Do You Need Help With Symptoms And Stress From Parkinsons Disease
- Jul 27, 2020
Parkinsons disease is a slowly progressing and long-lasting condition that can cause many challenges to those diagnosed and their families. In addition to affecting muscle movement, it can impact mood and cognitive abilities; involve pain; cause sleep disturbances and other distressing symptoms. While its not curable, much can be done to manage the disease and its symptoms. For example, patients and families can ask for a referral to a palliative care team a medical team that focuses on improving quality of life and relief of symptoms and stress caused by living with serious illnesses.
An Extra Layer of Medical Support for the Long Term
Palliative care is provided by a specially trained team of doctors, nurses and other specialists who work together with a patients other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with treatment geared to the Parkinsons disease . The team will work with you and your family for as long as you want.
When to Consider a Medical Referral to a Palliative Care Team?
The short answer about when to seek a palliative care referral is the sooner the better. Although living with PD is difficult, your burden may be easier with palliative care involved.
Palliative Care Shows Benefits Specific to Those with Parkinsons and Their Caregivers
How to Find Palliative Care
Reminder: Stay Safe from COVID-19
Environmental Toxins And Parkinsons Disease
Neuronal cell death in PD may also be triggered by exposure to toxic substances or environmental factors which precipitate the symptoms of the disease as they render the brain vulnerable to subsequent physiological chronic stress . The environmental cause of PD mainly refers to exposure to dopaminergic toxins 6-hydroxydopamine , 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine , paraquat and rotenone as these toxins are known to induce formation of reactive oxygen species and oxidative stress which may result in neuronal cell death .
DA is one of the common neurotransmitters present in most parts of the central nervous system . The mesocortical, mesolimbic, nigrostriatal and tubero-infundibular pathways are the four main pathways that play a key role in dopaminergic signaling . DA cannot cross the blood brain barrier, therefore, it is synthesized from tyrosine which is carried into the brain via amino acid transporters . At the dopaminergic neuron level, tyrosine is then converted into dihydroxyphenylalanine by tyrosine hydroxylase then finally into DA by aromatic L-amino acid decarboxylase . DA is then stored in the vesicle until an action potential allows the vesicle to be discharged into the synapse . Monoamine oxidase is the enzyme that is responsible for breaking down excess DA and is known to similarly act on 6-OHDA inducing oxidative stress resulting in apoptosis .
What Happens To Dopamine In The Brain Of Parkinsons Patient
As mentioned above, Dopamine is produced by Dopaminergic neurons. It is due to the loss of these neurons that cause the brain to stop releasing Dopamine and results in Parkinsons disease. But the death of these neurons doesnt happen suddenly, instead they die progressively; thats the reason why Parkinsons is said to be a progressive disease.
As soon as the disease strikes, the Dopaminergic neurons start to die that cause a steady decline in the Dopamine production in the brain. This is the very early stage that lasts for many years. Since the brain is still capable of producing Dopamine, the body wouldnt show any motor disability, and therefore it is often very difficult to diagnose the disease at this stage.
Nevertheless, the disease still affects the body in the form of non-motor signs like loss of smell, sleeping problem, constipation, and apathy . These are usually under-recognized and ignored, not only by the patient but also by doctors.
As time passes by, the brain ability of Dopamine production declines rapidly until it reaches the level where it starts to affect the body normal movement. At this stage, the disease can easily be diagnosed by its motor-symptoms tremor, slow movement, and rigidity. By this time, almost 70% of Dopaminergic neurons are lost in the brain.
Anxiety And Parkinsons Research
What does this finding mean for the future of diagnosis or treatment of Parkinsons? Ongoing research is compelling, says Pontone. Part of what we are doing is looking at anxiety disorders that occur long before the onset of Parkinsons to see if there are characteristics that may differentiate that anxiety or predict an increased risk of Parkinsons disease.
Meanwhile, because theres an established link between anxiety and Parkinsons disease, patients and their families should be upfront with their doctors about anxiety symptoms. Behavioral therapy and medications for example, anti-anxiety meds or antidepressants can effectively treat anxiety disorders. Theres no need for anyone to suffer in silence.
Targeting Parkinsons-Linked Protein Could Neutralize 2 of the Diseases Causes
Researchers report they have discovered how two problem proteins known to cause Parkinsons disease are chemically linked, suggesting that someday, both could be neutralized by a single drug designed to target the link.
Does Anxiety Cause Freezing Of Gait In Parkinson’s Disease
Affiliations Sun Life Financial Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada, Cognitive Neuroscience, Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
Affiliation Cognitive Neuroscience, Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
Affiliation Sun Life Financial Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada
Anxiety And Parkinsons Disease
Anxiety is another common mood disorder of PD and is characterized by excessive nervousness or worry over several months. Patients with generalized anxiety disorder may experience symptoms such as:
- Restlessness, feeling wound-up or on edge
- Difficulty controlling the worry
- Sleep problems, such as difficulty falling or staying asleep, or restless or unsatisfying sleep1,3
Anxiety is not linked with disease of PD. It may develop before or after a PD diagnosis. It is often experienced along with depression in people with PD, as the disease process of PD changes the chemistry of the brain. Treatment for anxiety may include anti-anxiety medications, psychological counseling, exercise, relaxation techniques, and/or meditation.1
Other Causes Of Parkinsonism
“Parkinsonism” is the umbrella term used to describe the symptoms of tremors, muscle rigidity and slowness of movement.
Parkinson’s disease is the most common type of parkinsonism, but there are also some rarer types where a specific cause can be identified.
These include parkinsonism caused by:
- medication where symptoms develop after taking certain medications, such as some types of antipsychotic medication, and usually improve once the medication is stopped
- other progressive brain conditions such as progressive supranuclear palsy, multiple systems atrophy and corticobasal degeneration
- cerebrovascular disease where a series of small cause several parts of the brain to die
You can read more about on the Parkinson’s UK website.
Page last reviewed: 30 April 2019 Next review due: 30 April 2022
Delusions From Parkinsons Disease
Delusions affect only about 8 percent of people living with PD. Delusions can be more complex than hallucinations. They may be more difficult to treat.
Delusions often start as confusion that develops into clear ideas that arent based on reality. Examples of the types of delusions people with PD experience include:
- Jealousy or possessiveness. The person believes someone in their life is being unfaithful or disloyal.
- Persecutory. They believe that someone is out to get them or harm them in some way.
- Somatic. They believe they have an injury or other medical problem.
- Guilt. The person with PD has feelings of guilt not based in real behaviors or actions.
- Mixed delusions. They experience multiple types of delusions.
Paranoia, jealousy, and persecution are the most commonly reported delusions. They can pose a safety risk to caregivers and to the person with PD themselves.
PD isnt fatal, though complications from the disease can contribute to a shorter expected life span.
Dementia and other psychosis symptoms like hallucinations and delusions do contribute to increased hospitalizations and increased rates of death .
One study from 2010 found that people with PD who experienced delusions, hallucinations, or other psychosis symptoms were about 50 percent more likely to die early than those without these symptoms.
But early prevention of the development of psychosis symptoms may help increase life expectancy in people with PD.
Treatment Of Depression/anxiety Associated With Parkinsons Disease
Antidepressants are a popular treatment for moderate to severe forms of depression in PD . Several classes of antidepressants are available and they work in a slightly different way with different side-effects. Neurotransmitters are associated with the pathogenesis of depression in PD . Antidepressants relieve the symptoms of depression by targeting these neurotransmitters . Tricyclic, monoamine oxidase inhibitors and newer selective antidepressants including serotonin and noradrenaline reuptake inhibitors are classes of antidepressants known to be effective in treating depression .
Tricyclic drugs are the older version of antidepressants . This class of antidepressant includes drugs such as desipramine, doxepin, imipramine, trimipramine . Although tricyclic antidepressant drugs are effective in treating depression, they have several side effects such as dry mouth, constipation, difficulty urinating, sedation, weight gain or sexual problems . Also, tricyclic drugs can be fatal in overdosing .
Foods Containing Saturated Fat And Cholesterol
Some studies suggest that dietary fat intake may increase the risk of Parkinsons.
Although having a higher intake of cholesterol can elevate a persons Parkinsons risk, having a higher intake of polyunsaturated fatty acids may reduce the risk.
Therefore, a person with Parkinsons may wish to reduce their intake of cholesterol to help control the symptoms of the condition. They may also wish to reduce the amount of saturated fat in their diet.
However, further studies are required to explore the link between dietary fat and Parkinsons.
Preventing Sodium And Fluid Imbalances
Hyponatremia is the most common medical complication of ultradistance exercise and is recognized as potentially serious, as reported in the Cleveland Clinic Journal of Medicine. It is difficult to recommend specific fluid and electrolyte intakes since an individuals needs vary depending on his sweating rate, degree of heat acclimation, and diet as well as on the exercise duration and environmental factors during exercise. The American College of Sports Medicine recommends that individuals develop customized fluid replacement programs that prevent excessive dehydration .
The routine measurement of pre- and post-exercise body weights is useful for determining sweat rates and customized fluid replacement programs . Monitoring for weight losses that are 2 percent or more from a baseline body weight is advisable. A baseline body weight should be obtained in the morning prior to any exercise and in a well-hydrated state. The individual should drink 20 to 24 fluid ounces of water for every one pound lost.
Consumption of beverages containing electrolytes and carbohydrates can help sustain fluid-electrolyte balance and exercise performance, especially for events lasting more than one hour.
Dyskinesia Cause #6: Too Much Medication
Each person with Parkinsons experiences symptoms a little differently than the next. The challenge for the physician is finding the dose and formulation of levodopa that provides the right balance of symptom relief while avoiding dyskinesia, says Todd Herrington, MD, PhD, a neurologist at Massachusetts General Hospital in Boston and an instructor in neurology at Harvard Medical School in Cambridge, Massachusetts. Too much levodopa can trigger dyskinesia and possibly make other Parkinsons symptoms worse, he says. But if people dont take enough medication, it can leave them feeling slow, stiff, and even trapped in their own body. So be sure to work with your doctor on the right treatment regimen for you.
How Is Anxiety Diagnosed
Anxiety is usually diagnosed by a primary care physician, or a mental health professional, who will ask questions about certain symptoms. The doctor will talk with the patient about mood changes and behaviors. For people with an anxiety disorder, their symptoms become so intense that they are unable to function normally in life. Overall, it is easier to diagnose anxiety than depression in PD, because symptoms of anxiety and PD do not overlap as much.
In general, symptoms of anxiety may include:
- Excessive fear and worry
In people with Parkinsons, a diagnosis of an anxiety disorder is made only if the symptoms involve a clear change in a patients previous behavior and are not easily confused with motor symptoms. For example, even though a patient may have a legitimate concern that a tremor or change in walking ability may be noticed in public, a diagnosis of social avoidance is only made if the patient realizes that the concern is excessive, the social situation is avoided, and it causes interference in the persons social or work life.
Dyskinesia Cause #4: Too Little Sleep
Symptoms like stiffness and cramping that accompany Parkinsons can make it difficult to get a good nights sleep. According to the American Parkinson Disease Association , people with the disease average just over five hours of sleep a night and wake up twice as many times as those who dont have Parkinsons. Keeping a regular sleep-wake schedule and only taking one short nap a day can help improve your shut-eye at night, according to the APDA.
Add Protein To Meals And Snacks
Because protein slows the bodys absorption of carbohydrates, it helps level out blood sugar. Fish, lean meat, beans, eggs and low-fat dairy are all healthy protein sources. To incorporate more protein in your diet, top your salad with a hard-boiled egg or blend a little protein powder into your morning smoothie.
Dopamine Hypothesis Of Depression
Dopamine is produced in the substantia nigra pars compacta in the midbrain. Dopaminergic projections in both the mesocortical and the mesolimbic systems are known to be disturbed by stress . Dopaminergic pathways are part of the reward system and the effects of chronic stress on reward perception that lead to depression can occur because of the interaction between the dopaminergic system and the HPA axis and between the dopaminergic system and the serotonergic system . Studies have demonstrated that early psychological stress that activates the HPA axis, exacerbates DA depletion and is associated with a decrease in DA synthesis in the brain . Auffret et al. and Leentjens, have shown that symptoms of depression can be improved by administration of DA agonists highlighting the possibility of antidepressant drugs to have an affinity to DA receptors. Since DA depletion may accompany depression, some antidepressant drugs may act on both dopaminergic and serotonergic systems to exert their antidepressant effect . Therefore, DA deficiency resulting from early life stress may in some instances predispose an individual to depression and eventually to neurodegenerative diseases such as PD.
Karl Robb Shares His Personal Story
A few years ago, I faced a dark period in my life. My mother was dying of cancer and the stress I was experiencing seemed too overwhelming to control. My medicines were not working nearly as well and my positive attitude was waning. It all began to take a toll on my body.
One Sunday afternoon I was watching television when out of nowhere these thoughts started racing through my head. It was as if 200 channels were playing at once. The flashing images were dizzying and upsetting. My pulse raced and my heart pounded. I was terrified, thinking I was having a heart attack.
I tried my best to slow my mind with deep breathing, calming thoughts, soft music and meditation. Only after about 40 minutes of focusing on my breath and visualizing calming images was I able to return to a more serene state of mind.
Afterward I realized that the buildup of stress over the previous weeks from work, my mom’s death, and my own attitude led to the panic attack. Since this episode, I have learned how to better manage stress and to reduce the triggers that make me anxious. That was the first and only panic attack I have ever had.
Reducing stressors in life is not always easy. You might need to take a closer look at your life to find what needs to change. Sometimes just reducing the negative influences in your life can make a big difference. Here is what I do to reduce stress and overcome anxiety and what you can try, too.
Stay open-minded and resilient. This will help you handle adversity.
Learn More About How Nutrition Affects Parkinsons
A diet thats rich in whole grains, lean protein, and fibrous fruits and vegetables is useful for fighting fatigue and may also reduce inflammation and oxidative stress, all of which help you live well today with Parkinsons.
How have you found different foods affect your energy levels? Consider logging your diet and making notes about how you feel after eating and between meals. Let your experiences help guide you to make healthy modifications to your diet.
How Do These Findings Fit Within Existing Models Of Freezing Of Gait
It is important to consider how some models of freezing of gait describe a downstream effect, without addressing the upstream cause. This might be why other models are not able to explain how anxiety or other processes might overload the basal ganglia, leading to increased freezing of gait. For example, the threshold model predicts that a motor deficit can accumulate to the point that reaches a threshold and freezing occurs . This model does not identify a root cause of the initial motor deficit. According to the current results, anxiety might be the key factor that initiates the motor deficit in the first place, and thus this model would be incomplete without the upstream cause having been identified. Similarly, the decoupling model does not identify the initial upstream event that leads to decoupling between preprogrammed and intended motor responses . Thus, in both cases identifying the upstream cause can elucidate why freezing of gait is the resultant behaviour.
Stress Factors In Parkinson’s
It is not unusual to feel stressed most of us succumb to it at various times – but there are a number of reasons why stress worsens Parkinsons symptoms, such as tremor, slow movement, freezing, speech and swallowing difficulties.
A diagnosis of Parkinsons can lead to stress as it brings with it worries and uncertainties about the future, both for you and your family.
Dopamine, which is deficient in the brains of people with Parkinsons, is used by the body to produce adrenaline. Adrenaline needs to be produced in order for the body to cope with stress. It is therefore not surprising that people with the condition do not produce adequate adrenaline to cope with physical, mental or emotional stress under control.
Analysing and addressing the reasons for stress and learning to relax is important in managing symptoms and maintaining a good quality of life. With the right attitude, careful planning and lifestyle adjustments many sources of stress can be eliminated or their impact reduced.
Parkinsons Disease And Anxiety: Why Does Anxiety Happen
People with Parkinson’s disease experience a number of different symptoms. As well as tremor, rigidity and slow movement, many PD patients feel depressed or anxious and struggle with the emotional impact of their illness.
Around 31% of people with Parkinsons disease will experience significant symptoms of anxiety. Those with early-onset Parkinsons are thought to have a higher risk of developing anxiety than older patients. Its unclear whether this occurs due to chemical changes in the brain, Parkinson’s medication side-effects or a combination of social, environmental and genetic factors, though scientists are devoting more research to this area.
According to Richard Brown, Professor of Neuropsychology and Clinical Neuroscience at Kings College London:
Anxiety, like all behavior and emotion, is ultimately controlled by our brain. Anxiety is related to a complex set of brain areas and chemicals, many of which are affected in Parkinsons.
There is no cure-all treatment for anxiety stemming from Parkinson’s disease because the cause of anxiety in PD is difficult to determine. If you experience anxiety with Parkinson’s disease, your doctor will suggest appropriate treatment that takes all of your PD symptoms into account.
The Research: The Mediterranean Diets Role In Themanagement Andprogression Of Parkinsons
Eating a plant-based diet also provides many benefits to people living with Parkinsons. Numerous studies have explored the eating plans effects on aging and cognitive function, including a systematic review published in Nutrients in 2017 that found that the Mediterranean diet could play a major role in cognitive health and risk of Alzheimers disease and dementia. Since cognitive changes are common as Parkinsons progresses, choosing foods that benefit your brain and can slow cognitive decline is one way to influence your Parkinsons journey positively.
The guts impact on Parkinsons also plays a role in managing and possibly slowing the progression of Parkinsons. Studies have found lower levels of Prevotella, a good gut bacterium, in people with Parkinsons, along with higher levels of inflammatory bacteria; other studies have shown that eating a whole-food plant-based diet creates a gut environment where Prevotella and other healthy bacteria can flourish. The more good bacteria present, the better your overall health and your ability to live well with Parkinsons every day.
In addition, eating a plant-based diet can help you manage multiple symptoms of Parkinsons, including:
Can Stress Cause Parkinsons
Research suggests that stressful life events may increase the risk of Parkinsons disease. In addition, animal studies indicate that stress damages dopamine cells, resulting in more severe parkinsonian symptoms. In humans, acute stress can worsen motor symptoms, including bradykinesia, freezing, and tremor.
Dyskinesia Cause #3: Happiness
Moments of joy and happiness, especially laughter, can bring on dyskinesia. Dyskinesia is influenced by whats going on in your environment, so whether youre happy, sad, or anxious, you can definitely see an increase in , says Thomas.
Its important to remember, especially in this case, that even though dyskinesia can make bystanders feel uncomfortable, the needs of the person with Parkinsons are what matter the most. For most people with Parkinsons, dyskinesia isnt a problem, says Alexander Pantelyat, MD, the director of the Johns Hopkins Atypical Parkinsonism Center in Baltimore. However, he says, dyskinesia can cause embarrassment for the persons friends and family members.
In the case of happiness and laughter, its good to be aware why dyskinesia might be worsening, even if you dont want to take measures to prevent it.
Psychological And Physiological Anxiety Measures
Repeated measures ANOVA indicated a significant effect on phase and group × phase interaction for VAMS anxiety factor . However, no difference was found between the groups . With regard to other VAMS factors, there was a significant effect of phase on mental sedation , physical sedation , and other feelings . However, there were no significant effects of these parameters on group × phase interaction and the groups.
Repeated measures ANOVA showed a significant effect of phase on heart rate without differences between the groups or group × phase interaction. Moreover, there were no differences in systolic or diastolic blood pressure between the phases, groups, or group × phase interaction.
Oxidative Stress Neuroinflammation And Parkinsons Disease
Oxidative stress is the result of an imbalance between the production of reactive oxygen species and the body capacity to counteract their harmful effects through neutralization by antioxidant defenses . Brain neurons are constantly exposed to reactive oxygen species and reactive nitrogen species as a result of endogenous or exogenous exposure to oxidative stress . Chronic psychological stress increases neuroinflammation which may facilitate nigral cell death in PD . For instance, under stress conditions, there is evidence that dysfunction of inflammatory markers such as tumor necrosis factor -, interleukin -1, IL-6, IL-10, transforming growth factor – in microglia of patients with depression participates in worsening PD symptoms .
PD research is often directed towards the prevention of DA neuron degeneration . However, all current treatments only address the symptomatic effects of the disease, none of which neither halt nor retard DA neuron degeneration . About 95% of PD cases are sporadic hence caused by environmental factors versus 5% that are inherited . The point of view in favor of exposure to stressful events early in life predisposing an individual to develop neurodegenerative disorders later in life seems to emphasize that PD is much more than just a DA-dependent motor deficit.