Over the past three years, I had noticed a significant decline in a close friend’s well-being as he generally showed deterioration in his speech, his gait and his strength. He began to take shorter shuffling steps when walking, his voice was quieter and I often had to have him repeat what he had said. Recently, he started using a walker because of the instability in his gait. He just seemed to be getting “older” faster than he should.
Since he was a widower living alone, I raised my concerns with his daughter, who had also noticed these changes when she occasionally visited from another city. She attended the family doctor appointments with her father on several occasions. No specific diagnosis was determined and a referral was made to a “memory clinic,” but no appointment had been confirmed after several months. Even when obtained, the waiting time was expected to be a number of months away. As the 80-year-old living alone was a concern, home care was initiated – including physiotherapy and meals. He was given an emergency wrist monitor which would warn of any emergencies, including falls. Several weeks ago, he had a fall during the night. The alert bracelet functioned and he was taken to the emergency room, admitted, properly investigated and treated. Fortunately, he had no fractures, was seen promptly by a neurologist, put through various examinations and eventually diagnosed with Parkinson’s disease. He is now in a rehab hospital receiving occupational and physiotherapy, as well as medicinal treatment.
Parkinson’s disease is a neurological disorder mainly affecting persons over the age of 65. It is estimated that, worldwide, more than 10 million people are living with Parkinson’s disease, including more than a hundred thousand in Canada. It is twice as common in men and numbers are rising, in part because of the increase in the aged population. Notable persons diagnosed with the condition include Michael J. Fox, Muhammad Ali, Linda Ronstadt and Neil Diamond.
Signs and symptoms begin with barely noticeable changes which may include slowness of gait and performance of daily movement in dressing, standing up and completing simple tasks. Writing often demonstrates small letters. Tremors can develop and worsen. Shuffling and shorter steps are common and balance may be a problem. Speech may be softened or flat and may show hesitation. There may be mood changes, anxiety and depression, as well as slowed thinking and memory.
Parkinson’s disease is a progressive neurological condition characterized by the degeneration of nerve cells in the brain which produce dopamine. Although in rare cases there may be genetic and environmental factors, the precise cause leading to the disease remains unknown. The condition often remains undiagnosed in the initial stages, as its onset is so slow. Even when suspected, there is no simple test to immediately confirm a diagnosis. A careful history, as well as thorough physical and neurological examinations, should create a high degree of suspicion leading to referral to a neurologist as soon as possible. Blood tests, MRI and Pet scans are often ordered, mainly to rule out other conditions. For cases in which there is a family history, genetic testing may be indicated. In the end, careful assessment by a neurologist will lead to the diagnosis.
Once the diagnosis has been made, treatment initiatives should begin. If the patient is hospitalized, outpatient occupational therapy and physiotherapy will be initiated. Medications may be ordered, which could alleviate symptoms to some extent and, hopefully, slow the progression of the condition. After treatment commences, improvement in symptoms further supports the diagnosis. Many patients experience improvement and may live independently for many years, receiving their medication, ongoing physical and occupational support and regular neurological followup. For advanced cases, institutional care may eventually be necessary to provide more intensive management.
The medication to help control the symptoms of Parkinson’s disease is Levodopa. The drug is converted in the brain to dopamine, the natural chemical that is deficient in patients with the condition. This results in improvement in motor control. Levodopa is often combined with another drug to lessen side-effects. This combination drug, the most common medication prescribed for Parkinson’s disease, is Sinemet. Other medications may be prescribed according to the patient’s particular symptoms.
A major support group – Parkinson Canada (www.parkinson.ca) – offers information and support for persons affected and their families, as well as supporting research into the cause and management of the condition. The Michael J. Fox Foundation (www.michaeljfox.org) is dedicated both to finding a cure for Parkinson’s disease through an aggressively funded research agenda and to ensuring the development of improved therapies for those living with the condition.
Research into Parkinson’s disease continues throughout the world, with some recent results giving further hope that some day, the condition can be cured or prevented.