As Well As Movement Symptoms People With Parkinsons May Also Experience Other Symptoms Such As Anxiety In This Blog We Explore The Research Into This Challenging Symptom
Anxiety is a feeling of unease, worry, fear or dread, although it can feel different for everyone. Anxiety also has physical symptoms, which can include sweating, heart palpitations, breathlessness, dizziness, indigestion and nausea. Sometimes, people experience symptoms of depression as well as those of anxiety.
Everyone feels anxious occasionally, and different situations perhaps a trip to the dentist or a flight will cause different people to feel anxious. For most people, these anxious moments are few and far between and are over quite quickly. For someone who struggles with anxiety, these feelings can happen more often, last longer, and feel more intense.
Anxiety is a normal response when we find ourselves in a threatening or dangerous situation. It exists to help us fight an enemy or flee from danger. A surge of adrenaline makes our hearts beat faster, our breathing deeper and blood rush to our muscles preparing us to deal with a stressful situation. Now that we do less fighting and running from danger, this response can be activated inappropriately.
Whilst anyone can experience anxiety, it is estimated that at any given time, around 31% of people with Parkinsons will have significant symptoms of anxiety.
Im having really bad anxiety and panic attacks. Feel as though my world is shrinking and am becoming housebound.
Parkinsons UK Forum User
Can Anxiety Increase Tremors In Patients With Parkinsons Disease An Experimental Model
1 Department of Neuroscience and Behavioral Sciences, Faculty of Medicine of Ribeirão Preto, University of São Paulo , Ribeirão Preto, SP, Brazil.
2 Department of Gerontology, Center for Biological and Health Sciences, Federal University of São Carlos , São Carlos, SP, Brazil.
Institution where the study was conducted: University of São Paulo, Department of Neurosciences and Behavioral Sciences, Hospital das ClÃnicas, Ribeirão Preto Medical School, Ribeirão Preto, SP, Brazil.
Received: 10/26/16 Accepted: 06/10/2017
DOI: 10.1590/0101-60830000000126
Address for correspondence: Marcos Hortes N. Chagas. Universidade Federal de São Carlos. Centro de Ciências Biológicas e da Saúde, Departamento de Gerontologia. Rodovia Washington LuÃs, km 235, 13565-905 São Carlos, SP, Brazil. Telephone: +55 98145-2367. E-mails: ,
Abstract
Chagas MHN et al. / Arch Clin Psychiatry. 2017 44:85-8
Keywords: Parkinsons disease, anxiety, simulated public speaking test.
Introduction
Parkinsons disease is one of the most common neurological syndromes and is the main cause of Parkinsonism among older people. In Brazil, approximately 3.3% of the population above age 64 has PD1. Although diagnosis is based on motor symptoms , the presence of non-motor symptoms is common these symptoms potentiate the disability in PD and may have a major impact on the health and quality of life of patients2.
Methods
Local and participants
Measurements
The following parameters were measured:
Procedures
Results
Coping With Anxiety And Essential Tremor
If youre dealing with anxiety and essential tremor, you can take steps to better cope. EssentialTremor.org recommends the following steps:
- Therapy: Cognitive behavioral therapy can help you identify anxiety triggers and practice grounding techniques to stay calm. Therapy provides you with support while you deal with the uncertainties around essential tremor.
- Exercise: Not only can exercise improve your mood, but it can also reduce your stress.
- Avoid alcohol: Alcohol is a depressant and can worsen anxiety.
- Avoid smoking and coffee: Nicotine and caffeine are both stimulants that tend to make anxiety worse.
- Sleep: Getting enough sleep is another important step that can help you manage your anxiety. Sleep is critical for helping your body and brain function at optimal levels.
- Relax: Meditation, yoga, and visualization techniques can help soothe anxiousness.
In some cases, a doctor might prescribe an anti-anxiety medication to help those with chronic anxiety issues. There are some anti-anxiety medications that also might improve essential tremor symptoms. For example, benzodiazepines and beta-blockers are common anti-anxiety prescriptions that can also improve essential tremor. However, its not the only treatment option for dealing with essential tremor symptoms.
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Increased Feelings Of Anxiety Or Depression
Anxiety and depression have been linked to Parkinsons. In addition to movement problems, the disease can also have an impact on your mental health. Its possible that changes in your emotional well-being can be a sign of changing physical health as well.
If you are more anxious than usual, have lost interest in things, or feel a sense of hopelessness, talk to your doctor.
What Causes Parkinsons Disease
Parkinsons disease occurs when nerve cells in an area of the brain called the substantia nigra become impaired or die. These cells normally produce dopamine, a chemical that helps the cells of the brain communicate . When these nerve cells become impaired or die, they produce less dopamine. Dopamine is especially important for the operation of another area of the brain called the basal ganglia. This area of the brain is responsible for organizing the brains commands for body movement. The loss of dopamine causes the movement symptoms seen in people with Parkinsons disease.
People with Parkinsons disease also lose another neurotransmitter called norepinephrine. This chemical is needed for proper functioning of the sympathetic nervous system. This system controls some of the bodys autonomic functions such as digestion, heart rate, blood pressure and breathing. Loss of norepinephrine causes some of the non-movement-related symptoms of Parkinsons disease.
Scientists arent sure what causes the neurons that produce these neurotransmitter chemicals to die.
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What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms
Exercise: Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinsons disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didnt exercise or didnt start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.
Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinsons, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.
Preventing falls and maintaining balance: Falls are a frequent complication of Parkinson’s. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments whether medicines or deep brain stimulation are optimal and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.
Mood Changes In Parkinson’s
When faced with a diagnosis of Parkinson’s disease , it is understandable to feel depressed or anxious. But mood disorders such as depression and anxiety are clinical symptoms of Parkinson’s, just as are slowness of movement and tremor. In fact, up to half of all people with Parkinson’s may suffer from depression and/or anxiety at some point during the course of their disease. Like all symptoms of PD, mood changes are different for different people. Some people with depression feel sad and lose interest in things they used to enjoy, while others feel irritable and have difficulty sleeping. People with anxiety often feel overly worried or concerned, or say they are “on edge.”
The good news: Over the past decade, researchers have placed increasing focus on these aspects of PD, and today we have a better understanding of how to treat mood disorders in Parkinson’s.
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Can Parkinsons Disease Be Prevented
Unfortunately, no. Parkinsons disease is long-term disease that worsens over time. Although there is no way to prevent or cure the disease , medications may significantly relieve your symptoms. In some patients especially those with later-stage disease, surgery to improve symptoms may be an option.
Are The Symptoms Of Stress Similar To Those Of Parkinsons Disease
Many a times, in order to explain situations of stress and anxiety one may use terms like shaking in fear or frozen in fear. Such evidences stand evidence as the form of mimicry of some of the symptoms of Parkinsons disease. There are examples of reversible symptoms of Parkinsonism which were reported to occur during wars in Germany which mention of tremors manifested by many prisoners due to extreme exposure to stress. They were called by the name of war tremblers keeping in mind the incidence of war related to the symptoms.
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Brain Chemistry In Parkinsons Disease
Parkinsons disease is caused by a lack of dopamine production in the pars compacta region of the brain.
Dopamine helps to regulate the way a person moves. Reduced dopamine leads to the physical symptoms of Parkinsons disease.
Reduced levels of serotonin can affect a persons mood and may cause them to experience depression.
Can Stress Make Parkinsons Disease Worse
Stress is according to the researches, the pervasiveness of various diseases. There is ample evidence that the symptoms of Parkinsons disease worsen with stress. The impact of psychological stress on Parkinsons disease is essentially adversely negative, making the progression of the disease faster.
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What Treatment Is Available
There are many things you can do that may help to reduce feelings of anxiety. Learning how to relax, recognising triggers that make you anxious and regular exercise can all help to control anxiety. Reducing your intake of alcohol and caffeine , particularly late in the evening, may also help, as these can intensify anxiety symptoms.
What Are The Symptoms Of Parkinsons Disease
Symptoms of Parkinsons disease and the rate of decline vary widely from person to person. The most common symptoms include:
Other symptoms include:
- Speech/vocal changes: Speech may be quick, become slurred or be soft in tone. You may hesitate before speaking. The pitch of your voice may become unchanged .
- Handwriting changes: You handwriting may become smaller and more difficult to read.
- Depression and anxiety.
- Sleeping disturbances including disrupted sleep, acting out your dreams, and restless leg syndrome.
- Pain, lack of interest , fatigue, change in weight, vision changes.
- Low blood pressure.
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Identifying And Treating Depression
Between 17 to 50 percent of patients with Parkinsons have depression. Depression and Parkinsons have so many similar-looking symptoms that it is hard to tell the difference between them.
Its important to note, however, that depression is not a reaction to the disability. Rather, it seems to be related to the degeneration of specific neurons in Parkinsons disease itself.
Typical symptoms include:
What Are The Different Stages Of Parkinsons Disease
Each person with Parkinsons disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinsons disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset.
In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:
Early stage
Early symptoms of Parkinsons disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing.
Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.
Mid stage
Mid-late stage
Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.
Advanced stage
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Advancing The Understanding Prediction And Prevention Of Freezing Of Gait In Parkinson’s Disease
Up to 80 percent of people with Parkinsons disease will eventually experience freezing in place, a debilitating symptom precipitating falls and curbing peoples independence.
At the University of Waterloo, Assistant Professor Kaylena Ehgoetz Martens, a neuroscientist, studies whether anxiety helps cause or results from freezing of gait.
Previously, a lot of my work focused on whether anxiety was an underlying factor that led the brain to jam because of all this information it was trying to process, says Ehgoetz Martens.
Now, she wants to understand whether anxiety lies at the core of all of freezing of gait episodes, or only in a select subset in certain situations or in a certain subset of people.
Working with people who have Parkinsons, Ehgoetz Martens will show them pictures of environments that could cause freezing, as well as place them in virtual situations that could provoke freezing of gait. Shell measure their movements, heart, and brain wave activity during these virtual reality exercises to determine the role anxiety plays.
Ideally, at the end of this two years, were going to understand whether different subtypes of freezing of gait exist, and if people need different treatment strategies, we can make different recommendations.
In one exercise, for example, people will walk across a virtual high plank versus a flat surface. Another virtual scenario would see them maneuvering across thresholds or around corners in an apartment.
Medication Not Working The Way It Used To
In the early stages, taking medicine works well to get rid of symptoms. But as Parkinsons progresses, your medication works for shorter periods of time, and symptoms return more easily. Your doctor will need to change your prescription.
Dr. Valerie Rundle-Gonzalez, a Texas-based neurologist, says to pay attention to how long your medicine takes to kick in and when it stops working. She says you should feel like symptoms significantly improve or are almost gone while on medication.
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Parkinsons Disease And Depression
Parkinsons disease is a progressive neurodegenerative disorder that affects about 1% of individuals over the age of 65 and is characterized by severe loss of dopaminergic neurons in the nigrostriatal pathway, resulting in motor dysfunction . The exact etiology of PD is currently unknown, but the greatest risk factor for the disease is aging. While the cardinal motor symptoms of resting tremor, bradykinesia, postural instability and rigidity are the most identifiable manifestations of the disease, a plethora of non-motor symptoms may be present as well. One of the most common comorbidities is depression . The most commonly cited prevalence of depression in PD is between 4050% of all PD cases . While the elderly overall have an elevated risk of depression compared to the general population , there is a considerably enhanced risk of depression in PD. Depression in PD has adverse effects on the quality of life of Parkinsons patients and is one of the most disabling aspects of the disease . Depression is also associated with worsened motor function and increased disease severity that directly impacts daily living . However, though the rates of suicidal ideation are elevated in depressed PD patients, actual suicide attempts are uncommon .
What Are The Surgical Treatments For Parkinsons Disease
Most patients with Parkinsons disease can maintain a good quality of life with medications. However, as the disease worsens, medications may no longer be effective in some patients. In these patients, the effectiveness of medications becomes unpredictable reducing symptoms during on periods and no longer controlling symptoms during off periods, which usually occur when the medication is wearing off and just before the next dose is to be taken. Sometimes these variations can be managed with changes in medications. However, sometimes they cant. Based on the type and severity of your symptoms, the failure of adjustments in your medications, the decline in your quality of life and your overall health, your doctor may discuss some of the available surgical options.
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Other Complementary Therapies For Anxiety In Pd
Complementary therapies are a growing group of treatments which may improve the symptoms of PD without medication. I have written past blogs on two complementary therapy approaches for several symptoms of PD art therapy and music therapy.
Various complementary therapy modalities have been developed that may lower stress and anxiety in PD. These include yoga, massage, the Alexander technique, neurofeedback and others. Some of these therapies have been studied in small trials with data suggesting that they may be helpful for the anxiety of PD. Others have not yet been studied, although anecdotally, people with PD may feel that they are very useful in combatting anxiety. In general, this group of therapies may be effective for the anxiety of PD but needs to be studied more rigorously.
Is Parkinsons Disease Inherited
Scientists have discovered gene mutations that are associated with Parkinsons disease.
There is some belief that some cases of early-onset Parkinsons disease disease starting before age 50 may be inherited. Scientists identified a gene mutation in people with Parkinsons disease whose brains contain Lewy bodies, which are clumps of the protein alpha-synuclein. Scientists are trying to understand the function of this protein and its relationship to genetic mutations that are sometimes seen in Parkinsons disease and in people with a type of dementia called Lewy body dementia.
Several other gene mutations have been found to play a role in Parkinsons disease. Mutations in these genes cause abnormal cell functioning, which affects the nerve cells ability to release dopamine and causes nerve cell death. Researchers are still trying to discover what causes these genes to mutate in order to understand how gene mutations influence the development of Parkinsons disease.
Scientists think that about 10% to 15% of persons with Parkinsons disease may have a genetic mutation that predisposes them to development of the disease. There are also environmental factors involved that are not fully understood.
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