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Conditions Explained:
Parkinson's

Parkinson’s is a neurological condition caused by a lack of a neuro-chemical in the brain called dopamine, which is depleted because some of the nerve cells in the brain have died. Without dopamine people can find that their movements are slower and it takes longer to do things. 

Despite intense research efforts around the world, the molecular causes of Parkinson’s disease are still unclear. What doctors and scientists do know is that Parkinson’s is caused by the progressive loss of dopamine brain cells (neurons) in a part of the brain called the substantia nigra, which produces the chemical dopamine. As the cells die, less dopamine is produced and transported to the striatum, the area of the brain that co-ordinates movement.

Parkinson’s and dementia 

Dementia occurs in up to 40% of people with Parkinson's disease, a rate about six-times higher than that in healthy individuals. 

The memory impairment is progressive and often presents as slow thinking, difficulty learning new behaviours and completing complicated tasks, impaired interpretation of the visual environment and poor “memory”. As with many forms of dementia, the progression of these problems leads to difficulties in day-to-day life and so an increased level of care and support is essential. 

Just as important as medical treatments, and in many cases, more important is that the person living with Parkinson’s disease and associated dementia is looked after in a familiar environment by familiar carers who understand their needs.

Who does it affect?

Parkinson’s is thought to affect around 120,000 people in the UK. It is generally considered to typically affect older people, however, it is estimated that 1 in 10 people are diagnosed with Parkinson’s before the age of 50. One in twenty people are under the age of 40.

Parkinson’s disease affects both men and women but occurs about 50% more in men than women. The average age for the onset of Parkinson’s is 60 years old, however 5 – 10% of cases, called “early onset,” begin as early as 40 years old

What are the symptoms?

The main motor symptoms of Parkinson’s include tremor, rigidity and slowness of movement. However there are also a range of non-motor symptoms including tiredness, pain, depression and constipation. Symptoms fluctuate and differ widely between people. There is no known cure for Parkinson’s at the moment and little understanding of the cause. However there are a range of treatments and therapies available which help people manage their symptoms. 

How is it diagnosed?

Current evidence suggests that Parkinson’s tends to develop gradually and it may be many months, even years, before the symptoms become obvious enough for you to seek medical advice. 

Confirming someone has Parkinson’s can take some time as there are other conditions such as essential tremor with similar symptoms. Also there are currently no definitive tests for diagnosing Parkinson's. The majority of people with Parkinson’s are diagnosed by a specialist asking them about their symptoms and examining them.

How is it treated?

Medications management

Drug treatment is the main method used to control the symptoms of Parkinson's. Drug treatments aim to increase the level of dopamine that reaches the brain and stimulate the parts of the brain where dopamine works. Drug treatment for Parkinson's is prescribed to suit the individual. Each person will react to their medication in different ways. 

There are many different drugs prescribed for Parkinson's, none of which are perfect, but research into treatments is improving the options all the time. Every person with Parkinson's has a different experience of the condition.  A GP, specialist or Parkinson's nurse will aim to find the treatment that is best for the individual. Drugs will be reviewed over time to make sure the best combination is prescribed for the individual as the condition progresses.  It is vital that medications are taken exactly as prescribed, and each individual will have a unique regime which has been designed to work for them. 

Deep Brain Stimulation 

Deep brain stimulation involves implanting leads, which have electrodes at the end, into one of three target sites in the brain.  A small electric current will be sent through the leads to test how the person's symptoms respond to medication, to make sure they have been put in the right place.

The leads are connected to extensions that are tunnelled under the skin behind the ear and down the neck. They are then connected to a neurostimulator (a device like a pacemaker), which is placed under the skin around the chest or stomach area. 

Someone with a device fitted will be given instructions on how to use their own programmer. This will allow them to adjust the stimulation and check the battery life.  The stimulator may continue to be adjusted over a period of time.  It may take several months to fully programme the stimulator and adjust Parkinson's medication to get the most benefit from this treatment. 

Therapies 

Physiotherapists will support a person with Parkinson’s by assessing their movement and function.  They will give advice, education and support in keeping health and fitness levels high and on improving or maintaining balance and posture. 

Occupational therapy can help people to stay independent, carry on with hobbies and interests and deal with changes in abilities, such as handwriting, managing paperwork, using a computer and organising routines. It can help you to continue carrying out tasks such as doing up buttons and dressing, as well as eating and drinking. 

A speech and language therapist can support with problems such as slurred, hoarse or unsteady voice, or a quieter voice than it used to be. Some people with Parkinson’s also find their voice can sound monotonous. It may be hard to control the pace of speech, for example, some people may talk more slowly or more quickly than they used to.It can also become more difficult to talk clearly while doing other tasks or activities at the same time.  Chewing and swallowing problems can also occur and can be helped by a speech and language therapist.

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