5 April, 2023
It is not uncommon to come across a new medication, therapy, exercise program, or diet to cure Parkinson’s disease. A few patients also go through a variety of pricey, unproven therapies in hope of a cure. All of these fads, however, eventually pass. The failure to understand the full spectrum of illness and address the issues in a holistic manner is probably the reason why patients search so desperately for that holy grail.
Parkinson’s disease (PD) is due to the loss of dopamine-producing nerve cells in a particular region of the brain. It is the second most common degenerative condition of the brain after Alzheimer’s disease in people beyond the sixth decade. However, it is not uncommon to encounter this condition among young people.
The symptoms in Parkinson’s disease are broadly categorised into motor (or visible) and non-motor (invisible) domains. The typical motor symptoms include trembling in the limbs, stiffness, slowness in activities, and imbalance while walking, leading to falls. The non-motor symptoms include issues with mood, memory, sleep, and constipation, among others. The non-motor issues gain prominence as the illness progresses.
The treatment for Parkinson’s disease focuses on reducing the symptoms and improving quality of life. Although active research is underway, there is currently no cure or means to stop the disease’s progression. Medical or pharmacotherapy, including functional surgery like deep brain stimulation in some individuals, improves the motor symptoms to a large extent. The non-pharmacological measures, like patient education, diet, nutrition, exercise, and maintaining a healthy lifestyle, are equally important. Unfortunately, these are often unacknowledged and less discussed. Parkinson’s disease is a progressive illness with a range of symptoms at every stage; hence a “one size fits all” approach does not work.
It is important that patients and their caregivers have knowledge about the illness and management options. The treating physician, during the initial visit, should make an effort to comprehend the patient’s beliefs, concerns, and needs. They should be encouraged to actively participate in the decision making process. The patient should openly discuss their concerns during every visit. Having effective communication between the treating doctor, the patient, and their primary caregivers is crucial in this age of social media and an overabundance of information.
A positive mindset has a significant impact on the disease’s course. PD patients frequently experience anxiety, apathy (lack of motivation), depression, and mood swings. Social isolation is common, as they are often conscious of their symptoms in social gatherings. The patient’s attitude towards the illness and outcome are also influenced by the social support from his/her family and society.
Nutrition is an important aspect that should be actively discussed during doctor visits. PD patients often suffer from a reduced or lost sense of smell, which makes food tasteless. Loss of appetite, early satiety, constipation, and mood changes are some of the factors contributing to decreased food intake. The presence of food in the stomach (especially a high protein meal) can interfere with medicine (levodopa) absorption, leading to dose failure. Patients should be encouraged to have a balanced diet consumed in smaller quantities and at more frequent intervals.
Numerous studies have demonstrated the beneficial effects of increased physical activity and regular exercise. The effect is more pronounced for non-motor symptoms like sleep problems, anxiety, depression, and constipation, among others. It also improves the balance and reduces the risk of falling. It is important to time physical activities and exercise after medicine to prevent falls.
Last but not least, effective management of Parkinson’s symptoms necessitates good coordination between the treating neurologist, psychiatrist, psychologist, physiotherapist, speech therapist, occupational therapist, and clinician nurse. The multidisciplinary team should collaborate with the goal of providing these patients with a productive life. The patient and their caregivers should form the central part of all decision making processes.
World Parkinson’s Day is celebrated on April 11 every year to commemorate the birth anniversary of Dr. James Parkinson, a British surgeon who first described this condition in detail. The goal is to promote research and raise public awareness of this condition.