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Leticia is a 67-year-old ex-farmer who lives in solitary with her dog. Her husband died five years ago. Recently, she tripped over her dog and fell slightly, landing on her right hand and inflicting wrist pain (about three months ago). She visited her primary care physician for help with her wrist but also mentioned recent balance issues and a slight hand tremor. The neurologist assigned her a diagnosis. She was referred to physiotherapy to complete a fall risk assessment, maintain her functional status, and address her worries regarding the condition. The question is, what might the diagnosis be?
Meaning and Overview
Parkinson's disease is a chronic condition affecting the neurological system and the physical components under the nervous system's control. Symptoms emerge gradually. The initial sign could be a slight tremble in only one hand. Although tremors are typical, the disease might make you stiff or move more slowly. The face may be expressionless in the initial phases, with speech becoming slurred or dull. As it advances over time, the symptoms get worse. Even though there is no cure for Parkinson's, medicines may greatly reduce symptoms. On rare occasions, doctors may advise surgery to control specific brain areas and alleviate symptoms.
Each person will experience the signs and symptoms of Parkinson's disease differently, and early symptoms could be negligible and overlooked. Nevertheless, after signs begin to impact the legs on both sides, symptoms frequently start solely on a single side of the physique and typically continue to be severe. Parkinson's symptoms and indicators include −
Tremors − The first limb to experience a quake, or cyclical trembling, is typically the hand or fingers. Both the thumb and forefinger can be wiggled, and the term "pill-rolling tremor" describes this. Even at rest, the hand could shake, which may diminish when undertaking activities.
Slower movements (Bradykinesia) − Parkinson's disease may cause movement to slow down over time, making routine actions challenging and time-consuming. E.g., steps can get smaller while walking, it could be challenging to get up from a chair, or the feet might be dragged while attempting to walk.
Inflexible muscles − There may be muscle tightness in any body area. The movement range may be restricted and made painful by the stiff muscles.
Impairment in balance and poise − Our posture could slouch. Parkinson's disease may cause us to trip or have balance issues.
Redundant involuntary movements − We may be less able to make unconscious gestures like smiling, blinking, or swaying our limbs when we stroll.
Changes in speech and writing − We might mumble, speak fast, slur, or pause before speaking. Our speech may lack traditional speech patterns and seem more monotonous, and it could get challenging to compose, and our handwriting might look cramped.
Certain brain nerve cells (neurons) eventually deteriorate or die in Parkinson's disease. A decrease of neurons that generate the chemical messenger dopamine in your brain is the cause of many symptoms. Dopamine deficiency results in abnormal brain activity, which worsens movement impairment and other Parkinson's disease symptoms. Although there is no known cause for Parkinson's disease, several factors, including −
Genes − Researchers have identified specific genetic alterations that can develop Parkinson's disease. These, however, are unusual unless several family members also have Parkinson's disease. A relatively low probability of Parkinson's disease exists for every one of these genetic markers, although some gene changes appear to raise the risk of the disorder.
Environmental Triggers − Parkinson's disease may develop later if exposed to specific poisons or environmental factors, although the risk is quite low. Researchers have also discovered that persons with Parkinson's disease experience several alterations in their brains, which is unclear why these changes occur. These modifications include −
There are Lewy bodies present
Microscopical indicators of Parkinson's disease include clumps of chemicals within brain cells. Scientists think they offer a crucial insight into what causes Parkinson's disease.
Lewy body alpha-synuclein was discovered.
Lewy bodies include a variety of chemicals, but scientists think that the naturally occurring protein known as alpha-synuclein plays a significant role. All Lewy bodies contain it in clumped form, which cells cannot degrade.
Age − Parkinson's disease is a rare occurrence among young adults, and it usually starts mid or later, and the threat increases as we age. The disease typically strikes people at 60 or older.
Heredity − The likelihood of developing Parkinson's disease increases if we have close family members with the condition. Unless several family members have Parkinson's disease, the odds are still minimal.
Sex − Parkinson's disease affects men more frequently than it does women.
Being exposed to pathogens − The risk of developing Parkinson's disease may somewhat rise if we are constantly exposed to pesticides and herbicides.
These additional issues, which are frequently present in patients with Parkinson's disease and may be treatable −
Thinking Challenges − Dementia and other cognitive issues could affect our ability to think clearly. These typically manifest in Parkinson's disease's later stages.
Emotional Alterations and Depression − Depression is a possibility, even in its very early phases. Treating depression may make it simpler to deal with Parkinson's disease's other difficulties. Other secondary emotions, such as dread, anxiety, or motivation loss, could also occur.
Issues with Swallowing − As the health worsens, swallowing issues can develop. Slow swallowing may cause saliva to build up in the mouth and cause drooling.
Eating and Chewing Issues − Chewing becomes challenging when Parkinson's disease is in its late stages because it impairs the mouth muscles. Choking and inadequate nourishment may result from this.
Sleep Difficulties − People with Parkinson's disease typically experience sleep issues, such as numerous night-time awakenings, early morning awakenings, or daytime sleepiness. Rapid eye movement sleep behavior disorder, which incorporates acting out dreams, can also affect people.
Bladder Issues − Parkinson's disease can result in bladder issues, such as an inability to control pee or trouble urinating.
Constipation − Constipation is a common symptom of Parkinson's disease and is mostly brought on by a sluggish digestive system.
Changes in Blood Pressure − A quick drop in blood pressure when we stand could make us feel faint or woozy (orthostatic hypotension).
Dysfunctional Odour − There could be issues with smell perception, including trouble distinguishing between smells or recognizing some.
Fatigue − Parkinson's disease patients frequently feel tired and low in energy, particularly late in the day. Sometimes the cause is unknown.
Pain − Parkinson's disease patients occasionally suffer discomfort locally or more widely distributed throughout their bodies.
Sexual Maladjustment − Some Parkinson's disease patients report diminished sexual arousal or performance.
Parkinson's disease is diagnosed by a neurologist, a medical professional trained to treat disorders of the nervous system, based on the medical record, an analysis of the clinical indicators, and a physical and neurological evaluation.
A dopamine transporter (DAT) scan is a particular single-photon emission computed tomography (SPECT) test that the doctor could advise. Symptoms and a neurological exam ultimately determine the accurate diagnosis. To rule out other disorders that could be the source of symptoms, the healthcare provider may request lab testing, such as blood tests. Imaging tests, like MRIs, brain ultrasounds, and PET scans, can also be done to help strike out other conditions.
The doctor may also prescribe the Parkinson's disease drug carbidopa-levodopa (Rytary, Sinemet, among others) and examination. Small amounts for a day or two are not trustworthy; a large dose must be received to demonstrate the advantage. The Parkinson's disease diagnosis will be confirmed if there is a significant improvement while using this medication.
Although there is no known cure for Parkinson's, drugs can frequently significantly reduce the symptoms. Surgery could be suggested in special cases with more severe conditions. Additionally, the doctor could advise adjusting to the way of life, including regular aerobic activity. Physical therapy that emphasizes equilibrium and flexibility is crucial in some circumstances. A speech-language pathologist can assist in addressing speech issues.
We may be able to manage our walking, mobility, and tremor issues with medication. These drugs boost dopamine levels or act as a dopamine replacement. Dopamine levels in the brain are low in those with Parkinson's disease. Dopamine, however, cannot be administered directly since it cannot penetrate the brain.
After starting Parkinson's disease medication, symptoms may noticeably improve. Nevertheless, as time passes, the advantages of medications typically fade or stop being as reliable. Usually, there is still good control over symptoms. The doctor might prescribe carbidopa-levodopa, inhaled carbidopa-levodopa, carbidopa-levodopa infusion, dopamine agonists, MAO B inhibitors, etc. Alternatively, surgery options such as deep-brain stimulation are available for severe cases.
While Parkinson's disease sounds debilitating and reduces an individual to a vegetative state, it usually cannot be anticipated. While numerous researchers are being undertaken to combat the ailments of this disease, it is rather saddening to acknowledge such a diagnosis knowing it will worsen over time and there is no sure-shot miracle cure. Therefore, the best people can do is support such individuals and provide a safe social environment that accepts and appreciates them individual despite their condition.
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