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Different parts of the brain work together by sending signals to each other to coordinate all of our thoughts, movements, emotions, and senses. When we want to move, a signal is sent from the basal ganglia to the thalamus and then to the cerebral cortex, all different parts of the brain.
Nerve cells in the brain communicate by using chemicals. A chemical neurotransmitter called dopamine is produced in a group of cells called the substantia nigra and is essential for normal movement.
People may experience non-motor symptoms from loss of other neurotransmitters up to ten years before motor symptoms are noticed. Caring for a loved one with PD can be a challenging job, especially as the disease progresses. Preparing for caregiving starts with education. Reading this fact sheet is a good start.
More resources are available to you in the Resources section of this fact sheet. Although PD is more common in older persons, some people do begin to experience symptoms before they are 40 years old. Researchers have identified families who experience an increased incidence of PD, with some showing a genetic relationship from known PD genes. Most people diagnosed with PD do not have family members with PD.
Recent studies show there may be a genetic predisposition to developing PD, but environmental exposure to certain toxins many years prior to symptoms may be needed to develop the disease. People will experience both motor and non-motor symptoms.
Typically PD motor symptoms start on one side of the body, and over time may progress to both sides. Often, one side is more affected than the other. Usually a diagnosis is based on a neurological exam that covers evaluation of the symptoms and their severity. They are:. If you notice cognitive changes, it is valuable information to discuss with the care recipient and to share with their doctor.
If the disease progresses beyond minor symptoms, drug treatment may be indicated. The most commonly prescribed medication is L-dopa levodopa , and this helps replenish some of the depleted dopamine in the brain. In those older than 75, dopamine agonists should be used cautiously because of an added risk of hallucinations.
Other drugs are also used, and new drugs are continually being tested. It is common for multiple drugs to be prescribed because many of them work well together to control symptoms and reduce side effects.
Contrary to past beliefs, starting Sinemet in newly diagnosed people does not lead to early symptoms of dyskinesia involuntary movements such as twitching or jerking. It is very important for people with PD and their family caregiver to work closely with their doctor s and to seek advice from a movement disorders specialist, who can best manage the more complicated aspects of the disease.
Over time, physicians add combinations of drugs, and more frequent dosing is required as the disease progresses. People with PD need to pay close attention to the times they take their medications and note the length of time the medication helps their symptoms and how long the medication effects last before wearing off. This information helps the physician better determine the amount of medication and the schedule for its use.
As with all medications, side effects can be a problem. For some, starting Sinemet may cause dizziness or nausea. For other medications, side effects may appear after several years. Sometimes these hallucinations can be frightening. There is a well-described side effect from dopamine agonists that everyone who starts this class of medication should know about.
Agonists and higher doses of Sinemet may cause impulse control behavioral problems. These behaviors vary, but may include: excessive spending, gambling, sex, pornography, or hoarding behaviors. Often reducing or stopping this class of medications stops the behavior. These behaviors can be so embarrassing for the care recipient and their family that too often the topic is avoided when talking with the doctor.
Odd as it may feel, keeping track of unusual impulse behavior to report to the neurologist can provide critical medical management information. Sometimes, in the most advanced stages, a choice has to be made between motor function and cognitive function. High doses of medications may be required to manage the motor symptoms, but these same doses cause hallucinations or paranoia. The DBS system consists of leads precisely inserted into a specific brain target, the neurostimulator pacemaker implanted in the chest, and extension wires that connect the leads to the neurostimulator.
Though implantation of the system DBS surgery requires a neurosurgical procedure, the treatment itself consists of long-term electrical stimulation. Advantages of DBS include its ability to reduce the high doses of medications avoiding the systemic side effects of medication , its adjustability stimulation settings are programmed non-invasively using a wireless programmer by the clinician or a patient programmer , and its reversibility can turn it on or off.
Individuals whose condition meets these criteria are advised to seek a comprehensive evaluation from an experienced DBS team. The best candidates who have the most robust response to DBS tend to be younger than 70 years of age, with few center of the body symptoms such as swallowing and balance problems. Although there is no evidence that non-medical activities can affect disease progression, physical activity may assist with management of the symptoms of the disease while helping to increase enjoyment of life by staying active, having fun, and learning new skills.
Innovative programs are increasingly available. For example, one popular program started in New York and replicated in other states and countries offers dance classes for individuals with PD. Professional dancers teach the classes in a large dance studio with live piano accompaniment See the References section of this fact sheet for more information on these and other programs. They can recommend how hard you should be working intensity and the duration of the activity.
A recommendation from your doctor to consult with a physical, occupational, or speech therapist is often useful. These professionals can assist you in evaluating how to use non-medical interventions in a way that best suits your needs. In the simplest terms, Lewy bodies are abnormal clumps of proteins that develop in nerve cells.
This loss affects memory, thinking, language, judgment, and behavior. A few of the signs of dementia in PD include slowed thinking, a more passive or apathetic personality, memory problems, and trouble with decision-making. One particularly troubling symptom for a caregiver is when a care recipient experiences vivid hallucinations or delusions—seeing or hearing things that are not really present but seem very real to the individual.
Frightening or dangerous hallucinations may call for a medical intervention. Use of certain antipsychotic medication can have highly debilitating side effects due to a hypersensitivity to these drugs by many LBD patients. Highly cautious use and careful monitoring by your doctor is critical should the use of these drugs become necessary. This challenging, multi-system disorder involving movement, cognition, behavior, sleep, and autonomic function requires a comprehensive treatment approach to maximize the quality of life for both the care recipient and their caregiver.
It is very important to pay attention to symptoms of dementia and to search for an expert clinician who can diagnose the condition accurately. Therefore it is important to work closely with a physician to rule out other possible causes for the changes in behavior and thinking. Many resources are available online See the Resources section of this fact sheet for more information , and public libraries have literature on the disease. Probably one of the most important, and sometimes difficult, things caregivers can do is to take care of themselves.
This includes maintaining mental and physical health by making and keeping your own medical and dental appointments. As a caregiver, it is important to keep your job whenever possible as it provides not only financial help and possibly insurance coverage, but also a sense of self-esteem.
Support groups help you meet people who are going through what you are going though, vent frustrations, give and receive mutual support, and exchange resource information and coping strategies. Whenever possible get your sleep, take breaks, make and keep social activities, and try to keep your sense of humor. By getting help, a caregiver can lessen their sense of isolation, and it gives you more confidence in your own caregiving ability. Having help increases your ability to think creatively and helps you get those needed breaks.
Help is available through local and community services. These include neighbors, friends, churches, synagogues, senior centers, adult day health, Meals on Wheels, and door-to-door vans. For a fee there is in-home care for help with cooking, bathing, dressing, and meal preparation. Additionally, a social worker from your health plan or hospital can connect you with other services. However, research shows that despite high levels of strain, caregivers with good quality relationships have reduced depression and better physical health.
Remember, as a caregiver your service to your loved one is beyond measure in terms of love, depth of care, and concern. Family Caregiver Alliance FCA seeks to improve the quality of life for caregivers through education, services, research, and advocacy. Through its National Center on Caregiving, FCA offers information on current social, public policy, and caregiving issues and provides assistance in the development of public and private programs for caregivers.
American Parkinson Disease Association www. National Parkinson Foundation www. Parkinson's Patients Support Groups, Inc. This fact sheet was prepared by Family Caregiver Alliance, and reviewed by S. Riddle, American Parkinson Disease Association. All Rights Reserved. Learn more. Skip to main content. Search form Search. You are here Home. Order this publication. Lanier, RN, MS. Tremor often starts on one side of the body—usually with the hand—but may also involve the arms, feet, legs, and chin.
Rigidity or stiffness: In addition to making movement difficult, stiffness can also cause muscle aches. Slow movement bradykinesia , loss of movement akinesia : Symptoms present with a decreased arm swing on one side, or decreased ability to perform usual motor tasks at usual speeds. Family and friends may comment that the person smiles less or appears disinterested when in fact they are unable to make the facial muscles move in ways to help express what they are feeling.
Or, they may take unusually small steps to move forward or use several tiny steps to turn around. Eventually postural problems result in a stooped torso with a noticeable shuffling gait. The resulting body imbalance can cause the person to stumble or experience near falls. Most people do not develop postural problems until many years after they have been diagnosed.
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