Parkinson’s disease is a progressive neurological condition where part of the brain, called the substantia nigra, degenerates and that is the area of the brain that produces dopamine, and dopamine is needed to enable us to move smoothly and automatically. When there is not a lot of this chemical in the body, then patients will present with slowness, stiffness, and about 25% will show a tremor. The symptoms, as I say, will be stiffness, slowness of movement, and tremor. Often, their posture is affected and they become flexed, bent over, a stooped posture. Sometimes when you see them walking, they kind of walk more on their balls of their feet and have what are called a shuffling, festinating gait. And often going through busy places like doorways, they can get a bit stuck, as their feet, what we call, festinate and stop moving a bit.
Diagnosis, again, should be done by a neurologist. There is one test they can do, called a DaTSCAN, where this dye shows up whether that part of the brain has been… It has degenerated. A lot of people will have to get MRIs to check there is nothing else causing the problem, but the diagnosis is usually by history and examination of the patient. Often, if Parkinson’s disease is diagnosed, then patients are started on medication. If that medication is effective, then that is a good indication that it is Parkinson’s disease. The mainstay of treatment is treatment with a medication called levodopa. So there are different formats of this, Sinemet and Madopar are the two main ones, but there are lots of other drugs out there as well. Younger people will be started on slightly different drugs, but it is very much the choice of the consultant that sees the patient, what will be best for the patient to be started on. There is a medication that is believed to be a bit neuro-protective, which may help slow things down, but most of the medication is there to replace the missing dopamine.
Most areas would have a Parkinson’s disease nurse specialist. These specialist nurses will see patients in clinic, sometimes at home, to support them with the diagnosis and the different symptoms they are having, monitor their medication, and often would refer into other professionals who may help the patient. So these other professionals could be people like myself; as a physiotherapist, we play an important role in recommending people keep active. So a diagnosis of Parkinson’s is not a reason to stop, it is actually a reason to get active. To encourage patients to keep active. If they are doing golf or sport, to keep doing it, so they want to have an active life. We will do exercises to improve their posture, their ranges of movement, and their balance, and a lot of physiotherapists, certainly on our team, will review them regularly to make sure they are doing the right exercises.
Occupational therapists can play an important role. A lot of people with Parkinson’s have difficulty with what we call automatic movements, so things like getting in and out the bed, in and out the bath, those sort of things can become difficult. Bits of equipment provided by the occupational therapist, such as a bed stick, a rail by the bed, or toilet rails can make a real difference.
Speech and language therapists can also help. A lot of people with Parkinson’s, their voices can become a quite low volume and quite slurred, so speech and language therapists can teach them techniques to improve their speech, and also they may have problems with swallowing as well, so the speech and language therapist can advise on techniques to improve this.
The prognosis, my understanding is, it is a normal life expectancy, so Parkinson’s per se does not shorten life. However, obviously, if a patient was to get a chest infection or fall, unfortunately a lot of people with Parkinson’s disease do fall, and if they fall and break a hip, then obviously that can affect their mobility, and could affect not only their quality of life, if they are less mobile, it may shorten life.
In the UK, about 120,000 people have Parkinson’s disease. And certainly, in our team, we know about 500 or 600 patients with Parkinson’s in this northeast Essex area, which is a similar number to multiple sclerosis. Whereas other conditions like motor neurone disease, we have about 30 patients at any one time with this condition.
For more information on Parkinson’s Disease, we have a video online course available at www.protrainings.eu/courses