The Impact of Parkinson's Disease on Elderly

Parkinson’s disease is a neurodegenerative disorder by which people of various age groups are found to be affected today. The disease is common across both eastern as well as western countries.

But how exactly does the disease affect you? Well, it mainly affects the way you move. Our body movement is basically controlled by a chemical called dopamine that is secreted by the nerve cells. Thanks to dopamine, you can move smoothly, just the way you want to. In case of Parkinson’s disease the nerve cells break down and as a result they stop secreting dopamine. Naturally, you cannot move the way you wish to. The symptoms worsen with time and you are likely to face more difficulties with the passage of time.

Parkinson’s disease and Dementia are somewhat related. About 50-80% of people suffering from Parkinson’s disease are found to develop dementia too. It is featured by lack of proper thinking and reasoning. As a result, people may suffer from problems in memory, judgement and lack of concentration. They might also face difficulties in vision and speech or may go through problems of hallucination, depression and anxiety.  They may also get irritated at the slightest of instances.

The symptoms, however, take time to develop and early detection of the disease can help you to treat it and get cured as seen in most of the cases. The main symptoms of the disease include tremor and stiffness in the legs. However, by the time these symptoms develop, you are already 40-50% affected by the disease. So let us get acquainted with the early sign of PD so that it can be detected and diagnosed at an early stage.

Inability to Sleep: This is one of the early symptoms of Parkinson’s disease which doctors often fail to detect. PD patients often suffer from RBD or Rapid Eye Movement Disorder in the initial stage where they tend to act out their dreams. This even includes attacking their partners in certain instances and showing violent behaviour.

Dysfunction of Facial Muscles: Stoppage of Dopamine synthesis affects the facial muscles and this, in turn, results in lack of expression. This may render the person emotionless to the eyes of another. The extreme form of this condition is known as ‘Parkinson’s Mask’. Frequent blinking of eyes and delay in smiling or frowning are also found in certain cases.

Inability to Smell: Sense of smell is also impaired to a great extent during the early stage of Parkinson’s Disease. The patients are often found to be incapable of recognizing the smell of perfumes and other similar stuffs.

Problem in Urinating and Bowel Movement: PD patients may also be found to face problems in urinating and constipation problems. Gastric trouble is also observed in certain cases. This is because the nerve cells signalling the muscles of bladder and those related to bowel movement die out due to the disease.

Pain in the Neck: During the early stage of PD patients are also observed to have pain in their neck. Stiffness, tingling sensation and discomfort may also be there.

Naturally, due to the above mentioned problems caused due to the dying out of nerve cells, the following side effects of Parkinson’s disease may be observed:

Drowsiness: People suffering from PD are likely to feel sleepy throughout the day as they do not have a good night’s sleep. During night, nightmares can make them restless and their sleep might be disturbed. RBD, as already discussed, may hamper their sleep.

Leakage of Urine: Due to improper functioning of the muscles near the urinary bladder, leakage of urine may be observed.

Apathy: Apathy or anxiety is also common and the patients have the tendency to get irritated or lose their calm at the slightest of instances. Their mood as well as personality changes and they cannot behave normally in changed situations and social withdrawals. They become depressed very easily and execution of important tasks might also be affected.

Cramped Handwriting: As a result of Dementia, the routine jobs of a person gradually become slower. The handwriting also becomes small and cramped than usual.

Excessive Sweating: Along with other parts of the body, the sweat glands also stop functioning properly and as a result there can be sweating as well as other skin problems. It may also lead to oily skin and oily scalp.

Reduced Arm Swing: As already discussed, muscles become stiff due to PD and arms cannot stretch across considerable distances, as a result. In other words, the arms do not go where the brain tells them to go.

Thus a Parkinson’s disease patient has to go through all of these or at least some of these problems. The disease affects them mentally as well as physically and hampers their day to day activities severely.  

Tips to regain your Balance after Stroke

Stroke is one of the leading causes of disability that occurs because of permanent damage to brain and may lead to difficulty in movement, balancing, pain, memory loss, loss of function (of affected part), fatigue , emotional and psychological problems. Symptoms can range from mild to severe and can be temporary or permanent in nature. Many of the Stroke survivors face problems in balancing which may affect their ability to walk and also increases the risk of falling. Besides balancing some people may also have feeling of dizziness or spinning sensation (due to stroke) which can further increase the risk of falling to five times.

Balancing while walking requires coordination between ears, eyes and brain. Any damage caused by stroke in part of brain that control coordination of movement may hamper balancing. Similarly, impaired vision, hearing or inability to process information in relation to affected side of the body may also lead to imbalance. The other evident reason for balance problems in stroke survivors is that one side of the body (unaffected side) becomes stronger than the other.

Physical activity in form of exercise, yoga or any pleasurable activity can bring tremendous change in their lives. Physical activity will not only help in recovering from present disability but also prevent another episode of stroke. Physical therapy makes the patient more independent, boosts confidence, improves overall health and helps reduce depression and anxiety (related to the disease). Physical activity in any form helps improve heart function, lowers BP and the resting heart rate. It improves the overall metabolism. It improves the lipid profile by reducing total cholesterol. It also reduces the risk and severity of diabetes and improves the brain health by increasing strength, tolerance and endurance of the body.

Survivors are advised to start with stroke physical therapy for regaining balance as early as possible (after the stabilisation of the vitals).It may take a while for the body to start walking after a stroke. Initially easy and less strenuous exercises are suggested which can be gradually increased once body’s endurance and strength improves. Aim is to take small steps that will lead to long lasting healthy changes in body. During the recovery period, neither patient nor the caregiver should get discouraged because of the physical disability. Instead a lot of sincere and focused efforts are required on a daily basis (from patient) which will help lessen the symptoms and will lead to increased independence.

Physical activity has countless benefits for stroke survivors. Most common physical activities for stroke patients with severe- moderate disability are stretching the neck, moving/rotating the arm, lifting the knee, flexing and extending the elbows and arms, and ankle rotation on the unaffected side of the body. With the improvement in balancing, gradually the frequency and duration can be increased like, after learning to balance upright while sitting in a chair, next is to learn the transfers safely between bed and chair followed by beginning to learn to walk.

Patients with mild disability have numerous options for exercises such as swimming, walking, stair stepper and use of recumbent stationary bike as well. There are some fortunate stroke survivors who can move all the four limbs without any weakness. But they should also exercise after stroke on a regular basis. They can start with any form of physical activity of their interest e.g. gardening, playing sport, walking or swimming. Nowadays, many visual reality devices are also available which makes the physical activity more enjoyable by giving immediate feedbacks. This encourages the patient for active participation also.

Healthy food habits also proved to be highly effective during the recovery phase. Wisely chosen food items can also help reduce the stroke risk factors. Small frequent meals with large portions of fruits, vegetables and whole grains are advisable. Saturated and Trans fats should be completely avoided. Instead, lean meat and low fat dairy products should be consumed. Smoking and alcohol consumption should be completely stopped.

A Calculative approach on Parkinson's and Stroke diseases progress in India

What is Parkinson's disease? 

Parkinson's disease (PD) is typical degenerative issues of the focal sensory system, in which the development controlling cells of the cerebrum get debilitated, prompting tremors, impeded development, adjust issues, discourse and conduct changes. The primary hindrance in dealing with the illness originates from the absence of mindfulness and feel specialists. 

The yearly death rate per 100,000 individuals from Parkinson illness in India has expanded by 87.9% since 1990, a normal of 3.8% a year. In spite of the fact that this has been the pattern general, alter the channels at the highest point of the perception to perceive how the death rate for Parkinson infection has changed after some time for men and ladies of particular age bunches in India. 

As a guardian of somebody with Parkinson's illness, you can do the following

Right from the early signs of Parkinson's disease, you help keep up the personal satisfaction for your cherished one. You can teach yourself about indications, medicines, and the movement of the infection. You can monitor meetings with the specialist, medicine calendars, and exercise. You can offer the affection and bolster important to address the difficulties of Parkinson's ailment.

What is Stroke disease?

A stroke is caused by the sudden loss of blood stream to the cerebrum or seeping inside the head. Each can cause cerebrum cells to quit working or bite the dust. At the point when nerve cells in the mind bite the dust, the capacity of body parts they control is hurt or lost. Contingent upon the piece of the cerebrum influenced, individuals, can lose discourse, feeling, muscle quality, vision, or memory. 

As of 2013, Stroke is one of the main sources of death and inability in India. The evaluated balanced commonness rate of stroke run, 84-262/100,000 in rural and 334-424/100,000 in urban regions.

Role of Government to handle this deadly disease

The GOI has several concessions for people suffering from Parkinson’s and Stroke disease and for further prevention of stroke

1. Railroad – consent to go in the compartment saved for people with incapacity 
2. Air travel concessions 
3. Transport travel concessions 
4. Wage Tax diminishment benefits 

The Center for Rehabilitation and Education through Distance Mode (CREDM) has thought on making of a devoted Helpline for Persons with Parkinson's disease. This is the first in line to meet one of the destinations of the middle to connect with elderly people with different correspondence issue. The government has started several Parkinson's awareness programs and Stroke support programs.

How individuals can Volunteer or Donate and help FrontEnders Foundation in battling these savage ailments

FrontEnders establishment is Chennai based non-revenue driven association built up in the year 2015 to give a positive societal effect through the different engagement exercises/programs for the assorted groups. 

• Become a Volunteer 

           By becoming a volunteer, you can

• Help at their special occasions 
• Help them to direct mindfulness programs at your working environment or social gatherings 
• Make a Donation 

All gifts made to FrontEnders Foundation are exempted from assessing u/s 80G of IT Act. A receipt will be issued to you within one week after the acknowledgement of your gift in their record.

When You Need the Deep Brain Stimulation Surgery

Surgical treatment for Parkinson's might be considered over the span of the malady, particularly if side effects cannot be enough controlled with the drugs. Like the greater part of the directly accessible Parkinson's medications, surgical alternatives offer a symptomatic advantage. Older surgeries like Thalamotomy focused on the annihilation of mind cells adding to the symptoms. While, DBS surgery conveys electrical pulses to mind cells to terminate the symptoms.

•    Why is DBS surgery required? 

Deep brain stimulation is a built up treatment for development issue, for example, basic tremor, Parkinson's malady and dystonia, and all the more as of late, over the top habitual issue. This treatment is saved for individuals who are not ready to gain the power of their symptoms with medications. 

Precisely how DBS functions are not totally seen, but rather numerous scientists and pros trust that DBS directs the abnormal electrical signaling patterns in the cerebrum. Keeping in mind the end goal to control ordinary development and different capacities, cerebrum cells speak with each other utilizing electrical signs. In Parkinson's illness, these signs wind up noticeably irregular and uncoordinated and prompt motor indications. DBS essentially interferes with the atypical flagging examples in a way that enables the cells to convey all the more easily and in this way reduces side effects. 

•    Surgery dangers 

DBS surgery includes making little openings in the skull to embed the anodes, and surgery to embed the gadget that contains the batteries under the skin in the trunk. Dangers of surgery may include: 

• Bleeding in the brain
• Stroke 
• Breathing issues 
• It may lower your blood pressure
• Nausea 
• Heart issues 
• Cerebral pain 
• Perplexity 

Before opting for a surgical treatment for Parkinson's, measure the advantages and disadvantages. Then plan for the surgery! Before the surgery, you will require medicinal tests to ensure that the surgery is a protected and fitting choice for you. You will likewise require a MRI before the surgery, to outline regions of your mind to embed the cathodes. 

•    Advantages of Deep Brain Simulation

DBS is the most regularly performed surgical treatment for Parkinson's, however it is not for everybody. It is normally done in individuals who have had Parkinson's for no less than four years. DBS regularly works best to reduce motor indications like solidness, gradualness and tremor. DBS may even fuel considering or memory issues so it is not suggested for individuals with dementia. 

•    Exploration on DBS and Parkinson’s

Scientists are attempting to enhance the current DBS surgery gadgets and surgical techniques with the objective of making the treatment gainful for more manifestations and hence for a more prominent number of individuals. A few specialists are focusing on DBS to an alternate range of the mind - the Pedunculopontine core (PPN) - to treat strolling and adjust issues that don't normally enhance with present-day DBS techniques. Others are growing alleged "shrewd" DBS, in which gadgets record a man's one of a kind mind flags and convey electrical incitement just when required, for example, when manifestations return, instead of ceaselessly, as the present frameworks do.

What causes PD

At the moment the causes of Parkinson's disease is unknown, except for cases induced by trauma, drug addiction and medication, and some hereditary forms in certain family groups. Numerous theories try to explain the neurological deterioration that produces this pathology. Experts believe that a few pesticides and toxins, along with individual genetic predisposition, could be the triggers of the disease. Nevertheless, here are some common cause of Parkinson’s Disease.

Genetic Causes

During the past one decade, researchers have identified a number of occasional cases where Parkinson's disease appears to be caused by a single genetic mutation. In these cases, the mutated gene is passed from one generation to other, resulting in a great number of Parkinson's disease cases within an extended family. And this is one of the greatest causes of Parkinson's disease identified till date.

Environmental Causes

Environmental causes are another leading factor to Parkinson’s Disease. Some external toxins may particularly extinguish the dopaminergic neurons, causing Parkinson's disease. Toxins that may be linked to Parkinson's Disease include manganese, carbon monoxide, carbon disulphide, and some other pesticides.

A Combination of Both

For most Parkinson's patients, the cause is a combination of both genetic and environmental factors. It is not necessary for a person to get the disease even if he has family history of one or more Parkinson’s Patients. Similarly, some patients experience Parkinson’s Disease while they got exposed to some other chemicals and environmental toxins. So most of the scientists currently believe that both genetic and environment factors can contribute to Parkinson’s Disease, and unfortunately, it is impossible till date to determine the specific causes of the condition.

Age and Gender Factors

Another risk factor for Parkinson's disease is age. Men have a higher risk than women to get the condition.

Other than this there are a lot of factors associated with Parkinson's disease. For example, head injury and accidents have been associated with higher risk.

Diagnosis of Parkinson

People with Parkinson's disease experience several particular characteristics such as rest tremor, slowness in the initiation of movements and muscular rigidity. Diagnosis of Parkinson is quite difficult in its initial stages, as it is confused with the symptoms of other pathologies. According to the latest studies, the diagnosis of Parkinson's takes between one to five years.

Twenty percent of the diagnoses come after five years, and in 25 percent the diagnoses are wrong. The diagnosis is clinical and is based on the patient's symptoms. To confirm the diagnosis, a computerized axial tomography (CT) is performed, which detects brain lesions in the midbrain.

However, the best way to detect this pathology is observation, exercised by both the doctor and the patient's relatives, since the permanent contact allows them to confirm the continuity or progression of the symptoms and possible changes of both physical and emotional. Early diagnosis of Parkinson's disease is essential, as each type of Parkinson has a different treatment.

Parkinson’s medication

It is a chronic pathology that, for the moment, has no cure. The goal of such treatments is to slow the progression of the disease, control the symptoms and side effects derived from the drugs used to combat it.

Surgical treatment in PD

PD or Parkinson's disease is a progressive and chronic movement disorder, which means that the symptoms continue to grow over a period of time. There are millions from all over the world who are suffering from this ailment; the USA alone has 2 million people who are suffering from Parkinson's disease. The cause of this disease is unknown, and presently, despite so much of development in the domain of medical science, there is no permanent cure for this disease; however, with the help of surgery and proper medications, it is possible to manage the symptoms. 

When it comes to Parkinson's disease, it causes death and malfunction of the neurons, which are an important nerve cell located in the brain. With the help of the medication for Parkinson, these dead cells can be rejuvenated, and the situation can be corrected to a certain extent. In this disease, the neurons in a particular area of the brain known as “Substantia Nigra” are affected. The dying neurons generate Dopamine which is a type of chemical which transmits messages to other sections of the brain which controls the process of coordination and movement. When someone is affected by PD as the situation worsens, the production of Dopamine in the brain keeps decreasing which causes problems for an individual to control his movements normally. 

The Surgical Procedure

DBS or Deep Brain Stimulation is one of the surgical procedures which is used when it comes to treating the symptoms of this disease. The Parkinson's disease surgery is used to address various types of neurological issues which can be caused by PD. Here are some of the symptoms which can be controlled with the help of a surgery. 

• Rigidity in movement

• Stiffness in the body parts

• Tremor

• Problems in walking

• Slowed movement

The surgery is performed to insert electrodes into the specific area of the brain. DBS is considered as a most important therapeutic advancement. But this is not the ultimate solution to cure PD, but it can hold the progress of the disease for some years. The surgery is not advisable for every person, and your doctor suggests it based on your medical condition and the duration of your medication period.

There are certain criteria to undergo the surgery. Patients have to take a minimum of five years of medication to undergo a surgery. Physicians normally don’t encourage people with psychological disorders to undergo this surgery.  The surgery is also not recommended for people in the late stage of PD. 

Usually, the surgery is carried out after giving medications for a certain period of time. For those who are suffering from advanced Parkinson’s disease, both surgery and medications are recommended based on their health condition.

Memory and Behavioural Changes in PD Patients

Some of the most intense penalties of Parkinson's disease may affect not from motor indications, but from psychiatric and behavioural difficulties. These conditions often go unseen and untreated. Such conditions are mainly caused due to the disease medications. Here are some common psychiatric and behavioural changes in Parkinson’s patients.

Mental Changes

While Parkinson's disease essentially affects the aptitude to move about and do work, in some patients, mental changes do start to appear. These mental changes are often proportionate to the amount of medication being taken as well as the duration of the treatment.

 1.    Dementia

Loss of memory is one mental symptom that can either be drug induced or it can be the result of another disorder running corresponding with the Parkinson's disease. The disease does not cause dementia in itself. Yet dementia can be caused due to drugs and dosage needed to treat Parkinson’s. Reduction in dosage is one advised cure for dementia. In such a case, the patient may have to accept increased rigidity.

2.    Hallucinations

Some patients put on prolonged treatment with some medications of Parkinson’s, might develop hallucinations. Those individuals may see long deceased relatives. They may also start questioning the fidelity of their partners. Although such visions are harmless, the patient may feel anxious. To treat hallucination, the doctor can reduce the dosage of treatment drugs.

3.    Confusion

When a patient is uncertain of the time, place or his/her identity, they are termed as confused. Although Parkinson's is hardly the cause of confusion, the treatment with anti-Parkinson medication can be the chief cause. Positive home care is advised in such a case. A calm environment should be provided to reduce all forms of stress.

Behavioural Changes

1.    Depression

About half the patients with Parkinson's show signs of depression. Typically, it is mild to moderate in strength, but about 5 to 10 percent of the cases may be a severe form of depression. Research shows that despair in patients occurs partially from neurochemical changes in the brain. This is during the process of the disease.

To rightly identify this mood chaos, doctors look for individual clues such as continued feelings of sadness, insignificance, guilt, or bad temper. This mood can be cured with psychotherapy and drugs.  In worse cases, electroconvulsive therapy may be essential.

2.    Compulsive behaviour

Employment of Parkinson's drugs, chiefly dopamine agonists, has on instance led to uncontrollable behaviour such as gambling, shopping, or even compulsive repetition of certain traits such as gathering or adding particular objects. The solution again is to reduce or change medication.

3.    Anxiety

Patients with the disease may often undergo nervousness when their medication drugs start wearing off. They start to fear that the subsequent dose will not be able to control their indications. They may even start to fear that they will be abandoned in public, powerless to move well. Intense anxiety can produce frightening panic attacks that may leave the patient unable feeling as if they are having a heart attack.

Care from family and friends is the best solution to support the patients during these situations. Don’t ignore any of the above conditions and consult your doctor to get support on the management of these situations.