Tips to stay healthy

Parkinson’s disease (PD) mainly develops in people over the age of 50. It becomes more common with increasing age. About 5 in 1,000 people in their 60s and about 40 in 1,000 people in their 80s have PD. It affects both men and women but is a little more common in men. Inherited (genetic) factors may be important in the small number of people who develop PD before the age of 50.

Many parts of the world including India where the age expectancy is improving will see an increase in number of PD cases. The brain cells and nerves affected in PD normally help to produce smooth, coordinated movements of muscles mediated by a chemical called Dopamine. There are three common PD symptoms that gradually develop include:

• Slowness of movement (Bradykinesia). For example, it may become more of an effort to walk or to get up from a chair. When this first develops you may mistake it as just 'getting old'. The diagnosis of PD may not become apparent unless other symptoms occur. In time, a typical walking pattern often develops. This is a 'shuffling' walk with some difficulty in starting, stopping and turning easily.
• Stiffness of muscles (rigidity) and muscles may feel tenser. Also, your arms do not tend to swing as much when you walk.
• Shaking (tremor) is common, but does not always occur. It typically affects the fingers, thumbs, hands and arms but can affect other parts of the body. It is most noticeable when you are resting. It may become worse when you are anxious or emotional. It tends to become less when you use your hand to do something such as picking up an object.

Some other symptoms may develop due to problems with the way affected brain cells and nerves control the muscles. These include:

• Fewer facial expressions such as smiling or frowning. Reduced blinking.
• Difficulty with fine movements such as tying shoelaces or buttoning shirts.
• Difficulty with writing (handwriting tends to become smaller).
• Difficulty with balance and posture and an increased tendency to fall.
• Speech may become slow and monotonous.
• Swallowing may become troublesome and saliva may pool in the mouth.
• Tiredness and aches and pains.

Most people with PD can expect to have some time of relatively mild symptoms. As the symptoms become worse, they can expect several years of good or reasonable control of the symptoms with medication. But everyone is different and it is difficult to predict for an individual how quickly the disease will progress.

Some people may only be slightly disabled 20 years after PD first begins, whereas others may be highly disabled after 10 years. In the initial stages of PD reasonable activity can be maintained as permissible. But later part as it advances, physical activity can be quite restricted.

Most treatments to combat PD works by increasing Dopamine levels.

• Increasing the amount of dopamine in the brain: Levodopa is a very potent drug with good effect on Bradykinesia and rigidity with little effect on tremor. But most dreaded complication is abnormal moments (dyskinesia). During later part of disease it can worsen confusion, hallucination.
• Acting as a substitute for dopamine by stimulating the parts of the brain where dopamine works (Ropirinole&Pramipexole) also Amantadine. Dopamine agonist is particularly preferred in young patients. Slightly lower in potency compared to levodopa but Impulsive and compulsive behaviour is the main limiting side effect.
• Central Anticholinergic (Trihexyphenidyl): used to control tremor but no action on rigidity and Bradykinesia. It can worsen confusion, constipation and urinary retention.

For people afflicted with PD constipation is a common problem. Having lot of fluids and eating plenty of vegetables, fruit, and foods high in fibre can reduce this. Exercise can also improve constipation. Sometimes laxatives may be needed to treat constipation.

In some people, protein (which is found mainly in meat, fish, eggs, cheese, yoghurt, nuts, beans and pulses) may interfere with the effects of their Levodopa medication. Hence, it is generally advised that you should take your Parkinson's medication at least 30 to 45 minutes before a meal. Written by Consultant Neurologist, Gleneagles Global Hospitals, LB Nagar, Hyderabad.

By Dr Rahul Konduri