What If You Have Parkinsons Disease And A Stroke
Stroke is relatively common and so is Parkinsons disease, so one person can have both. If you or your loved one has a stroke as well as Parkinsons disease, it is normal for you to be concerned.
The conditions have different causes, but the movement problems of Parkinsons disease combined with the effects of a stroke can make it even more difficult for you or your loved one to get around than if you only had one of the two problems.
If you have both conditions, it is more important to pay attention to things such as safeguarding your home to prevent falls and getting a walker or a cane in order to avoid falls.
What Is Parkinsons Disease
Parkinsons disease is a neurodegenerative brain disorder that progresses slowly in most people. Symptoms can take years to develop, and most people live for many years with the disease. The symptoms caused by Parkinsons include an ongoing loss of motor control as well as a wide range of non-motor symptoms .
Symptoms Of Depression In Ms
Like Parkinsons disease, vegetative or somatic symptoms do not tend to be good diagnostic discriminators for depression in MS. Some vegetative symptoms may be specifically related to fatigue rather than depression, but this area is fraught with methodological and conceptual difficulties. One study has indicated that disinterest in sex was uniquely related to depression in MS . Important clues to depression in MS are illustrated in table 4.
Important clues to depression in multiple sclerosis
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Upcoming Phase 3 Clinical Trial
The trial is being undertaken in partnership with U.K. charity Cure Parkinsons, the John Black Charitable Foundation, and the Van Andel Institute, a Michigan-based independent research facility.
It will follow 330 participants who have Parkinsons at between 10 and 12 locations in the U.K. The study will take both Parkinsons patients who have mutations in the GBA1 gene the most common genetic risk factor for Parkinsons disease and Parkinsons patients who have no genetic link.
Our studies in the laboratory suggest that the drug may be beneficial not just to those with the mutation, but may be also useful for those without the mutation, Dr. Schapira told MNT.
Participants in the placebo-controlled trial will take ambroxol daily for two years.
Mutations in GBA1 are a common known genetic risk factor for the development of Parkinsons disease. GBA1 is believed to provide the instructions for making an enzyme called glucocerebrosidase .
A 2009 study published in the Journal of Blood Chemistry reported that ambroxol increased levels of GCase in patients with Gaucher Disease.
GCase activity is reduced in the brains of both patients with Parkinsons with and without GBA1 mutations.
After that, researchers began to look at ambroxol as a possible treatment for Parkinsons, Dr. Schapira explained to MNT.
Is Parkinson’s Disease Or Stroke Fatal
Most people who have a stroke survive, but about 10% to 17% of people who have a stroke die from the stroke or from its complications. While Parkinson’s disease is not fatal, some individuals with severe Parkinson’s disease are very disabled because of the extreme movement problems.
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How Can I Or A Loved One Help Improve Care For People With Lyme Disease
Consider participating in a clinical trial so clinicians and scientists can learn more about Lyme disease and related disorders. Clinical research uses human volunteers to help researchers learn more about a disorder and perhaps find better ways to safely detect, treat, or prevent disease.
All types of volunteers are neededthose who are healthy or may have an illness or diseaseof all different ages, sexes, races, and ethnicities to ensure that study results apply to as many people as possible, and that treatments will be safe and effective for everyone who will use them.
For information about participating in clinical research visit NIH Clinical Research Trials and You. Learn about clinical trials currently looking for people with Lyme disease at Clinicaltrials.gov.
Changes Inside The Brain
In Parkinson disease, nerve cells in part of the basal ganglia degenerate.
The basal ganglia are collections of nerve cells located deep within the brain. They help do the following:
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Initiate and smooth out intended muscle movements
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Suppress involuntary movements
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Coordinate changes in posture
When the brain initiates an impulse to move a muscle , the impulse passes through the basal ganglia. Like all nerve cells, those in the basal ganglia release chemical messengers that trigger the next nerve cell in the pathway to send an impulse. A key neurotransmitter in the basal ganglia is dopamine. Its overall effect is to increase nerve impulses to muscles.
When nerve cells in the basal ganglia degenerate, they produce less dopamine, and the number of connections between nerve cells in the basal ganglia decreases. As a result, the basal ganglia cannot control muscle movement as they normally do, leading to tremor, slow movement , a tendency to move less , problems with posture and walking, and some loss of coordination.
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What Is Lyme Disease
Lyme disease is caused by a bacterial organism that is transmitted through the bite of an infected tick. Most people with Lyme disease develop a characteristic skin rash around the area of the bite that may look similar to a “bull’s eye” .
The first stage of Lyme disease may begin with flu-like symptoms such as fever, chills, swollen lymph nodes, headaches, fatigue, muscle aches, and joint pain from seven to 14 days, or in some cases 30 days, following a bite.
Neurological complications most often occur in the second stage of Lyme disease and include:
- Visual disturbances
- Meningitis-like symptoms such as fever, stiff neck, and severe headache
Other neurological problems, which may not appear for weeks, months, or years after a bite, include decreased concentration, memory and sleep disorders, and nerve damage in the arms and legs.
Lyme disease is treated with antibiotics under the supervision of a physician. Many individuals with Lyme disease respond well to antibiotics. Varying degrees of permanent joint or nervous system damage may develop in individuals with late-stage Lyme disease.
Mortality Rates In Different Stroke Cohorts
According to the Kaplan-Meier plots, considerable differences were observed in the cumulative incidence of mortality among the non-stroke, PSN, and PSP cohorts . The PSP cohort had the highest cumulative incidence of mortality compared with the PSN and comparison cohort during the 14-year follow-up .
Figure 1
As listed in Table 2, the IRs of mortality for the total stroke, PSN, PSP, and comparison cohorts were 75.2, 69.1, 124.9, and 38.8 per 1,000 person-years. Moreover, the mortality risk increased with age: IRs of mortality in patients aged 40 to 64, 65 to 74, and 75 years were 21.5, 49.1, and 108.5 per 1,000 person-years. Compared with patients aged 40 to 64 years, those aged 65 to 74 years and 75 years had 2.16-and 4.80-fold higher mortality risk. Male patients had 1.28-fold higher mortality risk than did female patients. Furthermore, in the model with and without comorbidities, mortality risk was significantly higher in patients with alcohol-related illness , COPD , CAD , diabetes , hypertension , asthma , cancer , liver cirrhosis , and end stage renal disease than in patients without any comorbidity. In addition, the mortality risk was lower in patients with anxiety disorder and hyperlipidemia than in patients without these comorbidities .
Table 2
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Neurogenesis After Ischemic Injury In Normal And Vehicle
In postischemic brain injury, neuronal cells derived from neural precursor cells are newly born and the cells can be detected by bromodeoxyuridine . The BrdU-immunopositive cells were observed in the postischemic cortex, striatum, and subventricular zone on the ipsilateral side of the ischemic infarct at 1 month and 6 months and 4). The BrdU-positive cells were more frequently observed in the ipsilateral side of the statin-treated mice than in the contralateral side. Especially at 1 month after tFCI, many BrdU- and NeuN-immunopositive cells were detected in the lesioned cortex and striatum at the direct site to ischemic damage by MCAO ). It could be implicated that newborn cells have arisen from the SVZ and migrated into striatum and even into cortical area. Moreover, the proliferation of neural cells is promoted by long-term statin treatment. At 6 months and 8 months after fFCI, the incidence of BrdU-positive cells in the ipsilateral striatum and cortex was significantly diminished compared to that of 1 month after fFCI . The BrdU-positive cells were not detected in either striatum or cortex, but a few BrdU-positive cells were detected in SVZ and corpus callosum.
Quantification Of Dopaminergic Neurons In Histological Sections
Quantification of dopaminergic neurons was based on a previously described method . Dopaminergic neurons characterized by visible nuclei after hematoxylin staining and by entire neuronal somas positive for tyrosine hydroxylase were quantified under masked conditions in three sham-treated and five MCAO-treated animals per time point. The number of tyrosine hydroxylase-positive cells was counted in both brain hemispheres in matching sets of coronal midbrain sections at2.90 mm,3.08 mm,3.26 mm, and3.44 mm relative to bregma, and the area of the substantia nigra was identified corresponding to areas depicted in figures 55 to 60 of a mouse brain atlas . The data was summarized for each group and hemisphere as mean tyrosine hydroxylase-positive cells±standard deviation per section.
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Symptoms Of Parkinsons Disease
Parkinsons has four main symptoms:
- Tremor in hands, arms, legs, jaw, or head
- Muscle stiffness, where muscle remains contracted for a long time
- Slowness of movement
- Impaired balance and coordination, sometimes leading to falls
Other symptoms may include:
The symptoms of Parkinsons and the rate of progression differ among individuals. Early symptoms of this disease are subtle and occur gradually. For example, people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly, or that their handwriting is slow and looks cramped or small. Friends or family members may be the first to notice changes in someone with early Parkinsons. They may see that the persons face lacks expression and animation, or that the person does not move an arm or leg normally.
People with Parkinson’s disease often develop a parkinsonian gait that includes a tendency to lean forward take small, quick steps and reduce swinging their arms. They also may have trouble initiating or continuing movement.
Symptoms often begin on one side of the body or even in one limb on one side of the body. As the disease progresses, it eventually affects both sides. However, the symptoms may still be more severe on one side than on the other.
Support For People Living With Parkinsons Disease
While the progression of Parkinsons is usually slow, eventually a persons daily routines may be affected. Activities such as working, taking care of a home, and participating in social activities with friends may become challenging. Experiencing these changes can be difficult, but support groups can help people cope. These groups can provide information, advice, and connections to resources for those living with Parkinsons disease, their families, and caregivers. The organizations listed below can help people find local support groups and other resources in their communities.
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Treating Depression In Ms
There is only one double blind RCT of treatment of depression in MS. This trial compared desipramine plus psychotherapy to placebo plus psychotherapy. Half the patients in the drug treatment arm did not reach the specified dose because of adverse effects. However there was a significant, if modest, effect in favour of desipramine.
There have been open label trials of a number of drug treatments including SSRIs . In general, SSRIs are easier to tolerate and are likely to be equally effective compared to tricyclic drugs.
Clinical experience would suggest that the best strategy would be to start low, go slow when initiating antidepressant treatment . If side effects are encountered, judicious reduction in dose may be the best strategy.
Mild to moderate forms of depression may be managed with cognitive behavioural therapy . CBT can also work well in a group setting, enhancing its cost effectiveness. For more severe forms of depression and in those with cognitive impairment, drug treatments are probably the best first line treatment.
Other models of psychotherapeutic treatment have been used in people with MS . In general, experience has been favourable but there is very little evidence for or against effectiveness.
Parkinson’s Disease And Parkinsonism
There is also another similar disease called Parkinsonism, which is a condition in which people have some of the symptoms of Parkinson’s disease, but do not have Parkinson’s disease itself. Parkinsonism occurs when one or more of the regions of the brain that are responsible for Parkinson’s disease become damaged.
One of the early symptoms of Parkinson’s disease is a loss of the sense of smell, which can happen years before other symptoms appear. The symptoms of Parkinson’s disease and Parkinsonism also include a fine tremor, which is very noticeable in the hands and arms and happens when the hands and arms are at rest.
Beyond loss of sense of smell and tremor, Parkinson’s is associated with several other physical symptoms, including slowness of movement , rigidity and postural instability. These symptoms can make walking or generally moving around extremely difficult and can lead to abnormal body posture. Additionally, people who have Parkinson’s disease or Parkinsonism often have very little facial expression, which is typically called a “masked face.”
The areas of the brain involved in Parkinson’s disease and Parkinsonism are called the substantia nigra and the basal ganglia. Parkinson’s disease is normally caused by slowly progressive degeneration of these two areas, which control the rhythm and smoothness of our movements and the tone of our muscles. As the substantia nigra and the basal ganglia degenerate, the typical symptoms of Parkinson’s disease begin to emerge.
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Epidemiology Of Depression In Ms
Many of the earlier studies into prevalence of depression in MS were subject to considerable ascertainment bias. Two recent, community based studies have addressed this problem to some extent. In the first study, subjects from a large community sample were evaluated using the Center for Epidemiological Studiesdepression scale , which is used to screen for depression in primary care. Forty one per cent of respondents had depression with a subgroup of 30% having moderate or severe depression . Depression was related to shorter duration of illness. Patten et al obtained data from the Canadian community health survey, which looked at health in 115 071 people. The prevalence of depression in MS in this study was 25%. Rates of depression are higher in nursing home settings and one study noted that younger people with MS were more likely to be depressed than their older counterparts with similar levels of physical disability.
Causes Of Parkinson Disease
In Parkinson disease, synuclein forms clumps called Lewy bodies in nerve cells. Lewy bodies consist of misfolded synuclein. Synuclein can accumulate in several regions of the brain, particularly in the substantia nigra and interfere with brain function. Lewy bodies often accumulate in other parts of the brain and nervous system, suggesting that they may be involved in other disorders. In Lewy body dementia Dementia With Lewy Bodies and Parkinson Disease Dementia Dementia with Lewy bodies is progressive loss of mental function characterized by the development of Lewy bodies in nerve cells. Parkinson disease dementia is loss of mental function characterized… read more , Lewy bodies form throughout the outer layer of the brain . Lewy bodies may also be involved in Alzheimer disease Alzheimer Disease Alzheimer disease is a progressive loss of mental function, characterized by degeneration of brain tissue, including loss of nerve cells, the accumulation of an abnormal protein called beta-amyloid… read more , possibly explaining why about one third of people with Parkinson disease have symptoms of Alzheimer disease and why some people with Alzheimer disease develop parkinsonian symptoms.
About 10% of people with Parkinson disease have relatives who have or have had the disease. Also, several gene mutations that can cause Parkinson disease have been identified.
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Scales Used To Measure Depression In Parkinsons Disease
As mentioned above, symptoms of idiopathic PD have considerable overlap with those of depression. This means that standard rating scales for depression may not be valid in this situation. Rating scales for depression may be loaded with somatic or vegetative symptoms, which reduce their validity.
Three rating scales have been tested using a clinical interview with operationalised diagnosis as a gold standard. Using receiver operating curves, the sensitivity and specificity at a given cut off point can be calculated. From this methodology, it is clear that the Beck depression inventory is not a useful rating scale in PD. The Montgomery and Asberg depression rating scale and the Hamilton depression scale have performed better. In summary, diagnosis of depression should be made clinically, using appropriate diagnostic criteria, with severity or response to treatment being measured using MADRS or HAM-D.
How Do I Take Care Of Myself
If you have Parkinsons disease, the best thing you can do is follow the guidance of your healthcare provider on how to take care of yourself.
- Take your medication as prescribed. Taking your medications can make a huge difference in the symptoms of Parkinsonâs disease. You should take your medications as prescribed and talk to your provider if you notice side effects or start to feel like your medications arenât as effective.
- See your provider as recommended. Your healthcare provider will set up a schedule for you to see them. These visits are especially important to help with managing your conditions and finding the right medications and dosages.
- Dont ignore or avoid symptoms. Parkinsons disease can cause a wide range of symptoms, many of which are treatable by treating the condition or the symptoms themselves. Treatment can make a major difference in keeping symptoms from having worse effects.
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