Parkinson's disease: symptoms, progression, and patient coping strategies

Parkinson's Disease: A Patients Perspective

Being diagnosed with a progressive neurological disease is never easy for a patient or family member. Recently my father was diagnosed with Parkinson's disease. A proud man, it took a lot of strength and courage initially to admit that something was wrong. Because Parkinson's is a progressive disease there is a strong likelihood that my father's symptoms will get worse as time goes on.

Though there is no cure, there are a number of treatments currently available to help reduce the signs and symptoms of this insidious disease. Below you'll find not only a description of the primary symptoms and physiology of the disease, but also tips to help patients and caregivers cope with a diagnosis of a chronic illness.

Signs and Symptoms

The primary symptoms of Parkinson's include tremors, muscular stiffness or rigidity and a conditions called bradykinesia (Henkel, 1998; PDS, 2005). Tremors involve shaking that typically occurs in the hands and arms. Usually these tremors occur when a person is at rest, feeling anxious or strenuously taxed. The tremors decrease slightly when the affected area of the body (such as the hands or arms) are in use. Many patients with Parkinson's, up to 70% in fact, have tremors (PDS, 2005). Tremors are more often noticeable in older patients diagnosed with the disease than in younger ones.

Muscular rigidity may result in difficulty moving, turning over or performing fine motor skills tasks (Henkel, 1998; PDS, 2005). For others rigidity and stiffness may make correct posture difficult. Some patients with Parkinson's will experience facial tightening or stiffness. Rarely muscle stiffness can result in pain and discomfort.

Bradykinesia refers to the lessening coordination and slower movements often associated with Parkinson's disease (PDS, 2005). Patients with Parkinson's often find that it takes more time to perform common movements (like walking or moving from one location to another). Other symptoms associated with the disease vary from person to person. My father found that he started having difficulty handwriting letters and communicating with people using certain facial expressions. Tremors did not occur until several years into his diagnosis.

Who's At Risk

Most people develop key symptoms of Parkinson's well after their 40s and 50s, however people as young as 30 are diagnosed with Parkinson's. When Parkinson's occurs in patients prior to the age of 40 it is referred to as "young onset" Parkinson's (PDS, 2005).

Studies suggest that as many as 4 million people globally suffer from Parkinson's (PDS, 2005). At this time the exact number of patients suffering from the illness is not certain as many people have symptoms of Parkinson's early on without realizing their condition is deteriorating. Usually Parkinson's disease creeps up on people. An individual may gradually begin noticing symptoms over a slow period of time. A person may for example realize they have a small tremor that comes and goes with certain activities. Others may realize more muscle stiffness or rigidity with time. Parkinson's does not manifest the same in all people, thus it is difficult to generalize how one person will experience symptoms vs. another.

Causes

At this times researchers believe that decreasing amounts of dopamine in the brain may contribute to Parkinson's disease. Studies suggest that dopamine works in synergy with a chemical called acetylcholine in the body to transmit important messages from nerve cells to the muscles and brain (PDS, 2005). When these chemical "messengers" are imbalanced people have difficulty coordinating muscle movements (PDS, 2005). Other factors researchers suggest may contribute to the disease include environmental factors, viruses and possibly genetics (PDS, 2005; Gao, Hong & Liu, 2003). More research is necessary in this area to identify the specific causes of the disease.

Emotional Impact of Parkinson's

While Parkinson's disease itself will not kill a person, many people find the disease gradually impacts their physical and mental well being (PDS, 2005). Diagnosis with a progressive illness is difficult for any person of family to deal with. Fortunately there are a number of treatments currently available that can help improve the symptoms patients experience from their disease. This alone may help improve a patient's quality of life. Drug treatments are sometimes combined with other therapies including speech or language therapy for patients with facial rigidity or stiffness, physiotherapy and even occupational therapy to help patients continue to work despite their condition (PDS, 2005). Many patients also find support networks vital toward their mental health and well being after diagnosis.

Patients with Parkinson's will flourish the most when they have a firm network of friends, family members and health care providers they can lean on for support and understanding. This is particularly the case for young people diagnosed with Parkinson's who often find their condition more burdensome. It is not difficult to see why someone diagnosed with Parkinson's may feel their life is over. Diagnosis with a progressive illness definitely impacts ones quality of life. Fortunately with proper support channels and treatments many patients can overcome these obstacles to lead relatively normal lives.

Family members of patients with Parkinson's or any other progressive illness for that matter will also need support. Children of family members with Parkinson's, particularly young children, often find it difficult to understand why their parents aren't able to enjoy some of the activities they used to. Some patients also have extensive concerns about their ability to carry out daily functions or retain gainful employment. The good news here is patients with Parkinson's have rights and benefits under the law. The American's with Disabilities Act protects patients with disabilities in the workplace. Many employers are required to make accommodations so that patients with progressive illnesses or disabilities are able to maintain meaningful jobs at their companies. Occupational therapy programs can often help patients with Parkinson's gain back the self-respect and dignity they need to carry on in their work and personal life.

While full blown Parkinson's is often considered a 'crippling or disabling disease" many of the early years when a patient is diagnosed are filled with very subtle symptoms that may not impact a person's ability to thrive even minimally (Henkel, 13). Some patients continue to experience symptoms that are so mild they attribute them simply to the process of aging (Henkel, 1998). Family members sometimes recognize symptoms before a patient might. One patient for example reported feeling remarkably well until his wife "noticed he had stopped swinging his right arm when walking" (Henkel, 13).

Patients should keep in mind that Parkinson's is sometimes diagnosed or mistaken for other conditions like arthritis. Muscle stiffness and rigidity or pains for example are often symptoms of other age related diseases. It is important that patients and family members work together to find a competent physician and ensure they get a proper diagnosis. Early treatment can help extend a patients quality of life particularly in the early stages of the disease. Fortunately my father's symptoms early on have been quite mild thus far. With the exception of some slight tremors in the hands now, my father exhibits relatively few of the debilitating or crippling symptoms associated with Parkinson's. Though this may change with time, our hope is that new therapies and treatments will soon be discovered to extend and continue to improve the quality of life for patients with Parkinson's disease far into the future.

It is also important that family members and patients are realistic in their treatment expectations (Kindracke, 2001). Parkinson's is a progressive disease that some find crippling and debilitating as life goes on. Many patients grow to resent their bodies for "betraying them" as time goes on (Kindracke, 2001). Again however, the best steps a patient and family member can take to conquer this disease are to live life to the fullest each and every day they are able to.

Conclusions

It is never easy for a patient to be diagnosed with a progressive disease. Parkinson's for many may result in a crippling and life threatening condition. Fortunately patients with a progressive illness, even one as seemingly insidious as Parkinson's may expect to lead a reasonable quality of life in many circumstances. Seeking out treatment early on will help minimize the impacts of the disease and help a patient enjoy life to the best ability possible until they are not able to. When it comes to Parkinson's, as with any other chronic disease, regardless of the negative effects there is always hope. As long as researchers continue to explore new avenues for treatment patients will always have the hope that there will one day be a cure for this mysterious disease. As my father will tell you, hope is everything.