Parkinson Disease

Your doctor should evaluate you, specifically if you are older than 55 years, if you feel you are beginning to experience symptoms of Parkinson disease.

Because PD is a progressive disease, you will continue to experience new and disturbing symptoms.

These symptoms can sometimes be hard to distinguish from side effects of medications, which can be numerous in someone with PD.

Thus, any change in your baseline condition should prompt an evaluation to rule out other medical conditions or medications side effects.

Although the emergency department is not the setting for deciding whether you have Parkinson disease, visits may be needed to rule out or treat other medical conditions.

Specific complications associated with PD may need an emergency department visit.

• At times, new or changing symptoms may mimic other diseases and cause you or your family anxiety. (For instance, you may have changes in your ability to think or be unable to move a certain body part that is worse than before, mimicking signs of a stroke.)
• With advancing PD, you become more likely to fall because of increasing problems with walking.
• Many people with PD may also develop osteoporosis (loss of calcium in bone), which in combination with walking problems of PD can make you more likely to have pelvic, hip, and other types of fractures.
• The involuntary nervous system problems of PD may cause you to have severe urinary retention (inability to urinate), constipation, or fecal impaction requiring medical intervention.
• The movement disorder may also affect the swallowing mechanism and esophagus causing you to choke or have food become impacted within the esophagus.
• Another associated complication is aspiration (inhalation of food) of either liquids or solids, which makes you more likely to have pneumonia  and possibly can cause you to choke.
• The medications used to treat PD are not without complications either. For instance, low blood pressure may result and contribute to the sense of imbalance or increase the risk of falls or other trauma.
• In addition, people with PD can become immobilized by the disease, which can lead to painful muscle contractions. The muscles can become locked in spasm preventing you from moving the extremity. If a person with Parkinson disease is unable to communicate effectively, this may cause a great deal of anxiety. Certain medications and physical therapy may help alleviate this problem.

Self-Care at Home

The decision to care for a family member with Parkinson disease is very complex.

In the beginning, the symptoms are minimal. The person may continue carrying out the activities of daily living, for example, eating, bathing, dressing, taking medications, and toileting. In fact, the person may continue to work and excel in other areas of life.

A time will come when the symptoms of the disease progress to the point of decline. It is, however, impossible to predict which symptoms will become most pronounced and debilitating. This makes it especially difficult in planning and arranging future care. Nevertheless, with adequate planning, providing for the person at home is feasible.

• It must be determined what level of care is required and what financial and social resources will be available to accomplish home care. There will need to be a designated caregiver, preferably someone with few other family responsibilities.
• With time, the needs of the person with Parkinson disease will only increase. The demands on the caregiver will mount. In terms of living independence, the ability to safely cook, drive an automobile, or use public transportation will be lost. A caregiver will assume full responsibility.
• The home should be large enough to accommodate the person's needs. Special medical equipment such as a walker, wheelchair, bedside commode, or chair lift may be required. In terms of added safety, dangerous and breakable objects will have to be removed.
• Medications should not be accessible to the person once or if confusion becomes part of the symptoms.

As with all things in life, a spectrum in the level of needs will vary from person to person. One person may need only moderate assistance. Someone else might require full-time care.

Follow-up

To manage your Parkinson disease effectively, your doctor must carefully balance the symptoms of the disease with the side effects of medications.

• No single approach to treatment of PD exists. Rather, every person must work in tandem with doctors and therapists throughout the course of disease to design a program for their specific and changing needs.
• Always consult your doctor before changing or stopping a medication.
• At any point during the course of Parkinson disease, an open discussion regarding new or changing symptoms or side effects must exist between you and your doctor.

Outlook

Parkinson disease reduces the length of your life, but it is not fatal. It is a disease that progresses from a phase without symptoms to possibly a state of complete disability, sometimes within 10-20 years. As with all diseases, a spectrum of possibilities exists. The course a particular person will experience cannot be predicted. Certain patterns have been noted.

• PD has been characterized by some as either tremor predominant or postural instability and gait disturbed (PIGD).
• Younger people usually have tremor as the main symptom, but progression of the disease is slower. They also seem to have more muscle control problems.
• By contrast, older people experience more from PIGD. This can be a serious problem in this age group because of an increased fall risk.

In addition to the physical problems with PD, a significant emotional price is paid as well.

• Many people have profound onmouseover="className='over';" onmouseout="className='out';">depression  and other thinking problems throughout the disease.
• It is estimated that about 30% of people with PD experience altered mental status.

Treatment is getting better at easing symptoms and may even slow progression of the disease. With continued research and clinical trials investigating new medications and surgical procedures, it is thought that one day we may be able to either prevent or cure PD.