical treatments only manage to alleviate the symptoms and hinder its progression. Its diagnosis requires that physicians possess thorough knowledge about its characteristics. Being able to properly diagnose the disease and differentiate it from other disorders enable physicians to provide interventions at the earliest possible time. Medications and surgery is perceived to be the best that medical science has to offer at the moment, but it can only buy time for the patient while better treatments or a cure could be discovered. Therefore, further research is needed to fully understand the disease in order to finally develop a cure for the disease. References American Medical Association (2004). Family medical guide. Hoboken, NJ: John Wiley & Sons. Christensen, J. H. (2005). The first year - Parkinson's disease: An essential guide for the newly diagnosed. Emeryville, CA: Marlowe & Company. Duvoisin, R. C. & Sage, J. (2001). Parkinson’s disease: A guide for patient and family. Philadelphia, PA: Lippincott, Williams & Wilkins. Jancovic, J. (2008). Parkinson’s disease: Clinical features and diagnosis. Journal of Neurology, Neurosurgery, and Psychiatry, 79(4), 368-376. Maetzler, W., Liepelt, I. & Berg, D. (2009). Progression of Parkinson’s disease in the clinical phase: Potential markers. The Lancet Neurology, 8(12), 1158-1171. Minen, M. T. & Louis, E. D. (2008). Emergence of Parkinson’s disease in essential tremor: A study of the clinical correlates in 53 patients. Movement Disorders, 23(11), 1602-1605. Rahman, S., Griffin, H. J., Quinn, N. P. & Jahanshahi, M. (2008). Quality of life in Parkinson’s disease: The relative importance of the symptoms. Movement Disorders, 23(10), 1428-1434. Schapira, A. H. V. (2010). Parkinson’s disease. New York: Oxford University Press. Sharma, N. & Richman, E. (2005). Parkinson’s disease and the family: A new guide. Cambridge, MA: President and Fellows of Harvard College. Tuite, P. J. (2009). Parkinson’s disease: A guide to patient care. New York: Springer Publishing. Read More