UNDERSTANDING PARKINSON'S DISEASE


Parkinson's disease(PD) is a degenerative disorder of the central nervous system. It was first described in 1817 by James Parkinson, a British physician who published a paper on what he called "the shaking palsy." In this paper, he set forth the major symptoms of the disease that wold later bear his name.


SYMPTOMS: Early symptoms of PD are subtle and occur gradually. Affected people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly or that their handwriting is slow and looks cramped or small. They may lose track of a work or thought, or they may feel tired, irritable, or depressed for no apparent reason. This very early period may last a long time before the more classic and obvious symptoms appear.

• Tremor. The tremor associated with PD has a characteristic appearance. Typically, the tremor takes the form of a rhythmic back-and-forth motion at a rate of 4-6 beats per second. It may involve the thumb and forefinger and appear as a "pill rolling" tremor. Tremor often begins in a hand, although sometimes a foot or the jaw is affected first. It is most obvious when the hand is at rest or when a person is under stress.




• Rigidity. Rigidity, or a resistance to movement, affects most people with PD. A major principle of body movement is that all muscles have an opposing muscle. Movement is possible not just because one muscle becomes more active, but because the opposing muscle relaxes. In PD, rigidity comes about when, in response to signals from the brain, the delicate balance of opposing muscles is disturbed.




• Bradykinesia. Bradykinesia, or the slowing down and loss of spontaneous and automatic movement, is particularly frustrating because it may make simple tasks somewhat difficult.




• Postural Instability. Postural instability, or impaired balance, causes patients to fall easily. A number of other symptoms may accompany PD. Some are minor, others are not. Many can be treated with medication or physical therapy. No one can predict which symptoms will affect an individual patient, and the intensity of the symptoms varies from person to person.




• Depression. Depression is a common problem and may appear early in the course of the disease, even before other symptoms are noticed. Fortunately, depression usually can be successfully treated with antidepressant medications.




• Emotional changes. Some people with PD become fearful and insecure.




• Difficulty with swallowing and chewing. Muscles used in swallowing may work less efficiently in later stages of the disease.




• Speech changes. About half of all PD patients have problems with speech.




• Urinary problems or constipation. In some patients, bladder and bowel problems can occur due to the improper functioning of the autonomic nervous system, which is responsible for regulating smooth muscle activity.




• Sleep problems. Sleep problems common in PD include difficulty staying asleep at night, restless sleep, nightmares and emotional dreams, and drowsiness or sudden sleep onset during the day. Patients with PD should never take over-the-counter sleep aids without consulting their physicians.




• Dementia or other cognitive problems. Some, but not all, people with PD may develop memory problems and slow thinking. In some of these cases, cognitive problems become more severe, leading to a condition called Parkinson's dementia late in the course of the disease. This dementia may affect memory, social judgment, language, reasoning, or other mental skills.




• Orthostatic Hypotension. Orthostatic hypotension is a dudden drop in blood pressure when a person stands up from a lying down position. This may cause dizziness, lightheadedness, and in extreme cases, loss of balance or fainting.




• Muscle cramps and Dystonia. The rigidity and lack of normal movement associated with PD often causes muscle cramps, especially in the legs and toes. Massage,stretching, and applying heat may help with these cramps.




• Pain. Many people with PD develop aching muscles and joints because of the rigidity and abnormal postures often associated with the disease.




• Fatigue and loss of energy. The unusual demands of living with PD often lead to problems with fatigue, especially late in the day. Fatigue may be associated with depression or sleep disorders, but it also may result from muscle stress or from overdooing activity when the person feels well.

COPING WITH PD:

While PD usually progress slowly, eventually the most basic daily routines may be affected - from socializing with friends and enjoying mormal relationships with family members, to earning a living and taking care of a home. These changes can be difficult to accept. Support groups can help people cope with the disease emotionally. These groups can also provide valuable information, advice, and experience to help people with PD, their families, and their caregivers deal with a wide range of issues, including locating doctors familiar with the disease and coping with physical limitations. People with PD also can benefit from being proactive and finding out as much as possible about the disease in order to alleviate fear of the unknown and to take a positive role in maintaining their health. Many people with PD continue to work either full or part time, although eventually they may need to adjust their schedule and working environment to cope with the disease.

source: www.ninds.nih.gov/disorders/parkinsons_disease