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 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.
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.
What Is Parkinson’s Disease
Parkinson’s disease affects the way you move. It happens when there is a problem with certain nerve cells in the brain.
Normally, these nerve cells make an important chemical called dopamine. Dopamine sends signals to the part of your brain that controls movement. It lets your muscles move smoothly and do what you want them to do. When you have Parkinson’s, these nerve cells break down. Then you no longer have enough dopamine, and you have trouble moving the way you want to.
Parkinson’s is progressive, which means it gets worse over time. But usually this happens slowly, over many years. And there are good treatments that can help you live a full life.
The Lee Silverman Voice Treatment
The Lee Silverman Voice Treatment is the first speech treatment for PD proven to significantly improve speech after one month of treatment.
- Exercises taught in the LSVT method are easy to learn and typically have an immediate impact on communication.
- Improvements have been shown to last up to two years following treatment.
- LSVT methods have also been used with some success in treating speech and voice problems in individuals with atypical PD syndromes such as multiple-system atrophy and progressive supranuclear palsy .
- Must be administered four days a week for four consecutive weeks.
- On therapy days, perform LSVT exercises one other time during the day. On non-therapy days, perform LSVT exercises two times a day.
- Once you complete the four-week LSVT therapy, perform LSVT exercises daily to maintain your improved voice.
- Schedule six-month LSVT re-evaluations with your specialist to monitor your voice.
- If available in your area, participate in a speech group whose focus is on thinking loud.
- A Digital Sound Level Meter can help you monitor voice volume. Place the meter at arm distance to perform the measurement. Normal conversational volume ranges between 68-74dB.
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Clinical Evaluation To Assess Breathing Abnormalities
A physician should evaluate shortness of breath and any other breathing abnormalities. Potential causes of breathing difficulty include heart and lung conditions, which should be ruled out. People with PD often see general practitioners for medical care in addition to neurologists. It is important for such providers to be aware that PD and associated medications can cause shortness of breath.3
Origins Of Breathing Disorders
The book by Leon Chaitow and co-authors cited above explains how breathing disorders are intrinsically linked to chronic stress and anxiety. The shallow, fast chest breathing through the mouth is a hallmark of the body preparing itself for the exertion of flight or fight due to a stress response. While this adaptive in acute stress situations, when stress is chronic and the body is spending a lot of time in fight or flight, the associated pattern of breathing becomes habitual, and eventually the system gets stuck in the new equilibrium of the CO2 intolerant state. However, the vicious circle work both ways, because overbreathing itself puts the body into a stress response state and feeds anxiety. A very good tutorial about the two way links between anxiety and breathing patterns is given by Robert Litman in the video below.
It is not surprising therefore that people with PD can present with disordered breathing associated with chronic stress and anxiety, since there are very significant overlaps between the other symptoms of chronic stress and those of Parkinsons Diseases, and ingrained fight or flight behaviours are common to the pre-diagnosis background histories of people with PD. Conversely, it is important to note that techniques which have been developed to treat breathing disorders should also help to decrease the symptoms of PD, including reduction of anxiety and increasing resilience to stress.
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Production Of Dopamine Neurons From Stem Cells: Could We Be One Step Closer To The Cure
As the disease progresses, people may experience reduced quality of life, if normal functions such as swallowing, start to be affected. Currently, there is no known cure for Parkinsons disease. Once Parkinsons is diagnosed, the symptoms can often be treated with medications and therapies, especially in the early stages. However, the scientific community is making every effort to find a way to cure or at the very least find more effective ways to lessen the symptoms of this physically impairing disease.
As we mentioned before, the disease primarily affects dopamine-producing brain cells or neurons. The good news is, scientists in Sweden have identified some insights and a set of markers that should help control the quality of stem cells engineered for clinical use to treat Parkinsons disease. As the disease progresses and dopamine-producing brain cells malfunction and die, it leads to lower levels of dopamine, which is a chemical messenger essential for controlling movement. These findings should help fine-tune stem cell engineering to produce pure populations of high-quality dopamine neurons. Then, a pool of progenitor cells can be transplanted into the brains of patients, so they can make new supplies of dopamine cells.
But while this exciting new research is still in the lab, what else can we hope for to delay the symptoms of Parkinsons and improve the quality of life of those suffering from the disease?
How Are Speech Problems Treated
There are many options to help improve your speech. A speech-language pathologist can help you pick the right approaches for you. Speech-language pathologists are trained health care professionals who specialize in evaluating and treating people with speech, swallowing, voice, and language problems.
Ask your doctor for a referral to a speech-language pathologist. It is also important to contact your health insurance company to find out what therapy and procedures are eligible for reimbursement and to find a list of SLPs covered by your plan. Finally, visit a SLP who has experience treating people with PD.
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Breathing & Respiratory Difficulties
Some people with Parkinsons disease may experience shortness of breath. There is no clear cause underlying respiratory dysfunction in PD, its frequency or the effect that medications have on respiration. Several reasons for shortness of breath in PD include:
- Wearing off is a common experience among people with PD who have been taking levodopa for several years. These occur when the medication benefit wears off and PD symptoms return before the next dose.
- Respiratory dyskinesia refers to an occurrence of irregular and rapid breathing when levodopa medications reach their peak effect. These may accompanied by involuntary body movements, typically experienced as dyskinesia.
- Anxiety is a common symptom of PD that may also exacerbate shortness of breath, whether by itself or as a consequence of wearing off of the medication.
- Aspirationpneumonia is a pneumonia that develops after food or liquid goes down the wrong pipe. Advanced PD can increase the risk of swallowing difficulties, choking and aspiration pneumonia.
- Non-PD health issues include conditions such as asthma, allergies, lung disease, heart disease and other conditions that may cause shortness of breath.
Other Symptoms To Spot For Potential Early Warning Signs
A telltale sign you have Parkinson’s is slight shaking or tremor in your thumb, finger, hand or chin, the health site says.
It adds: “A tremor while at rest is a common early sign of Parkinson’s disease.”
It is worth noting that a person with Parkinson’s disease can also experience a wide range of other physical and psychological symptoms.
According to the NHS, these include depression and anxiety, balance problems , loss of sense of smell , problems sleeping and memory problems.”
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How Parkinsons Disease Affects The Autonomic Nervous System And The Heart
In PD, there are two major reasons why the automatic control of the cardiac system is impaired. First, areas of the brain that control this system often contain Lewy bodies and have undergone neurodegeneration. In addition, the autonomic nervous system itself is directly affected by Lewy body-like accumulations and neurodegeneration. This means, when the baroreceptors in the heart and carotid artery sense a drop in blood pressure and try to generate a signal to the heart and blood vessels to increase the blood pressure, the message may not get through. This results in neurogenic orthostatic hypotension , or drops in blood pressure upon standing due to autonomic nervous system dysfunction. There are no medications that can cure nOH by restoring the autonomic nervous system in PD. nOH however, can be treated. Read more about nOH and its treatments here.
Structural problems of the heart such as coronary artery disease or cardiomyopathy are not thought to be part of the pathology of PD, although of course, could co-exist with PD.
How Does Parkinson’s Cause Vision Issues
Parkinsons is characterized by a loss of dopamine producing cells in the substantia nigra portion of the brain. The reduction of dopamine can affect the visual cortex. So Parkinsons can impair mobility of the eyes just like the limbs. There are several kinds of visual disturbances that may be experienced by people with Parkinsons. Many who experience changes in vision or eye mechanics seek out a consultation from a neuro-opthalmologist, someone who specializes in visual problems associated with neurological disease.2
Dystonia Recovery Program Neuroplasticity Training For Dystonia: A Full Body Recovery Experience
teaches that re-training breathing is one of the top priority areas in any progressive symptom reduction plan. Dr Farias views PD as a form of generalized dystonia. However, Dr Farias also coaches that breathing techniques which force the diaphragm to move will actually make the situation worse for people with dystonia and PD, causing the diaphragm muscle to go into even greater spasm. This matches my own experience, since I have always found deep breathing exercises from other modalities to be more triggering of my symptoms, and hence detrimental, rather than being helpful/relaxing. Indeed, he teaches that deep breathing does not mean forced breathing, or even taking in lots of air, but breathing small amounts with controlled finesse of the diaphragm. He talks about small breaths going “all the way down”, and demonstrates how to breathe from the diaphragm without the neck or ribs engaging at all. Apparently, forms of cervical dystonia can be completely recovered from through breathing exercises alone, but this has to be done ever so gently over a very long time.
Dr Fariass success with clients at least shows that unhealthy breathing habits can be changed over time even with movement disorders, and doing so can greatly benefit quality of life. I personally know it is possible to fix breathing issues, even with Parkinsons Disease, as some time ago I sorted out my lifelong mouth breathing habits, and now naturally default to nose breathing,
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Apda In Your Community
It is common for a person with Parkinsons disease to attribute every new symptom that develops to PD. That is largely because the list of non-motor symptoms commonly associated with PD is so varied, it can seem that almost anything is a symptom of PD! But if you take a closer look, there are some symptoms that are very commonly associated with PD, others that are virtually never associated with PD, and some in between.
Lets divide up non-motor symptoms into the following categories:
What Are The Symptoms Of Central Sleep Apnea
The most common symptom of central sleep apnea is short periods during sleep when breathing stops. Some people exhibit very shallow breathing instead of actually stopping breathing. You may wake up feeling short of breath. The lack of oxygen can cause you to wake up frequently throughout the night, and can lead to insomnia.
Other symptoms associated with central sleep apnea occur during the day as a result of an interrupted nights sleep. You may feel very sleepy during the day, have trouble concentrating or focusing on tasks, or have a headache when you wake up.
Central sleep apnea caused by Parkinsons disease or other neurological conditions can be characterized by additional symptoms, including:
- difficulty swallowing
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Exercises For Restoring Health Breathing
There are various suggested types of exercise which can help gradually shift the equilibrium point of CO2 intolerance back to healthy states. However, all of these emphasize nose breathing over mouth breathing , and diaphragmatic breathing over chest breathing. This represents an immediate roadblock for people with PD, for whom mouth breathing is likely to have become so ingrained that it feels like the nose is permanently stuffed up, and who have diaphragms which are so frozen that it cannot voluntarily be flexed. However, it is possible to open the nose in the majority cases through some simple exercises. Robert Litman in the above video demonstrates this, and below is another video of Patrick McKeown on the topic. See also my article on how I restored nose breathing with the help of a red light anti-allergy device. It is also possible to restore access to diaphragmatic breathing, as I covered in another article, which explains how I used Block Therapy to achieve this.
Once nasal and diaphragmatic breathing is made possible there are a few different types of breathing exercises one try for restoring CO2 tolerance to more normal levels. It is important to note that these exercises are not necessarily targeted at immediate regulation of the Nervous System, unlike breathing methods designed for in-the-moment relaxation or mobilization, but are aimed at long term retraining of breathing patterns in order to restore healthy oxygenation levels to the brain and muscles.
Breathing Problems And Parkinsons Disease
Usually, trouble breathing is not thought of as a symptom of PD. Those with PD who complain of this will typically have testing of their heart and lung function. This is necessary since, as we continue to emphasize, a person with PD can develop medical problems unrelated to PD and needs every new symptom evaluated like someone without PD. However, often the testing does not reveal a cardiac or pulmonary abnormality. Could difficulty breathing be a symptom of PD itself?
There are a number of ways in which difficulty breathing may be a symptom of PD:
Shortness of breath can be a wearing-OFF phenomenon
Some non-motor symptoms can fluctuate with brain dopamine levels, which means that they change as a function of time from the last levodopa dose. For some people, shortness of breath can be one of the non-motor symptoms that appears when medication levels are low. However, shortness of breath can be due to anxiety which can also be a wearing-OFF phenomenon. Sometimes it is not possible to determine whether the key symptom is anxiety or shortness of breath. Treatment involves changing medication dosing and timing so that OFF time is minimized. You can view this webinar which discusses the concept of wearing OFF and potential treatments.
Abnormal breathing can be a type of dyskinesia
Restrictive lung disease
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Breathing Problems In Parkinsons Disease: A Common Problem Rarely Diagnosed
Parkinsons disease is the second most common neurodegenerative disorder after Alzheimers disease. It is characterized by bradykinesia tremor, rigidity, and postural instability. Potential non-motor manifestations of PD include depression, anxiety, constipation, overactive bladder symptoms, dementia, and sleep disturbances.
Although James Parkinson, in 1817, described breathing abnormalities in his Essay on the shaking palsy, there has been limited research on this important non-motor symptom.
People living with Parkinsons may present with a wide variety of respiratory symptoms, ranging from shortness of breath at rest to acute stridor. Shortness of breath can be very distressing for patients and clinicians alike. Multiple investigations may be undertaken, looking for infection, blood clots and heart problems. Although these potential causes of breathing abnormalities need to be excluded, clinicians must remember that PD itself and its medications can cause SOB and that normal investigations should not automatically lead to a diagnosis of anxiety, depression or lead to inappropriate treatment plans.
Several different patterns of breathing abnormality may be found in PD:
KM Torsney, D Forsyth