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 Is Parkinson’s Disease Diagnosed
There is no test that can prove that you have PD. The diagnosis is based on you having the typical symptoms . In the early stage of the disease, when symptoms are mild, it may be difficult for a doctor to say if you definitely have PD. As the symptoms gradually become worse, the diagnosis often becomes more clear.
PD is sometimes confused with other conditions. Some conditions can give ‘Parkinsonism’ features – that is, symptoms similar to PD but caused by other conditions. For example, some medicines used to treat other conditions can cause side-effects which resemble symptoms of PD. Some rare brain disorders can also cause similar symptoms.
Therefore, it is normal practice in the UK to be referred to a specialist if PD is suspected. The specialist will be used to diagnosing PD and ruling out other causes of the symptoms. They will usually be either a neurologist or a doctor specialising in elderly care. If there is still doubt about the diagnosis, sometimes a scan of the brain is carried out. This helps to differentiate PD from some other conditions that can cause Parkinsonism features. Other tests sometimes needed include blood tests and tests of your sense of smell.
Tips For Coping With Breathing Difficulties
- Work with your doctor to identify and treat any non-PD causes of shortness of breath, such as lung disease, heart disease or lack of physical conditioning and endurance.
- Exercise as much as possible. Shortness of breath may lead a person to move less. Less physical activity reduces the ability to take deep breaths. Staying active improves pulmonary function.
- Take steps to cope with anxiety. Talk with your doctor to figure out what sets off anxiety and find treatments and techniques that work for you.
- Speak to your doctor about getting an evaluation performed by a speech-language pathologist who can help you address issues related to swallowing.
- Give up smoking.
Page reviewed by Dr. Chauncey Spears, Movement Disorders Fellow at the University of Florida, a Parkinsons Foundation Center of Excellence.
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What Causes Parkinson’s Disease
PD is a disorder of the nervous system. A small part of the brain, called the substantia nigra, is mainly affected. This area of the brain sends messages down nerves in the spinal cord to help control the muscles of the body. Messages are passed between brain cells, nerves and muscles by chemicals called neurotransmitters. The brain cells in the substantia nigra produce dopamine, the main neurotransmitter.
If you have PD, a number of cells in the substantia nigra become damaged and die. The exact cause of this is not known. Over time, more and more cells become damaged and die. As cells are damaged, the amount of dopamine that is produced is reduced. A combination of the reduction of cells and a low level of dopamine in the cells in this part of the brain causes nerve messages to the muscles to become slowed and abnormal.
What Does This Mean For People With Parkinson’s
Professor Donald Grosset, leader of the Tracking Parkinson’s study and one of the authors of the study, explains:
“It’s not surprising that many people living with Parkinson’s also have an increased risk of cardiovascular disease as both conditions get more common as we get older.
“But our study highlights the impact of living with both at the same time.
“People with poorer cardiovascular health had worse walking and memory even in the early stages of Parkinson’s, so improving cardiovascular health may help these aspects of the condition.
“We were slightly surprised that so few people in the high and medium risk groups were taking statins, since they are proven to reduce the risk of heart attacks and strokes.
“We hope our findings will help to start a conversation about vascular health in Parkinson’s, so that it can be assessed and, where appropriate, treated.”
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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.
What Medications Are Used To Treat Parkinsons Disease
Medications are the main treatment method for patients with Parkinsons disease. Your doctor will work closely with you to develop a treatment plan best suited for you based on the severity of your disease at the time of diagnosis, side effects of the drug class and success or failure of symptom control of the medications you try.
Medications combat Parkinsons disease by:
- Helping nerve cells in the brain make dopamine.
- Mimicking the effects of dopamine in the brain.
- Blocking an enzyme that breaks down dopamine in the brain.
- Reducing some specific symptoms of Parkinsons disease.
Levodopa: Levodopa is a main treatment for the slowness of movement, tremor, and stiffness symptoms of Parkinsons disease. Nerve cells use levodopa to make dopamine, which replenishes the low amount found in the brain of persons with Parkinsons disease. Levodopa is usually taken with carbidopa to allow more levodopa to reach the brain and to prevent or reduce the nausea and vomiting, low blood pressure and other side effects of levodopa. Sinemet® is available in an immediate release formula and a long-acting, controlled release formula. Rytary® is a newer version of levodopa/carbidopa that is a longer-acting capsule. The newest addition is Inbrija®, which is inhaled levodopa. It is used by people already taking regular carbidopa/levodopa for when they have off episodes .
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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.
The Role Of Dementia And Age
Dementia also plays an important role in survival with Parkinson’s. By the end of the above study, nearly 70% of the population with Parkinson’s had been diagnosed with dementia, and those with dementia had a lower survival rate as compared to those without.
This means that those with dementia were more likely to die during the six-year period than those without dementia. In addition, scientific studies have shown that increasing age is linked to an increased risk of death.
It’s important to remember that how a person’s Parkinson’s disease manifests and progresses is variable, and a person’s neurologist cannot accurately predict individual life expectancy.
There are simply no key signs or symptoms that allow a doctor to perfectly predict longevity. An older age and the presence of dementia are simply associated with an increased risk of dying.
What Can Be Done About These Unpleasant Gi Problems
Unfortunately, research studies on GI problems related to PD have been few and far between, so doctors do not have any tried and true methods to deal with them. Some of the drugs to treat GI problems in people without PD cannot be used for those with PD because these drugs negatively impact dopamine systems in the brain.
If you have PD and experience constipation, it makes sense to try to use safe and simple methods to address this issue before you add new drugs to your daily regimen. Increasing dietary fiber and drinking lots of water and other fluids is a reasonable first step in treatment. If your doctor approves it, you might also consider taking fiber supplements, such as psyllium or methylcellulose. If these simple methods dont work, your doctor might consider giving you a stool softener or a laxative.
The Last Year Of Life In Parkinson’s Disease
The study also examined nearly 45,000 hospitalizations in people with terminal Parkinson’s, meaning their end-of-life period.
Of those with terminal PD, the most common reasons for being in the hospital were:
- Heart disease
- Lung disease that was not from an infection
Less common causes for hospitalization were problems related to the stomach or intestines, muscles, nervous system, or endocrine system .
It is not surprising that infection was the most common hospitalization before death, as people with Parkinson’s are vulnerable to developing a number of infections as a result of their disease. For example, bladder dysfunction in Parkinson’s increases a person’s risk of developing urinary tract infections, which can become life-threatening if not detected and treated promptly.
In addition, research suggests that aspiration pneumonia is 3.8 times more common in people with Parkinson’s as compared to the general population. It has also been consistently reported to be the main cause of death in people with Parkinson’s.
Aspiration pneumonia results from underlying swallowing difficulties, which leads to stomach contents being inhaled into the lungs. Immobilization and rigidity, which can impair phlegm removal, also contribute to the development of pneumonia in people with Parkinson’s.
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The Spread Of Parkinsons
Researchers have found that areas of the brain stem below the substantia nigra show cell loss in Parkinsons. And cells in these areas have been found to contain clumps of alpha-synuclein protein, which may form before those in the substantia nigra.
These findings have led some researchers to suggest that Parkinsons spreads up the spinal cord to the substantia nigra. Indeed, there is evidence that, for some, Parkinsons may start in the gut and travel up the vagus nerve, which connects the gut and the brain, to the substantia nigra.
The theory that Parkinsons may spread up the brain stem and progress throughout the brain is the basis of the Braak staging of Parkinsons.
The 6 stages in Braaks theory aim to describe the spread of Parkinsons through the brain:
While there is still some debate over the origin of Parkinsons, and even competing and more complex theories about the spread of Parkinsons, attempts to understand how and why different areas of the brain are involved in the motor and non-motor symptoms are helping in the development of better treatments.
Cognitive Changes In Pd
Cognitive symptoms in Parkinsons disease are common, though not every person experiences them. In some people with PD, the cognitive changes are mild. In others, however, cognitive deficits may become more severe and impact daily functioning. Similar to slowness of movement , people with Parkinsons disease often report slower thinking and information processing . Attention and working memory, executive function, and visuospatial function are the most frequently affected cognitive domains in PD.
Cognitive deficits that are mild and do not impair ones ability to carry out activities of daily living have been termed mild cognitive impairment. Studies estimate that mild cognitive impairment occurs in about 20-50% of patients with PD. We now recognize that mild cognitive changes may be present at the time of Parkinsons disease diagnosis or even early in the course of PD. They may or may not be noticeable to the person. They may or may not affect work or activities, depending on the demands of specific tasks and work situations.
The substantia nigra is an area of the mid brain located at the top of the spinal cord, which has been the focus of much work into how Parkinsons affects the brain.
You can read more about the alpha-synuclein protein, and how it plays a role in the spread of Parkinsons, in a previous blog post:
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Study Shows Link Between Alzheimers And Heart Disease
Recently, researchers discovered that Alzheimers is caused by amyloid beta proteins building up in the spaces between brain cells. While this causes noticeable symptoms in the brain first, this same protein plaque can build up around the heart.
This was discovered in a study that examined 22 patients with Alzheimers and 35 patients without, all of whom were 78 or 79 years old. The goal was to analyze the stiffness present in the hearts left ventricle the thickest chamber of the heart responsible for transporting blood throughout the body.
During the study, published in the Journal of the American College of Cardiology, researchers discovered that those with Alzheimers had a thicker left ventricle than those without Alzheimers. This thickness was caused by the same plaque protein buildup that was building in the Alzheimers patients brains. The thickness can lead to various cardiovascular issues if and when the left ventricle becomes too thick to successfully pump blood through the body. As a result, this puts Alzheimers patients at a higher risk of heart attack and stroke.
Data Source And Study Design
This study was conducted using the NHIRD data files maintained by the Health and Welfare Data Science Center . The NHIRD is a claims-based database managed by the National Health Insurance Administration of Taiwan Taiwan’s NHI provides coverage for 99% of its residents. The NHIRD files include inpatient, outpatient, and pharmaceutical claims and disease diagnoses coded according to the International Classification of Diseases, Ninth Revision, Clinical Modification . In addition, the enrollment files of beneficiaries and providers were also included. The data in this study were from 2000 to 2015. Additionally, we linked the collected data with the national death registry to obtain death records. The two data sets can be linked according to the regulations of the HWDC. Both case-control and cohort studies were applied to examine the temporal relationship between PD and AF.
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Alzheimers Patients And Heart Health
Those with loved ones suffering from Alzheimers should keep the signs of a heart attack in mind. These include chest pain, pain that spreads to the arm, dizziness or nausea, pain in the throat or jaw, and an irregular heartbeat. Not all heart conditions have easily noticeable symptoms like a heart attack, however, which is why it is imperative to see a cardiologist regularly to monitor blood pressure, atherosclerosis and other signs of heart disease. Like Alzheimers, heart conditions are known to worsen over time, and early intervention is key to prevention.
How Is Parkinsons Disease Diagnosed
Diagnosing Parkinsons disease is sometimes difficult, since early symptoms can mimic other disorders and there are no specific blood or other laboratory tests to diagnose the disease. Imaging tests, such as CT or MRI scans, may be used to rule out other disorders that cause similar symptoms.
To diagnose Parkinsons disease, you will be asked about your medical history and family history of neurologic disorders as well as your current symptoms, medications and possible exposure to toxins. Your doctor will look for signs of tremor and muscle rigidity, watch you walk, check your posture and coordination and look for slowness of movement.
If you think you may have Parkinsons disease, you should probably see a neurologist, preferably a movement disorders-trained neurologist. The treatment decisions made early in the illness can affect the long-term success of the treatment.
I’m Concerned About My Cardiovascular Health What Should I Do
The first thing to do is make an appointment with your GP or practice nurse.
They can carry out an assessment using special computer software that can calculate your risk based on factors including things like age, blood pressure and family history of vascular disease.
If you are at medium or high vascular risk they will be able to discuss the best ways to reduce your risk. These include lifestyle changes to diet and exercise, and possibly medications like statins.
Medication Used For Treating Parkinsons
Low blood pressure can also be caused by medication used for the treatment of Parkinsons disease. This is especially associated with medications used for elevating the motor symptoms .
The most commonly used drugs that are associated with blood pressure include carbidopa and levodopa. These drugs are used to treat tremor and muscle stiffness. But their frequent use is reported to widen blood vessels and leads to fall in blood pressure 00053-6/fulltext” rel=”nofollow”> 8).
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