Causes and Symptoms of Parkinsons Disease - Research Paper Example

?Introduction: - Parkinson’s disease was first described in 1817 by British physician James Parkinson. The primary problem underlying the disease, however, was discovered as late as the early 1960s when scientists identified absence of brain cells that produce dopamine, an important chemical in the nervous system, as the cause of PD. (NIH, 2004) Parkinson’s leads to tremors and shaking of head, trauma, and difficulty with walking, movement and coordination. Research suggests that Parkinson’s impacts around 500,000 people in the United States alone and the total cost of the disease to the nation is estimated to be around $6 Billion annually (NIH, 2004). Parkinson’s Disease most often develops at the age of 50 and is one of the most common nervous system diseases. It impacts men and women both and may be a part of heredity of some families. Causes and Symptoms: - The striatum is responsible for accepting information from neurotransmitters and interacting with other parts of the brain, especially the cerebellum to form movement. The primary region impacted as a result of PD is called the Substantia Nigra. This region contains specialized neurons that send signals in the form a neurotransmitter called Dopamine. Degeneration of Substantia Nigra results in excessive firing of nerve cells resulting in huge difficulties in controlling movement, eventually resulting in primary motor symptoms of PD (Driley, Aelang, Blair, ABirniuam, & Bried, 1989). Scientists have identified several cellular characteristics responsible for neuronal degeneration. Parkinson’s disease may affect one or both sides of the body, however, the amount of functionality of any part lost may vary from patient to patient. Initial symptoms are mild, e.g. a patient may have a mild tremor or a slight feeling or being dragged. Such symptoms culminate latter during the disease and can lead to several malfunctioning or nonfunctioning body parts (AE, 2009). Some of the chief symptoms may include automatic movements of body parts, such as increase or decrease in the speed of blinking, constant constipation and digesting difficulties, difficulty in swallowing, drooling, impaired balance and walking sense which can cause faintness or falls, lack of expression on the face which may be perceived as numbness or indifference and muscle aches and pains. Parkinson’s Disease is a devastating disease that interferes with and hinders movement more and more as time progresses. The most significant difficulties faced by Parkinson’s patients are movement problems which are signified by the following characteristics: - Slowed movement patterns in all fronts. Constant stooped position. Complete loss of small or fine hand movements and difficulty in writing and eating. Difficulties in initiating and continuing movements such as starting to walk or moving across the table. (Zesiewicz, Sullivan, Arnulf I, Morgan, & GS, 2010). Parkinson’s disease also results in shaking and tremors that can take the following forms: - Tremors usually occur in the limbs when at rest or when the arm or leg is held out. Movement circumcises tremors temporarily. The tremors start affecting head, lips, tongue and feet over time, Finger-thumb rubbing can also be seen. Other symptoms of Parkinson’s disease include Anxiety, stress and tension, confusion, Dementia, Depression, hallucinations and an incessant sense of fainting. There is considerable debate over whether Parkinson’s disease in inherited or not. The form of Parkinson’s disease prevalent in younger people may show that it is inherited. Parkinson’s in elderly patients, however, does not show any sign of inheritance. The current consensus on the subject is that although Parkinson’s is not completely inherited, there is some component of the gene which may react in only specific subjects to produce Parkinson’s disease. (Tanner, Goldman, & Ross, 2002) Diagnosis: - Healthcare providers across the country can diagnose Parkinson’s disease in patients via physical tests or identification of symptoms. Identifying symptoms is difficult, however, in case of elderly patients. Furthermore, the signs of Parkinson’s disease such as tremors, loss of motion, memory loss, hallucinations, etc become more care as the disease progresses into a later stage and hence relying on symptoms for diagnosis may result in culmination of the disease. (Weaver, Follet, & Sterm, 2009). Parkinson’s diagnosis may involve tests which, in case of discovery, may show the all or some of the following specifics: - Difficulty in starting or ending movements. Jerk movements/ stiffness. Muscle antropy. Parkinson’s tremors. Inconsistent heart rate. Although Parkinson’s disease affects the brain, a brainscan cannot be used as a reliable source to identify the disease. However, CT and MRI scans can be used to identify other disorders that may be causing the patient symptoms (Weaver, Follet, & Sterm, 2009). PET and SPECT tests can visualize the level of dopamine in the brain and may be used to support a diagnosis of the disease. Treating Parkinson’s disease: - There are two main types of treatment for Parkinson’s Disease: Drug Treatment and Surgery. 1) Drug Treatment: - Medication for Parkinson’s has three types that have varied impact on the disease. The first type of medication works to increase the level of Dopamine in the system. This chemical is an important part of the system and reduction in it leads to Parkinson’s disease. People cannot simply inject dopamine in the blood vessels because it does not easily pass through them. The most common drugs for dopamine are dopamine precursors. The second category of medication works to affect other parts of the nervous system to subside symptoms of Parkinson’s disease. These drugs help reduce tremors and muscle stiffness that can result from having more acetycholine than dopamine in the system (NIH, 2004). Anticholenergic drugs are prime examples of this category: these drugs work to reduce the impact of acetycholine. The third category of medication helps improve non-motor symptoms of the disease. Anti-depressants are prime examples of this category. Following are the classes of drug treatment of Parkinson’s disease: - i) Levodopa: This drug is converted into dopamine in the brain and helps increase the flow of dopamine which is essential to prevent symptoms. Levodopa can be administered with a combination of other antiparkinson’s drugs including dopamine agonists, MAO-B inhibitors, etc. ii) Dopamine Agonists: This category includes drugs such as ropiniglorine, cabergoline, bromocriptine, etc. These drugs mimic the actions of dopamine and the nerve cells respond as if dopamine was present in the system. iii) MAO-B inhibitors: This category includes drugs such as rasagiline and selegiline. An enzyme called MAO-B breaks down the functioning of dopamine resulting in symptoms. As the name suggests, MAO-B inhibitors work to stop MAO-B and allow proper functioning of dopamine in the system. iv) COMT inhibitors: Entacapone and telcapone are included in this category. COMT breaks down levodopa in the body and in the brain to thrash products that do not include dopamine. These inhibitors help to prevent the breakdown of levodopa before it reaches the brain. One of the COMT inhibitors can enter the brain and therefore prevent levodopa from reducing. (Tanner, Goldman, & Ross, 2002) 2) Surgical treatment: - Surgical treatments are usually recommended for only severely impaired PD patients who can no longer get relief from medication. The two types of surgical treatments commonly used include pallidotomy and deep brain stimulation. Brain surgery was one of the pioneering solutions to Parkinson’s disease as surgeons discovered that by removing some of the destroying parts of the brain, some of the symptoms of the disease can be cured. Popular early brain operations were pallidotomy, which worked on the globus pallidus, and thalomotomy which destroyed impaired parts of the thalamus. Although affective in the short run, these techniques were dangerous and irreversible, often leading to complications. Latest surgical techniques now allow surgeons to copy the effects of pallidotomy and thalomotomy by deep brain stimulations (Tanner, Goldman, & Ross, 2002). Through deep brain stimulations, an electrode is implanted in the brain which calms the abnormal neuronal firing and appeases the patient. This process is much safer than previously used methods because it does not result in permanent damage and the electrodes can be turned off as soon as the patient experiences problems. The deep brain stimulation technique was discovered by scientists in France in the 1980s when they found out that chronic stimulation of a brain part, thalamus, can stop patient’s tremors. This pawed the way for newer researches and eventually led to the development of the deep brain stimulation technique now commonly used across the world. The DBS is accredited by the US food and drug association (NIH, 2004). Other Therapies:- Numereous complementary and supportive techniques can be used to reduce the affects of Parkinson’s disease. Standard rehabilitation techniques are of significant use as they can help prevent walking and voice disorders, tremors and mental disorders. Exercise can help improve mobility whereas it can also help put underused and rigid muscles through a constant strain of motion. While excersice cannot stop disease progression it can help strengthen the body to help people cope better with the disability. Some specially targeted excercises can improve balance, help overcome walking and mobility problems and make certain muscles stronger to allow people to speak and swallow better. it is also important that general physical activity such as running, walking swimming and sports, etc is continued as is essential along with structured exercises in the recovery process. Dietary supplements may be proactive in parkinson’s diseases, however complete reliance on it is not recommended. Other therapies suggested include massage, yoga, acupuncture and the Alexander technique(Driley, Aelang, Blair, ABirniuam, & Bried, 1989). The socioeconomic impact of Parkinson’s disease: - Parkinson’s is a unique disease and requires significant care and consideration for patients. The cost of nurturing Parkinson patients and help them recover is significant. As the symptoms of Parkinson’s culminate, the patient requires much more care and assistance in all fronts. The symptoms and results are so damaging that patients may find it difficult to survive without consistent care and support. In such cases, if a family member or friend takes up the responsibility of caring the patient he usually bears the whole burden of the patient. The disease, however, is physically and emotionally draining and may require specialized care and assistance for patients through medics and hospitals. Such considerations have significant financial impact as well. The cost of drugs and surgery is cumbersome and as the disease progresses it may be impossible for the patient to survive except a 24 hour day care home. Parkinson’s is also considered one of the costliest chronic diseases and many economic aspects are to be considered when starting a fully fledged support program for patients. Bibliography AE, L. (2009). When and How should treatment be started in Parkinson Disease? Neurology , 72(7 Suppl):S39-43. Driley, Aelang, Blair, R., ABirniuam, & Bried. (1989). Frozen Shoulder and Other Shoulder Disturbances in Parkinson's Disease. Journal ofNeurology, Neurosurgery, and Psychiatry . NIH, N. I. (2004). Parkinson's Diseases: Challenges, Progress and Promise. NIH Publications , 2-3. Tanner, C., Goldman, S., & Ross, G. (2002). Parkinson's Disease and Movement Disorders. Phillidelphia, USA: Lippincott, Williams and Wilkins. Weaver, F., Follet, K., & Sterm, M. (2009). Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. Jama , 63-73. Zesiewicz, T., Sullivan, K., Arnulf I, C., Morgan, J., & GS, G. (2010). Practice Parameter: treatment of nonmotor symptoms of Parkinson disease: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology , 924-31. Read More