Description

People affected by Parkinson's Disease have uncontrolled tremors and movement disorders that become progressively worse. Normally, cells in a specific part of the brain produce a neurotransmitter called dopamine. In Parkinson's Disease, these cells degenerate and produce smaller and smaller quantities of dopamine. Initial signs and symptoms of Parkinson's Disease may be subtle as it involves fine "shaking" motor movements.

As the disease progresses, the shaking becomes worse and other signs become noticeable. Hallmarks of this disease are: tremors (typically people look like they are rolling something between their thumb and fingers), increase rigidity of all extremities, gait disturbances first noted as a difficulty initiating steps which leads to a uncontrolled accelerated gait with body leaning forward or shuffling gait, and loss of facial expression.

Ultimately Parkinson's Disease results in the total inability to walk, difficulty swallowing and managing saliva (drooling) with high aspiration risk, loss of ability to perform actions that require fine motor skills such as dressing, feeding self, brushing teeth, etc., incontinence of bowel and bladder and loss of the ability to communicate. As with any progressive degenerative diseases of the brain, dementia can be a feature of late stage Parkinson's Disease.

Care giving needs increase as the disease progresses. In initial stages of this disease, medications may be helpful in managing the physical signs of the disease to maintain independent function. Medical management by a neurologist and/or primary care physician will be most beneficial and should involve a plan of care based upon individual needs and responses to treatment.

Initial doctor's visit questions

• Has there been any new difficulty with tasks involving the hands such as buttoning, zipping, tying laces, etc.?
• Has there been any deterioration in handwriting?
• Has there been any increase in tremors causing difficulty using utensils, holding cups/glasses, brushing teeth, shaving or putting makeup or glasses on?
• Has there been any rigidity in any extremity?
• Have there been any changes in gait or ability to walk? Increased bumping into furniture or doors? Any falls or near falls?
• Has there been any difficulty coughing or choking while swallowing solids or liquids? (Most people will have difficulty swallowing liquids first.)
• Has there been a decrease in the desire or willingness to participate in customary activities?
• Have there been a change in tidiness/resulting in an unkempt appearance?
• Has there been any difficulty with memory or behavior? Changes in personality?

Follow up doctor's visit questions

• Are medications being taken as prescribed? If not, why not?
• Have medications been effective in controlling signs and symptoms?
• How long does the effect from the medications last?
• What kinds of side effects are present with medications?
• Has there been any worsening or development of additional signs or symptoms on current dosages of medications?
• Has there been a benefit in regards to independent performance of daily activities?

Important Points to Consider

There is understandable frustration for people suffering from Parkinson's disease as it is progressive. Loss of independence and therefore dependence on someone else has broad ramifications including physical, emotional and psychological needs.

Individuals have varying degrees of responsiveness to medications. For some people medication administration may be required every few hours to achieve any beneficial effects. This will impact both the caregivers as well as the care recipient if medications need to be given throughout the night. This can lead to sleep deprivation for all parties involved. As the disease progresses, medications become less effective, or may not be helpful at all. Newer medications are often poorly tolerated and may cause hallucinations. Elderly patients with chronic health problems may not be candidates for treatments such as deep brain stimulation.

Long term care giving should be planned to include respite and additional care giving support. Community resources should be considered. Support groups may be helpful.

Early in the disease process physical and occupational therapy may be helpful to support safe ambulation and introduce/ provide adaptive equipment aimed at compensating for loss of fine motor skills. Memory and behavioral issues may require an additional treatment plan, and should be discussed with medical providers. Safety concerns regarding falls and aspiration pneumonia need to be included and addressed in any plan of care. Discuss fall prevention and safe eating techniques with medical providers. Speech therapy may be helpful with swallowing/safe eating techniques.

Related topics

Caring for a person with Parkinson's disease
Discussing Dementia
Managing Dementia
Recognizing Signs and Symptoms of a Stroke
Preparing a Bed for Comfort and Convenience
Turning and repositioning a bedbound person
Making an Occupied Bed
Bathing and Skin Care
Mouth Care
Moving from a wheelchair to a bed
Moving from a bed to a wheelchair
Safe Feeding Techniques
Incontinence Care