Parkinson’s is a degenerative disorder of the nervous system affecting the motor system. The brain has a degeneration of basal ganglia and a lack of dopamine. A person with Parkinson’s experiences different kinds of symptoms like: Tremors, bradykinesia, pore posture, loss of balance, stiffness and hallucinations or delusions. Scientist are still unsure how Parkinson’s develops. There are a variety of medications that help with the effects of the disease. The medications increase the amount of dopamine.
There are five stages of Parkinson’s designed by the “Hoehn and Yahr rating scale” and discussed is what treatment is best for each stage and the effects of treatment and what effects it has on the disease. There are no time specifications on how fast or slow the disease progresses. Toward the final stage of Parkinson’s, it becomes crippling. Patients become bedridden and cannot complete activities of daily living so around the clock care is needed and medication no longer works. A treatment that is beneficial is deep brain stimulation.
Deep brain stimulation is when electrical shocks are sent to the globus pallidus (near the thalamus) in the brain in Parkinson’s patients to reduce tremors and help with motor skills. This is the most beneficial treatment for the later stages of Parkinson’s. It is medical device put into the skin near the chest which sends electrical stimulation to the brain that help with motor control. Stage one of Parkinson’s At the beginning of Parkinson’s, it can be almost unnoticeable. Often at this stage patients can go undiagnosed. Patients with Parkinson’s can live normally and do daily tasks without any help.
Posture, walk, or light tremors might be present but the treatment like medication can help with the light tremors. Parkinson’s only affects one side of the body at this time. At this stage, it is best for the patient to care about their recent diagnosis. For a patient to be apathetic about the disease can make the symptoms of Parkinson’s worse and can also lead into depression which happens often. Others symptoms can occur from this like fatigue, lower cognitive, and dysautonomic symptoms more often than non-apathetic patients. This should be thought about throughout the stages of Parkinson’s.
Stage two of Parkinson’s Stage two of Parkinson’s become more noticeable such as the tremors, facial expressions, walk, and stiffness. These are both motor and non-motor symptoms and both sides of the body are affected in stage two. At this stage patients, can still maintain balance. Patients with Parkinson’s can still do activities of daily living but may take longer than before. Speech problems may occur like a softer voice and stuttering. This can affect the patient’s communication with friends, family, and the community. Treatment for stage two, like one is medication.
Common medications used for Parkinson’s are Levodopa and carbidopa/levodopa. Levodopa helps mimic dopamine which helps with bradykinesia. Carbidopa/levodopa contains levodopa and the carbidopa increases the effectiveness of levodopa and helps with side effects. Medications should be taken at the same time each day for the medication to be more effective and having times where your medication has worn off. Stage three of Parkinson’s At this point in Parkinson’s balance becomes an issue. Patients will need help getting around but can still complete tasks.
Walking becomes more like shuffling and have a decreased of facial expression almost like a blank stare. Ongoing medication is required to help with balance and tremors. A cane will help assist with balance. Physical or occupational therapy can help with posture and strength. Posture will help with balance. Patients often experience fear of falling and physical therapy will help reduce that fear. Parkinson’s patients fall twice as often as healthy people. Intense training for about two hours a week can help improve symptoms.
Auditory cues like “ready, set, go” or “1,2,3” can help a patient from freezing spells and help the patient start moving. Stage four of Parkinson’s Patients are unable to live alone, a walker or a cane is required to move around, symptoms are severe. Standing still, still can be done without an assistant device. Movement and reaction time are delayed and doing activity of daily living becomes nearly impossible. Around the clock assistant will be need to help complete tasks. Treatment for this would be the ongoing physical or occupational therapy.
Deep brain stimulation is a great option in this stage before the Parkinson’s progresses to stage five. Deep brain stimulation sends electrical impulses to the globus pallidus which is next to the thalamus. A medical device called an implantable pulse generator is put under the skin near the chest area with a wire leading up to the brain which sends electrical impulses the to the brain that helps control movement by regulating electrical impulses. A recent study showed a significant increase in mobility, speech, and time response in patients who received deep brain stimulation.
Even though Parkinson’s patients are receiving deep brain stimulation that are still required to take medications, but the stimulation can help reduce medications. All previous treatments should still be going on like physical therapy and being aware of the disease and being nonapathetic about it. With all treatments combined patient should having the best quality of life as possible. Deep brain stimulation does not stop the progress of Parkinson’s. Stage five of Parkinson’s This is the final stage of Parkinson’s, at this time patient is in a wheel chair or is bed ridden.
There are no activities of daily living. Around the clock care in needed. Strength is weak due to immobility. At this time patient, can be experiencing delusion or hallucinations and cognitive is impairment. Treatment for this stage is medications. When patients have cognitive impairment they often develop dementia. Parkinson’s is not deadly but a fall could be. Patients may have trouble swallowing and something could get caught in air passage way or may fall into the lung. Not all patients progress to stage five of Parkinson’s. Overall treatments Parkinson’s disease is best caught in stage one.
Being apathetic about the disease can make the symptoms of Parkinson’s worse and lead into depression which can develop dementia earlier due to the cognitive impairment. Being aware of the disease will help throughout the progression and help with symptoms. Taking the medications on time make the medication more effective and patient will not experience time when the medication has worn off. At this time patient, will experience stiffness, freezing spells, and tremors worsen. This can lead to a fall or leave a patient unable to move. Physical or occupational therapy will help with posture can gait.
Therapy will also help in muscle tone can help the patient move their own body if legs become stiff while using verbal cues to help the legs start moving. If daily living is to impacted from the disease an option is deep brain stimulation. Patients experience a quicker reaction time, can move better, and can speak better. Brain stimulation is not needed until the later stages Parkinson’s. Levels of movement and speech are still below a healthy but improved the function of the patient with Parkinson’s. This treatment should be used to help patients with activity of daily living it will improve the quality of life for the patient.
