Wednesday, May 15, 2024
Wednesday, May 15, 2024
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Parkinson’s Effect On Brain

Symptoms Of Parkinson Disease

Parkinson’s Disease: How is the brain affected?

Usually, Parkinson disease begins subtly and progresses gradually.

The first symptom is

  • Tremors in about two thirds of people

  • Problems with movement or a reduced sense of smell in most of the others

Tremors typically have the following characteristics:

  • Are coarse and rhythmic

  • Usually occur in one hand while the hand is at rest

  • Often involve the hand moving as if it is rolling small objects around

  • May be worsened by emotional stress or fatigue

  • May eventually progress to the other hand, the arms, and the legs

  • May also affect the jaws, tongue, forehead, and eyelids and, to a lesser degree, the voice

In some people, a tremor never develops. Sometimes the tremor becomes less obvious as the disease progresses and muscles become stiffer.

Parkinson disease typically also causes the following symptoms:

Walking becomes difficult, especially taking the first step. Once started, people often shuffle, taking short steps, keeping their arms bent at the waist, and swinging their arms little or not at all. While walking, some people have difficulty stopping or turning. When the disease is advanced, some people suddenly stop walking because they feel as if their feet are glued to the ground . Other people unintentionally and gradually quicken their steps, breaking into a stumbling run to avoid falling. This symptom is called festination.

Parkinson disease also causes other symptoms:

Foster A Good Relationship

Lastly, maintaining your relationship and communication with the person with Parkinsonâs can be the most challenging and rewarding aspect of caregiving. As Parkinsonâs disease progresses, the roles change and the person with Parkinsonâs may go from being an independent head of the household to a very dependent person requiring a significant level of care. However, research shows that despite high levels of strain, caregivers with good quality relationships have reduced depression and better physical health. Remember, as a caregiver your service to your loved one is beyond measure in terms of love, depth of care, and concern.

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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Executive Dysfunction In Parkinsons

Executive functions in cognition are higher-order mental processes, including the ability to plan, organize, initiate and regulate behavior to meet goals. Executive functioning is present in activities such as multitasking, switching tasks, and solving problems. The prefrontal cortex of the brain and the dopamine system are responsible for executive function. As PD damages these areas, executive dysfunction occurs, and executive dysfunction is one of the most common cognitive impairments found in people with PD.3,4

Complementary And Alternative Therapies

What Is Deep Brain Stimulation For Parkinson

Some people with Parkinson’s disease find complementary therapies help them feel better. Many complementary treatments and therapies claim to ease the symptoms of Parkinson’s disease.

However, there’s no clinical evidence they’re effective in controlling the symptoms of Parkinson’s disease.

Most people think complementary treatments have no harmful effects. However, some can be harmful and they shouldn’t be used instead of the medicines prescribed by your doctor.

Some types of herbal remedies, such as St John’s wort, can interact unpredictably if taken with some types of medication used to treat Parkinson’s disease.

If you’re considering using an alternative treatment along with your prescribed medicines, check with your care team first.

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How Does This Condition Affect My Body

Parkinsons disease causes a specific area of your brain, the basal ganglia, to deteriorate. As this area deteriorates, you lose the abilities those areas once controlled. Researchers have uncovered that Parkinsons disease causes a major shift in your brain chemistry.

Under normal circumstances, your brain uses chemicals known as neurotransmitters to control how your brain cells communicate with each other. When you have Parkinsons disease, you dont have enough dopamine, one of the most important neurotransmitters.

When your brain sends activation signals that tell your muscles to move, it fine-tunes your movements using cells that require dopamine. Thats why lack of dopamine causes the slowed movements and tremors symptoms of Parkinson’s disease.

As Parkinson’s disease progresses, the symptoms expand and intensify. Later stages of the disease often affect how your brain functions, causing dementia-like symptoms and depression.

Parkinsons Gut Health Jump Start

Its no surprise that the hunt is on for new therapeutic approaches for Parkinsons that target the gut microbiota . Fortunately, you dont have to wait for the next scientific breakthrough to get a jump start on improving the health of your gut.

The goal of this jump start is to begin to decrease inflammation, heal the gut lining, and restore healthy gut balance through 4 simple strategies that you can start today with very little investment and very little change to your diet.

Lets take a look

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Why Do Protein Deposits Form In The First Place

Researchers want to know why these protein aggregates form in the first place, how they distribute in the brain, how their signalling works, and how they and their precursors cause neurodegeneration.

A range of theories have been put forward to explain what kickstarts damaging protein aggregation. In the case of Alzheimers, this includes problems with the way oxygen is metabolised in brain cells and the movement of internal cell contents. The brains response to inflammation, and its systems for clearing waste could also play a role.

One main theory is that once amyloid-ß begins to accumulate, it then promotes the build-up of tau. But the relationship is not simple, because tau also has a role in influencing the toxic effects of amyloid-ß.

Although some genetic risk factors for dementias have been identified, particularly for Alzheimers disease , we still dont know how these act to influence protein aggregation and cause degeneration. This is a key area of research focus, and knowing the answers to these questions is crucial to the prevention and treatment of dementia.

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How Parkinsons Disease Affects The Autonomic Nervous System And The Heart

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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.

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Other Medicines Used For Pd

  • Catechol-O-methyltransferase inhibitors are relatively new medicines. They include tolcapone, entacapone and opicapone. These help to stop the breakdown of levodopa by the body, so more of each dose of levodopa can get into the brain to work. A COMT inhibitor is sometimes advised in addition to levodopa when symptoms are not well controlled by levodopa alone.
  • Other medicines are sometimes used to help relieve symptoms. They have various effects which try to correct the chemical imbalance in the brain. They include beta-blockers, amantadine and anticholinergic medicines. One of these may be tried when symptoms are mild. However, you are likely to need levodopa or a dopamine agonist at some point.

Various things may influence which medicine is advised. For example, your age, severity of symptoms, how well your symptoms respond to treatment, if side-effects develop, other medicines that you may take, etc. Your specialist will advise on the best medicine for you to take. Whatever medicine or medicines you are prescribed, read the leaflet in the medicine packet for a full list of possible side-effects. Mention to your doctor if you develop a troublesome side-effect. A modification of the dose, dose schedule, or the type of medication, may be possible to help keep side-effects to a minimum.

How Is A Diagnosis Made

Because other conditions and medications mimic the symptoms of PD, getting an accurate diagnosis from a physician is important. No single test can confirm a diagnosis of PD, because the symptoms vary from person to person. A thorough history and physical exam should be enough for a diagnosis to be made. Other conditions that have Parkinsons-like symptoms include Parkinsons plus, essential tremor, progressive supranuclear palsy, multi-system atrophy, dystonia, and normal pressure hydrocephalus.

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Who May Benefit From Deep Brain Stimulation

A number of criteria can help identify people who are good candidates for deep brain stimulation. This includes people who:

  • Have been living with Parkinsons disease for at least five years, though the procedure was approved for early symptoms in 2016 and is now being evaluated to see if it offers benefits for people earlier in the disease
  • Have symptoms that are not well controlled on medications
  • Are responding to Parkinsons medications : The procedure should only be done for people who are responding to this treatment, but the medication effects fluctuate during the day and the effectiveness of the medication is getting shorter.
  • Find that the uncontrolled symptoms are lowering their quality of life
  • Are doing relatively well cognitively

At the current time, there is no set age limit for DBS, but the effectiveness may be lower in older people.

How Are Cognitive Changes In Pd Different Than Alzheimers Disease

What Is Deep Brain Stimulation For Parkinson

Overall, dementia produces a greater impact on social and occupational functioning in PD than Alzheimers due to the combination of motor and cognitive impairments.

There is some overlap between symptoms and biological changes seen in Alzheimers and PD. However, it is less likely for both disorders to occur at the same time. Development of dementia in people with PD represents progression of the disease, usually after several years of motor impairment.

Dementia may or may not occur in people with PD. According to recent research, 30% of people with Parkinsons do not develop dementia as part of the disease progression.

  • May be as common as depression in Parkinsons.
  • While less studied, up to 40% of people with PD experience some form of anxiety.
  • Can interfere with memory storage, disrupt attention and complex task performance. For example, most people remember going blank on a school exam when feeling anxious.
  • Negatively impacts social life. People with poorly controlled anxiety often avoid social situations, which can impact family and work relationships.
  • People with PD may experience anticipatory anxiety in situations where they have to use cognitive skills.
  • Similar to depression, successful treatment can lead to improvement of cognitive problems related to anxiety.
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    Can You Protect The Brain From Further Damage

    The goal of the treatment is to improve the patients quality of life and slow progression of the disease. There is still no cure for Parkinsons disease, but it can be very well managed. However, there are several ways that anyone who is diagnosed with Parkinsons disease can help protect their brain and mitigate the damage that has occurred.

    How Soon After Treatment Will I Feel Better And How Long Will It Take To Recover

    The time it takes to recover and see the effects of Parkinson’s disease treatments depends strongly on the type of treatments, the severity of the condition and other factors. Your healthcare provider is the best person to offer more information about what you can expect from treatment. The information they give you can consider any unique factors that might affect what you experience.

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    How Is Essential Tremor Treated And Is There A Cure

    Theres no cure for essential tremor, but there are ways to treat it. The main treatment options are medications, assistive devices, botulinum toxin, deep brain stimulation and focused ultrasound. Your healthcare provider may recommend deep brain stimulation or focused ultrasound if other treatments arent enough to help your tremors.

    • Medication: The most common medications, taken either on their own or in combination, to treat essential tremor are beta-blockers like propranolol and anti-seizure drugs like primidone.
    • Adaptive devices: Many devices have been developed to improve tremor control, such as weighted items, tremor-canceling devices, vibration devices and peripheral nerve stimulation.
    • Botulinum toxin: This involves injection into the tremoring muscles to temporarily weaken the muscles and lessen tremor severity.
    • Deep brain stimulation: This is a surgery to implant a device that delivers electrical impulses to a specific part of your brain. The electrical impulses interrupt the signals that cause essential tremor muscle movements. This can improve tremors on both sides of your body.
    • Focused ultrasound: This procedure uses ultra-high-frequency sound waves focused onto a single point in your brain involved in the production of tremor, destroying the targeted tissue. This destruction can greatly reduce the severity of the tremor and improve hand steadiness. This can improve tremors on only one side of your body.

    Complications/side effects of treatments

    Parkinsons Disease Affects The Brain Because Of Nerve Degeneration

    Deep Brain Stimulation for Parkinsons, Tourettes

    Parkinsons disease affects the brain in specific ways. Through neurodegeneration, there is a break down of nerve structures over time. With that breakdown of nerves, the disease will continue to progress. The disease process of PD can be very insidious. Seeing your doctor at the onset of symptoms, even if its a slight tremor, can help with tracking the progression of the disease, and ensure you get the treatment as soon as possible.

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    Freezing As Response Conflict Impairment: Corticalsubcortical Substrates

    Freezing is the inability to begin or continue a voluntary discrete or rhythmic movement. It can affect walking, writing, speech, and is also associated with deficits in a number of executive functions including attention and conflict resolution. The vast range of conditions provoking or relieving freezing supports the involvement of a complex brain network including both cortical and subcortical areas.,

    Pivoting on the anatomical connections between BG and Ctx, and between BG and Cer,,, and on recent data about the involvement of pre-SMA,,, and Cer,, in freezing, we propose here some system-level hypotheses on the possible alterations of corticalsubcortical circuits that might underlie freezing . Striatum modulates the output nuclei of BG through two pathways. The first is the direct pathway that involves a Str GABAergic connection directly inhibiting GPi and substantia nigra pars reticulata . The second is the indirect pathway involving two sub-routes: the short indirect pathway, linking the external globus pallidus to GPi/SNr via GABAergic connections and the long indirect pathway linking GPe to STN which in turn projects to GPi/SNr.

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    Sites Of Deep Brain Stimulation And Symptom Control

    While both subthalamic nucleus and globus pallidus internus stimulation help improve the motor symptoms of Parkinsons disease, studies have found a few differences.

    DBS of the third target, the ventral intermediate nucleus, can be beneficial for controlling tremors but does not work as well at addressing the other motor symptoms of Parkinsons disease.

    In a Canadian study, targeting the subthalamic nucleus allowed people to reduce the doses of their medications to a greater degree, while targeting the globus pallidus internus was more effective for abnormal movements .

    In another study, STN deep brain stimulation also led to a greater reduction in medication dosages. However, GPi stimulation resulted in greater improvement in quality of life, and also appeared to help with the fluency of speech and depression symptoms.

    Side effects of DBS can sometimes include subtle cognitive changes . A different study compared these effects with regard to these different areas.

    GPi showed smaller neurocognitive declines than STN, though the effects were small with both. On a positive note, both procedures seemed to reduce symptoms of depression following surgery.

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    Care Partners: Burden Assessment And Support

    Care partners or caregivers are an invaluable healthcare resource. When caregivers are present, patients are less likely to move to nursing homes. Caregivers also improve participation rates and retention of people with PD in research studies, which helps advance the path towards finding more effective therapeutics. Furthermore, many clinical trials for PDD require a caregiver in the study inclusion criteria.

    Informal caregivers are providers who supervise or assist with instrumental and/or basic activities of daily living without pay to someone who cannot do these activities independently due to cognitive, physical, or psychological impairment. However, caregivers provide much more than this formal definition states. They often provide medical care including administration of medications, emotional and social support, and advice on medical decision-making. About 90% of men and 80% of women with PD have caregivers during their physician visits, and most caregivers are spouses.

    Despite existing therapeutic support and resources for caregivers, there are several challenges to overcome. These include sex disparities in caregiving and the substantial financial strain that can be associated with caregiving. Caregivers are frequently at the forefront of providing medical history and administering complicated medication regimens without formalized education or support.

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