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Parkinson's disease

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C. A. V. Nogueira, M.D. |
Parkinson's diseaseParkinson's is a brain disorder which affects walking, talking, and writing. After Alzheimer’s disease, Parkinson's disease is the most common neurodegenerative disease.


The British doctor James Parkinson was the first to identify this progressive neurological condition and hence the name. The disease is result of a loss of nerve cells in the part of the brain known as the substantia nigra. Those cells produce a vital chemical known as dopamine which allows smooth, coordinated function of the body's muscles and movement. When 80 percent or more of the dopamine-producing cells are damaged, the person has symptoms of Parkinson's disease.

The characteristic symptoms are the rest tremor of a limb (which means that the limb is shaking while at rest), slowness of movement (bradykinesia), increased resistance to passive movement of the limbs or trunk, and poor body balance. When a person has at least two of these symptoms - and especially if they are more evident on one side than the other - that means Parkinson's. At the first time symptoms are a combination of tremor, bradykinesia, rigidity and postural instability. Those symptoms typically begin on one side of the body and spread over time to the other side.

Facial expression also occurs. There is a certain blank expression showing little emotion or a staring appearance because of reduced frequency of eye blinking. The frozen shoulder or foot drag on the affected side are common. The symptoms come on gradually and that's the reason why older patients say "that's a sign of aging". The tremor is called "shakiness," bradykinesia is "normal slowing down," stiffness is often called "arthritis,", and the bad posture is "osteoporosis." The problem here is that younger and older patients may experience initial symptoms for a year or more before seeking medical evaluation which can reveal that those symptoms has nothing in common with ageing.

Parkinson's is a progressive disease and over time initial symptoms are worse and worse. A mild tremor becomes more noticeable. The patient can't cut the food with the affected limb. Slowness may interfere with daily routines: getting dressed, shaving or showering may take much of the day. There is difficulty in getting into or out of a chair or a car, or turning over in bed. Walking is slower and there is a stooped posture with the head and shoulders hanging forward. The voice becomes soft and monotonous. A poor balance may lead to falls. Handwriting becomes small and unrecognizable. Automatic movements, such as arm swing when walking, are reduced.

Unfortunately, it is not possible to predict the likely course of the disease in an individual patient. The rate of progression and resulting level of disability vary in different patients. When the disorder is such that normal activities of daily living are impaired, at least to some extent, symptomatic treatment begins.

The bad news number two: there is no treatment to slow or stop the progression of this disease. Thus, the doctors are treating the symptoms that are most bothersome to an individual with Parkinson's disease. So, there is no "best" treatment for this disease. Treatment includes medication, surgical therapy, general lifestyle modifications, physical therapy, and speech therapy. Because individuals with PD have a range of symptoms the decision whether to treat with medication varies between individuals.

When first diagnosed, very often the patient denies the illness. He questions the diagnosis, avoids medical evaluation, refuses to tell anyone including family... Denial can be a barrier to seeking appropriate treatment and support. However, many Parkinson's disease patients have successful, satisfying work lives, and often early in the disease make no changes in their normal work habits or routines. Although some changes are required in lifestyle, it can be changed to the point when the lifestyle is absolutely satisfactory.

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