1. PARKINSONS A GUIDE FOR THE NEW PATIENT supported by theNeurological Foundation
2. INTRODUCTIONContents The diagnosis of Parkinsons is often unpleasant news. Usually a patient leaves the doctors clinic 1. Introduction remembering only a few points - the diagnosis and 2. Parkinsonsperhaps one or two other facts that may not even 3. The main symptoms of Parkinsons be particularly relevant. After the news has sunk in, 6. What causes Parkinsons? most people want to know more about Parkinsons, 7. How does Parkinsons develop?how can it be treated and what is the outlook. 8. Treatment of Parkinsons This booklet is designed to provide you with this 10. Medications for the treatment of Parkinsonsinformation. The rst part of the booklet describes 13.The future Parkinsons. The middle part describes non-medical treatment, and the nal part describes medical 14.Parkinsons New Zealand treatments for Parkinsons. 1. If you have any questions about any of theinformation in this booklet, please refer to yourfamily doctor or specialist, or contact Parkinsons This booklet has been produced for New Zealanders who have New Zealand at the address on the back cover just been given a diagnosis of Parkinsons disease. The contentof this book. of the booklet is based on the discussions and questions that 2. Your doctor or specialist is the person who is have arisen in the Movement Disorders clinic when we have told our patients about Parkinsons. in the best position to make decisions about This is the fourth edition of the book with changes to reectthe medications that best suit your particular new developments.condition. If you have any questions about any Dr Barry Snow, Neurologist, Lorraine Macdonald, Movement medications including those for Parkinsons, 1 Disorder Nurse, Auckland Hospital. April 2008. please talk to your doctor or specialist.
3. PARKINSONS Parkinsons has probably always affected humans. this can interfere with handwriting, which becomes We have some accounts from Roman times thatsmall. Other people develop a stooped posture or a could do for descriptions of Parkinsons. The rst reduction in arm-swing when they are walking. Other authoritative, medical description was by Dr James people develop a sense of increased fatigue, making Parkinson in 1817 in a paper describing many tasks take longer and seem more of an effort. Often features of the condition. Since that time manythese changes are noticed by a family member or, doctors and scientists have taken an intense interestsometimes, by a new doctor or locum for the family in Parkinsons, and we now know more about it than doctor. This is because Parkinsons develops so slowly any other degenerative condition of the brain. that people who see the person every day may miss Parkinsons is quite common. Over the wholethese small changes. population between 1-2 people in a thousandApproximately 80% of people with the symptoms have the condition. It becomes more common of Parkinsonism have Parkinsons. There are a with older age groups however, and perhaps 1%number of other conditions that can resemble of people above the age of 60 have Parkinsons.Parkinsons. These conditions include medication- Nowadays, with good medical treatment, Parkinsons induced Parkinsonism, Multiple System Atrophy generally has only a small effect on life expectancy.(MSA) (previously known as Shy-Drager syndrome) However, it can be disabling. With a positive outlook, and Progressive Supranuclear Palsy (PSP). These good medical care and good support from otherconditions are less common than Parkinsons, and resources, most people with Parkinsons can lead a sometimes they can be difcult to distinguish in the productive life for many years.early phases. For this reason, in a number of people The condition develops very slowly, and it may be athe diagnosis of Parkinsons may be revised after a while before the diagnosis can be made with certainty. few years. Fortunately however, the initial treatments Some people initially develop a tremor, which becomesof these different conditions is usually the same, obvious and often leads them to the doctor. Otherand therefore time is not lost if the diagnosis must people notice mild clumsiness of a limb. Sometimes be changed.2
4. THE MAIN SYMPTOMS OF PARKINSONSTremor of lacking emotion, not being interested in other people, or looking serious and not smiling. When the About three quarters of people develop a tremor atbradykinesia affects body movements the person has the onset of their illness. However, a number of people difculty rolling over in bed or sometimes getting never develop tremor throughout the course of their out of a chair. Bradykinesia in the limbs affects Parkinsons. The important feature of the tremor is that it tends to occur when the limb is relaxed. rapid movements. This is particularly noticeable The tremor tends to disappear while performingwith alternating movements such as cleaning teeth tasks such as writing or drinking from a cup. or combing hair. People with bradykinesia of the For this reason the tremor is frequently not particularly hands develop a distinctive change in handwriting disabling, although it can be embarrassing. where the letters get progressively smaller and less legible as the writing proceeds across the page.Stiffness Stiffness or rigidity is often detected by the Loss of balance examining doctor. These symptoms can contribute This tends to occur later in Parkinsons. Sometimes to deep aching sensations felt in the limbs.there is some difculty getting out of a deep chair or a low car seat. As the condition progresses, the Slowness of movementperson becomes less able to compensate for a mild This is also known as bradykinesia. It can affect loss of balance when walking on rough ground and various parts of the body. One of the early signs may tend to fall forwards. Sometimes to compensate of Parkinsons is a at or expressionless face. Thisfor this the feet move forward quickly to produce a 3 can sometimes give the person the appearancepeculiar running walk.
5. Other symptoms of constipation, in Parkinsons this must be done cautiously as the bowel may not have the strength The four main symptoms described on page 3 areto move the extra bulk. Often people need to treat characteristic of what is known as Parkinsonism.themselves with exercise and extra uid along with People with Parkinsons often suffer other symptoms stimulating agents such as fruit extracts. Sometimes however. These often go unrecognised despite thea special laxative such as lactulose is necessary. fact that they can be more annoying than the main symptoms. Some symptoms are curious such as the Tiredness loss of sense of smell that can occur many yearsFatigue, daytime sleepiness and a loss of motivation before the onset of other symptoms of Parkinsons.can be common symptoms for people with Parkinsons. Other symptoms can include the following. Some nd the tiredness can be improved with regular exercise and rest. When tiredness is prominent, people Skin sensations and painoften have to be careful not to take on too many Many people develop unusual skin sensations.responsibilities or tasks that they cannot complete. These are often electric or tingling sensations of the limbs. They are often more prominent at night. Depression Some people develop unusual aches and pains.Approximately one third of people with Parkinsons Sometimes these can be particularly severe. Some of develop depression at some time during their illness. the pains occur in the morning and relate to a lack Depression can sometimes precede the diagnosis of of medication overnight. Other pains develop when Parkinsons . The depression can also be associated the medication is at its peak. Often these pains arewith anxiety, which occasionally is severe. misdiagnosed as arthritis. The frequency of depression in Parkinsons is greater Constipationthan would be expected in people with other chronic illness. For example, there is much less depression in Constipation is very common in Parkinsons. This is people with heart disease. The increase in depression caused by a reduction in the ability of the bowel in Parkinsons is probably related to chemical changes to contract. While eating bran to increase the bulk in the brain, similar to the chemical changes that of the bowel motion is important for most causesproduce the Parkinsons itself.4
6. The depression of Parkinsons has traps for both The important point is to recognise the possibility of patients and doctors. Many of the symptoms ofdepression and bring it to the attention of your doctor. Parkinsons: namely the slow movement, the poor energy and disruptive sleep, are very similar to those Sleep disturbance of depression and can mask the true diagnosis ofMost people develop some form of sleep disturbance. depression. Often people think that the symptomsThis can include interruption of sleep by tremor, of depression are caused by under treatment, andpain or difculty rolling in bed. this can lead to inappropriate increases in the dose of the anti-Parkinsonian pills.Other people develop a more distinctive sleepdisturbance. The most striking of these is rapid A number of symptoms can point to the developmenteye movement (REM) sleep behaviour disorder. of depression. These include a disturbance of sleep,In this condition, the person acts out vivid dreams. a lack of energy, a feeling of hopelessness or lack ofThey may run, punch or kick as they dream about optimism, poor concentration and forgetfulness, aghting a wild animal or other assailant. The spouse change in appetite and feelings of sadness.often bears the brunt of the attack! REM sleep The depression associated with Parkinsons respondsbehaviour disorder is worth discussing with your to standard anti-depressant treatment and usuallydoctor as it can be treated with low doses of the requires medication. medication clonazepam. 5