OLD
Disabilities associated
with aging
Want to know about old people? Check out this packet that
includes the info you want!
Alzheimer’s pages 3-7
Parkinson’s pages 8-62
Other associated with old people pages 63-79
Alzheimer's and dementia basics





Alzheimer's is the most common form of dementia, a general term for
memory loss and other intellectual abilities serious enough to interfere with
daily life.
Alzheimer's disease accounts for 50 to 80 percent of dementia cases.
Alzheimer's is not a normal part of aging, although the greatest known risk
factor is increasing age, and the majority of people with Alzheimer's are 65
and older. But Alzheimer's is not just a disease of old age. Up to 5 percent of
people with the disease have early onset Alzheimer's (also known as
younger-onset), which often appears when someone is in their 40s or 50s.
Alzheimer's worsens over time. Alzheimer's is a progressive disease, where
dementia symptoms gradually worsen over a number of years. In its early
stages, memory loss is mild, but with late-stage Alzheimer's, individuals
lose the ability to carry on a conversation and respond to their environment.
Alzheimer's is the sixth leading cause of death in the United States. Those
with Alzheimer's live an average of eight years after their symptoms
become noticeable to others, but survival can range from four to 20 years,
depending on age and other health conditions.
Alzheimer's has no current cure, but treatments for symptoms are available
and research continues. Although current Alzheimer's treatments cannot
stop Alzheimer's from progressing, they can temporarily slow the worsening
of dementia symptoms and improve quality of life for those with Alzheimer's
and their caregivers. Today, there is a worldwide effort under way to find
better ways to treat the disease, delay its onset, and prevent it from
developing.
Help is available
If you or a loved one has been diagnosed with Alzheimer's or a related dementia,
you are not alone. The Alzheimer's Association is the trusted resource for reliable
information, education, referral and support to millions of people affected by the
disease.
*http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp
Alzheimer's disease
Senile dementia - Alzheimer's type (SDAT); SDAT
Last reviewed: September 26, 2011.
Dementia is a loss of brain function that occurs with certain diseases. Alzheimer's disease (AD), is one
form of dementia that gradually gets worse over time. It affects memory, thinking, and behavior.
Causes, incidence, and risk factors
You are more likely to get Alzheimer's disease (AD) if you:
 Are older. However, developing AD is not a part of normal aging.
 Have a close blood relative, such as a brother, sister, or parent with AD.
 Have certain genes linked to AD, such as APOE epsilon4 allele
The following may also increase your risk, although this is not well proven:
 Being female
 Having high blood pressure for a long time
 History of head trauma
There are two types of AD:
 Early onset AD: Symptoms appear before age 60. This type is much less common than late
onset. However, it tends to get worse quickly. Early onset disease can run in families. Several
genes have been identified.
 Late onset AD: This is the most common type. It occurs in people age 60 and older. It may run
in some families, but the role of genes is less clear.
The cause of AD is not clear. Your genes and environmental factors seem to play a role. Aluminum, lead,
and mercury in the brain is no longer believed to be a cause of AD.
Symptoms
Dementia symptoms include difficulty with many areas of mental function, including:
 Emotional behavior or personality
 Language
 Memory
 Perception
 Thinking and judgment (cognitive skills)
Dementia usually first appears as forgetfulness.
Mild cognitive impairment is the stage between normal forgetfulness due to aging, and the development
of AD. People with MCI have mild problems with thinking and memory that do not interfere with everyday
activities. They are often aware of the forgetfulness. Not everyone with MCI develops AD.
Symptoms of MCI include:
 Difficulty performing more than one task at a time
 Difficulty solving problems
 Forgetting recent events or conversations
 Taking longer to perform more difficult activities
The early symptoms of AD can include:
 Difficulty performing tasks that take some thought, but used to come easily, such as balancing
a checkbook, playing complex games (such as bridge), and learning new information or
routines
 Getting lost on familiar routes
 Language problems, such as trouble finding the name of familiar objects
 Losing interest in things previously enjoyed, flat mood
 Misplacing items
 Personality changes and loss of social skills
As the AD becomes worse, symptoms are more obvious and interfere with your ability to take care of
yourself. Symptoms can include:
 Change in sleep patterns, often waking up at night
 Delusions, depression, agitation
 Difficulty doing basic tasks, such as preparing meals, choosing proper clothing, and driving
 Difficulty reading or writing
 Forgetting details about current events
 Forgetting events in your own life history, losing awareness of who you are
 Hallucinations, arguments, striking out, and violent behavior
 Poor judgment and loss of ability to recognize danger
 Using the wrong word, mispronouncing words, speaking in confusing sentences
 Withdrawing from social contact
People with severe AD can no longer:
 Understand language
 Recognize family members
 Perform basic activities of daily living, such as eating, dressing, and bathing
Other symptoms that may occur with AD:
 Incontinence
 Swallowing problems
Signs and tests
A skilled health care provider can often diagnose AD disease with the following steps:
 Complete physical exam, including neurological exam
 Asking questions about your medical history and symptoms
 A mental status examination
A diagnosis of AD is made when certain symptoms are present, and by making sure other causes of
dementia are not present.
Tests may be done to rule out other possible causes of dementia, including:
 Anemia
 Brain tumor
 Chronic infection
 Intoxication from medication
 Severe depression
 Stroke
 Thyroid disease
 Vitamin deficiency
Computed tomography (CT) or magnetic resonance imaging (MRI) of the brain may be done to look for
other causes of dementia, such as a brain tumor or stroke.
 In the early stages of dementia, brain image scans may be normal. In later stages, an MRI may
show a decrease in the size of different areas of the brain.
 While the scans do not confirm the diagnosis of AD, they do exclude other causes of dementia
(such as stroke and tumor).
However, the only way to know for certain that someone has AD is to examine a sample of their brain
tissue after death. The following changes are more common in the brain tissue of people with AD:
 "Neurofibrillary tangles" (twisted fragments of protein within nerve cells that clog up the cell)
 "Neuritic plaques" (abnormal clusters of dead and dying nerve cells, other brain cells, and
protein)
 "Senile plaques" (areas where products of dying nerve cells have accumulated around protein).
Treatment
There is no cure for AD. The goals of treatment are:
 Slow the progression of the disease (although this is difficult to do)
 Manage symptoms, such as behavior problems, confusion, and sleep problems
 Change your home environment so you can better perform daily activities
 Support family members and other caregivers
DRUG TREATMENT
Medicines are used to help slow down the rate at which symptoms become worse. The benefit from these
drugs is usually small. You and your family may not notice much of a change.
Before using these medicines, ask the doctor or nurse:
 What are the potential side effects? Is the medicine worth the risk?
 When is the best time, if any, to use these medicines?
Medicines for AD include:
 Donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne, formerly called
Reminyl). Side effects include stomach upset, diarrhea, vomiting, muscle cramps, and fatigue.
 Memantine (Namenda). Possible side effects include agitation or anxiety.
Other medicines may be needed to control aggressive, agitated, or dangerous behaviors. Examples
include haloperidol, risperidone, and quetiapine. These are usually given in very low doses due to the risk
of side effects including an increased risk of death.
It may be necessary to stop any medications that make confusion worse. Such medicines may include
painkillers, cimetidine, central nervous system depressants, antihistamines, sleeping pills, and others.
Never change or stop taking any medicines without first talking to your doctor.
SUPPLEMENTS
Some people believe certain vitamins and herbs may help prevent or slowdown AD.
 There is no strong evidence that Folate (vitamin B6), vitamin B12, and vitamin E prevent AD or
slows the disease once it occurs.
 High-quality studies have not shown that ginkgo biloba lowers the chance of developing
dementia. DO NOT use ginkgo if you take blood-thinning medications like warfarin (Coumadin)
or a class of antidepressants called monoamine oxidase inhibitors (MAOIs).
If you are considering any drugs or supplements, you should talk to your doctor first. Remember that
herbs and supplements available over the counter are NOT regulated by the FDA.
Support Groups
For additional information and resources for people with Alzheimer's disease and their caregivers, see
Alzheimer's disease support groups.
Expectations (prognosis)
How quickly AD gets worse is different for each person. If AD develops quickly, it is more likely to worsen
quickly.
Patients with AD often die earlier than normal, although a patient may live anywhere from 3 - 20 years
after diagnosis.
The final phase of the disease may last from a few months to several years. During that time, the patient
becomes totally disabled. Death usually occurs from an infection or organ failure.
Complications










Abuse by an over-stressed caregiver
Bedsores
Loss of muscle function that makes you unable to move your joints
Infection, such as urinary tract infection and pneumonia
Other complications related to immobility
Falls and broken bones
Harmful or violent behavior toward self or others
Loss of ability to function or care for self
Loss of ability to interact
Malnutrition and dehydration
Calling your health care provider
Call your health care provider if someone close to you has symptoms of dementia.
Call your health care provider if a person with AD has sudden change in mental status. A rapid change
may be a sign of another illness.
Talk to your health care provider if you are caring for a person with AD and you can no longer care for the
person in your home.
Prevention
Although there is no proven way to prevent AD, there are some practices that may be worth incorporating
into your daily routine, particularly if you have a family history of dementia. Talk to your doctor about any
of these approaches, especially those that involve taking a medication or supplement.
 Consume a low-fat diet.
 Eat cold-water fish (like tuna, salmon, and mackerel) rich in omega-3 fatty acids, at least 2 to 3
times per week.
 Reduce your intake of linoleic acid found in margarine, butter, and dairy products.
 Increase antioxidants like carotenoids, vitamin E, and vitamin C by eating plenty of darkly
colored fruits and vegetables.
 Maintain a normal blood pressure.
 Stay mentally and socially active throughout your life.
 Consider taking nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin),
sulindac (Clinoril), orindomethacin (Indocin). Statin drugs, a class of medications normally
used for high cholesterol, may help lower your risk of AD. Talk to your doctor about the pros
and cons of using these medications for prevention.
In addition, early testing of a vaccine against AD is underway.
*http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001767/
What is Parkinson’s disease?
Parkinson’s disease (PD) is a neurodegenerative brain disorder that progresses
slowly in most people. What this means is that individuals with PD will be living
with PD for twenty years or more from the time of diagnosis. While Parkinson’s
disease itself is not fatal, the Center for Disease Control rated complications from
the disease as the 14th top cause of death in the United States. There is
currently no cure for Parkinson’s; however, your doctors will be focused and
dedicated to finding treatments that help control the symptoms of PD and have a
good quality of life.
Normally, there are brain cells (neurons) in the human brain that produce
dopamine. These neurons concentrate in a particular area of the brain, called the
substantia nigra. Dopamine is a chemical that relays messages between the
substantia nigra and other parts of the brain to control movements of the human
body. Dopamine helps humans to have smooth coordinated muscle movements.
When approximately 60 to 80% of the dopamine-producing cells are damaged,
and do not produce enough dopamine, the motor symptoms of Parkinson’s
disease appear. This process of impairment of brain cells is called
neurodegeneration.
The current theory (so-called Braak’s hypothesis) is that the earliest signs of
Parkinson’s are found in the enteric nervous system, the medulla and in
particular, the olfactory bulb, which controls your sense of smell. Under this
theory, Parkinson’s only progresses to the substantia nigra and cortex over the
years. This theory is increasingly borne out by evidence that non-motor
symptoms, such as a loss of sense of smell, hyposmia, sleep disorders and
constipation may precede the motor features of the disease by several years. For
this reason, researchers are increasingly focused on these “non-motor”
symptoms to both detect PD as early as possible and to look for ways to stop its
progression.
10 Early Warning Signs of Parkinson's
Disease
Sometimes it is hard to tell that you might have Parkinson's disease. Parkinson's
disease is when your brain stops making an important chemical called
dopamine. This chemical helps your body to move, and helps your mood. If you
do have Parkinson's, you can feel better by taking a pill that helps your body to
replace that chemical. Parkinson's disease will get worse slowly over time, and
your doctor can help you stay healthy longer. Some of the problems listed here
could be signs of Parkinson's disease.
No single one of these signs means that you should worry about Parkinson's
disease. If you have more than one symptom, you should make an appointment
to talk to your doctor.
Early diagnosis of Parkinson's disease gives you the best chance of a longer,
healthier life.
What you can do if you do have Parkinson's disease:
Work with your doctor to create a plan to stay healthy. This plan might include:
A referral to a neurologist, a doctor who specializes in the brain
· Care from an occupational therapist, physical therapist or speech therapist
· Meeting with a medical social worker to talk about how Parkinson's will affect
your life
· Start a regular exercise program to delay further symptoms.
· Talk with family and friends who can provide you with the support you
need.Tremor or Shaking
Have you noticed a slight shaking or tremor in your finger, thumb, hand, chin or
lip? Does your leg shake when you sit down or relax? Twitching or shaking of
limbs is a common early sign of Parkinson’s disease.
What is normal? Shaking can be normal after lots of exercise, if you have been
injured, or could be caused by a medicine you take.Small Handwriting
Has your handwriting suddenly gotten much smaller than in it was in the past?
You may notice the way you write words on a page has changed, such as letter
sizes are smaller and the words are crowded together. A sudden change in
handwriting is often a sign of Parkinson’s disease.
What is normal? Sometimes writing can change as you get older, if you have stiff
hands or fingers or poor vision, but this happens over time and not
suddenly.Loss of Smell
Have you noticed you no longer smell certain foods very well? If you seem to
have more trouble smelling foods like bananas, dill pickles or licorice, you should
ask your doctor about Parkinson’s disease.
What is normal? Your sense of smell can be changed by a cold, flu or a stuffy
nose, but it should come back after you are better.Trouble Sleeping
Do you thrash around in bed or kick and punch while you are deeply asleep? You
might notice that you started falling out of bed while asleep. Sometimes, your
spouse will notice, or will want to move to another bed. Sudden movements
during sleep may be a sign of Parkinson’s disease.
What is normal? It is normal for everyone to have a night when they ‘toss and
turn’ instead of sleeping.Trouble Moving or Walking
Do you feel stiff in your body, arms or legs? Sometimes stiffness goes away as
you move. If it does not, it can be a sign of Parkinson’s disease. You might notice
that your arms don’t swing when you walk, or maybe other people have said you
look stiff. An early sign might be stiffness or pain in your shoulder or hips. People
·
·
sometimes say their feet seem ‘stuck to the floor.’
What is normal? If you have injured your arm or shoulder, you may not be able to
use it as well until it is healed or another illness like arthritis might cause the
same symptom.Constipation
Do you have trouble moving your bowels without straining every day? Straining
to move your bowels can be an early sign of Parkinson’s disease and you should
talk to your doctor.
What is normal? If you do not have enough water or fiber in your body, it can
cause problems in the bathroom. Also some medicine will cause constipation too.
If there is no other reason such as diet or medicine that would cause you to have
trouble moving your bowels, you should speak with your doctor. A Soft or Low
Voice
Have other people told you that your voice is very soft when you speak in a
normal tone, or that you sound hoarse? If there has been a change in your voice
you should see your doctor about whether it could be Parkinson’s disease.
Sometimes you might think other people are losing their hearing, when really you
are speaking more softly.
What is normal? A chest cold or other virus can cause your voice to sound
different but you should go back to sounding the same when you get over your
cough or cold.Masked Face
Have you been told that you have a serious, depressed or mad look on your face
more often, even when you are not in a bad mood? This serious looking face is
called masking. Also, if you or other people notice that you have a blank stare or
do not blink your eyes very often, you should ask your doctor about Parkinson’s
disease.
What is normal? Some medicines can cause you to have the same type of
serious or staring look, but you would go back to the way you were after you
stopped the medication.Dizziness or Fainting
Do you notice that you often feel dizzy when you stand up out of a chair? Feeling
dizzy or fainting can be signs of low blood pressure and can be linked to
Parkinson’s disease.
What is normal? Everyone has had a time when they stood up and felt dizzy, but
if it happens on a regular basis you should see your doctor.Stooping or
Hunching Over
Are you not standing up as straight as you used to? If you or your family or
friends notice that you seem to be stooping, leaning or slouching when you
stand, it could be a sign of Parkinson’s disease.
What is normal? If you have pain from an injury or if you are sick, it might cause
you to stand crookedly. Also, a problem with your bones can make you hunch
over.
What are the symptoms of Parkinson's
disease?
Four Main Motor Symptoms of PD:
Shaking or tremor at rest.
Slowness of movement, calledbradykinesia.
· Stiffness or rigidity of the arms, legs or trunk.
· Trouble with balance and falls, also called postural instability. Postural instability
usually appears later with disease progression and may not be present with initial
diagnosis.
·
·
Secondary Symptoms of PD May Include:
Small, cramped handwriting, called micrographia.
· Reduced arm swing on the affected side.
· Slight foot drag on affected side creating a shuffled walk.
· “Freezing”—a term used to describe the phenomenon of being “stuck in place”
when attempting to walk.
· Loss of facial expression due to rigidity of facial muscles, calledhypomimia.
· Low voice volume or muffled speech, called hypophonia.
· Tendency to fall backwards, called retropulsion.
· Decrease ability in automatic reflexes such as blinking and swallowing.
·
Other Symptoms of PD
·
·
·
·
·
·
·
Depression
Anxiety- beyond the normal response to stress
Hallucinations, psychosis
Sleep disturbances (vivid dreams, talking and moving during night sleep)
Constipation
Pain
Increase in dandruff (seaborrhea dermatitis) or oily skin
Table 1. Symptoms in Parkinson’s disease
MOTOR SYMPTOMS
Bradykinesia (slowness of movement)
Rigidity (stiffness of movement)
Tremor (involuntary shaking of the hands, feet, arms, legs, jaw, or tongue, usually more
prominent at rest)
Postural Instability (tendency to fall without explanation, usually when pivoting)
NON-MOTOR SYMPTOMS
Mood (depression, anxiety, irritability)
Cognitive changes (attention, visuo-spatial problems, memory problems, personality
changes, psychosis/hallucinations)
Orthostatic hypotension (lightheaded and low blood pressure upon standing)
Constipation and early satiety (a feeling of fullness after eating small amounts)
Hyperhidrosis (excessive sweating), especially of hands and feet
Seborrhea dermatitis (dry skin) dandruff
Urinary urgency, frequency and incontinence
Loss of sense of smell (Anosmia)
Sleep disorders
Insomnia, Excessive Daytime Sleepiness (EDS), Rapid Eye Movement Behavioral
Disorder (RBD) or active dreaming, dream enactment, involuntary movements and
vocalizations during sleep, Restless Legs Syndrome (RLS)/Periodic Leg Movements
Disorder (PLMD)
Sensory (pain, tightness, tingling, burning)
MIXED MOTOR AND NON-MOTOR SYMPTOMS
Drooling due to slowed swallowing (Sialorrhea)
Speech and swallowing problem
How is PD Treated?
Currently, there is no cure for Parkinson’s disease. Instead, therapy is directed at
treating the symptoms that are most bothersome to an individual with Parkinson’s
disease. For this reason, there is no standard or “best” treatment for Parkinson’s
disease that applies to every patient. NPF is currently gathering the data to
develop an individualized best approach to patient care. Treatment approaches
include medication and surgical therapy. Other treatment approaches include
general lifestyle modifications (rest and exercise), physical therapy, support
groups, occupational therapy and speech therapy. In this section, you will
become more familiar with the different types of medications commonly
prescribed for PD, other alternative therapies, and surgical treatment options.
Recent studies have implicated that a treatment is better than no treatment. In
other words, medications and therapies may modify the progression of
Parkinson’s disease.
Medications for Motor Symptoms
Since most symptoms of PD are caused by the lack of dopamine in the brain,
many Parkinson’s drugs are aimed at either temporarily replenishing dopamine
or mimic the action of dopamine. These types of drugs are called dopaminergic.
These medications generally help reduce musclerigidity, improve speed and
coordination of movement and lessen tremor.
Always remember that medication usage is only part of the whole treatment plan
for effectively treating PD. Learn more about the available medications for the
treatment of PD now.
Caution: PD medications may have interactions with certain foods, other
medications, vitamins, herbal supplements, over the counter cold pills and other
remedies. Anyone taking a PD medication should talk to their doctor and
pharmacist about potential drug interactions.
Surgical Treatment Options
While surgery can be an effective treatment option for different symptoms of PD,
only the symptoms that previously improved on levodopa have the potential to
improve after the surgery. Surgical treatment is reserved for PD patients who
have exhausted medical treatment of PD tremor or who suffer profound motor
fluctuations (wearing off and dyskinesias).
Living With Parkinson’s Disease
While living with PD can be challenging there is hope. Hope in the fact, that there
are things you can do to maintain your quality of life and live well. In this section,
we will explore ways to:
Maintain a healthy diet
How to navigate daily activities of living like grooming and sleeping.
· Ways to make your life easier and safer at home.
· How to handle mental health issues such as depression, anxiety
andpsychosis.
· How to take care of your patient with Parkinson’s while taking care of yourself.
· How to boost your mobility confidence
·
·
Nutrition
A healthy diet with plenty of water is the foundation for good health, regardless of
whether or not you have PD. However, for those with PD, it is even more
important. The reason why it is so critical for those with PD is that healthy eating
can help keep your bones strong, thus decreasing the likelihood of a fracture if
you fall. It also helps you fight constipation, which is common with PD. In this
section, you will learn about which foods to eat if you have PD in order to
maintain your bone health and activity level.
Activities of Daily Living
Sometimes the challenges of living with PD interfere with basic activities once
considered routine like bathing, dressing, eating, sleeping and walking about.
While it may seem disheartening, there is help. Besides contacting a local
occupational therapist, here are a few tips to help you live a better quality of life.
Bathing
·
Bathtubs and shower stalls should have at least two handrails to hold on to as
you get in and out.
· Handrails should be professionally installed when possible.
· Never use the towel bar, soap dish, or faucet as a handrail.
· If you sit on a tub transfer bench or shower chair while showering, use a hand
held showerhead.
· All bathtubs and shower stalls should have a non-skid rubber bath mat.
· All bath rugs should have a rubber backing. Try kitchen rugs instead of bath
rugs, as they tend to be thinner.
· Don’t use bar soap! It is slippery and hard to hold and can leave a slippery film
on the floor for you to accidentally slip on. Use pump soaps instead.
· Keep a nightlight on in the bathroom.
· If you are alone, bring a cordless phone with you so you can call for help if you
need it.
Grooming
PD rigidity and tremor may make it difficult to handle toothbrushes, razors and
hairdryers. Here are a few tips that may help:
· Sit down to brush your teeth, shave, or dry your hair as it prevents you from
falling and helps you conserve energy.
· If your shoulders get tired, prop your elbows on the vanity or sink when you
shave, comb your hair or use a hairdryer.
· Use an electric razor.
· Use an electric toothbrush
· Use a hands-free hairdryer that can be mounted on a vanity.
Getting Dressed
Allow plenty of time for dressing. Hurrying can lead to stress and frustration,
which can slow you down.
· Do a few stretching exercises before getting dressed to “warm up” muscles.
· Sit down when dressing. Choose a chair with firm support and arms.
· Don’t sit on the edge of the bed to dress—this can lead to loss of balance and
falling.
· Use a footstool to make it easier to put on shoes and socks.
· Avoid socks with tight elastic bands.
· Wear non-skid socks should replace bathroom slippers, which can slide off
your feet.
· Wear lightweight, supportive shoes with Velcro closures or elastic shoelaces
make it easy to put on and take off shoes.
·
Toileting & Incontinence
·
Try a regular schedule for going to the bathroom (for example every two
hours).
· Avoid caffeinated drinks such as coffee, tea, and cola, which may worsen
problems.
· If getting up at night to use the bathroom is problem, limit evening fluids 2
hours before bedtime.
· Frequency and urgency with burning pain are symptoms of a urinary tract
infection. If you experience these symptoms, call your health care provider.
· You may also consider using an incontinence product such as a pad or shield
to help if you are prone to accidents. You can find these products at your local
drug store.
Getting Around: Canes
Do’s
Get a straight cane with a rubber tip.
Hand grips should be comfortable and the height of the cane should be
adjusted for best support.
· Hiking sticks or poles are also helpful and can help you keep a better posture
while walking.
· If you experience freezing of gait there are laser canes and walkers available.
In-Step has a laser cane with a triangular rubber tip that is more stable than a
standard rubber tip and is easy to put down correctly. (Triangular tip is optional,
not pictured at right)
·
·
Don’ts
Avoid tripod canes or quad canes (those with three or four-point bases).
People with PD tend to have difficulty using these types of canes as all points
don’t touch the ground at the same time and provide less stability.
·
Getting Around: Walkers
Do’s
Get a four, or more, wheeled walker, which offers better stability and easier
turns.
· Special features such as large wheels, swivel casters, and hand brakes
provide the most stability.
· Walkers with built-in seats and baskets can be especially helpful.
· If you experience freezing of gait there are laser canes and walkers available.
The U-Step has an optional laser cuefor helping with Parkinson's freezing.
·
Don’ts
Avoid four-post walkers, or standard walkers. Picking up the walker to
advance it can cause a backward loss of balance.
·
Wheelchairs: How to choose the right one
The time may come when use of a wheelchair may be a necessity. Usually, the
need for a wheelchair comes later in the advanced stages of PD. Therefore, it is
important to know what to look for in picking the right one and who to talk to on
your comprehensive care team to assist you in this important decision. The
following are a few tips to guide you through the process:
· Schedule an appointment with your occupational or physical therapist to find
out which chair best meets your individual needs.
· Check with your insurance company to learn about covered services in your
plan, as not all wheelchairs will be covered.
· Try to pick a lightweight wheelchair, as they are easier to lift in and out of the
car.
· Choose a reclining chair back, which is helpful is you have to make posture
changes, have low blood pressure, or you need to rest during the day.
How Can You Increase Your Mobility
Confidence?
Build physical activity into your daily routine: gardening, housework or washing
the car, as you are able.
· Walk with a friend
· Attend a community exercise program
· Move around frequently: walk during commercials if you tend to watch TV
· Put on some upbeat music and dance
· Take a grandchild for a walk
·
Vision
Are your eyes closing uncontrollably?
It is not common for people with Parkinson’s disease to experience involuntary
closure of the eyes, but it does occur in some cases. This phenomenon has been
referred to asblepharospasm, pronounced ['blef-a-ro-spaz-m' (click to hear it)].
“Blepharo” refers to the eyelid, and “spasm” is defined as an uncontrollable
muscle contraction.
If you are experiencing involuntary eye closure, it is important to see an
ophthalmologist first. There are many conditions that can cause involuntary eye
closure, and these conditions are not related to Parkinson’s disease. They
include:
· an inflammatory eye condition due to an infection or an allergy
· dry eyes
· damage to the surface of the eye
· ptosis (A person’s eyelid appears to be “drooping.” It can be caused by muscle
weakness, nerve damage, or looseness of the eyelid skin. This is often
associated with normal aging.)
· other conditions
If the ophthalmologist determines that the aforementioned conditions do not
account for the eye closure, the next step for patients is to see their neurologist
to determine whether their PD medications are optimized. The involuntary eye
closure may or may not be related to doses of PD medications (Optimizing your
medications refers to a process in which you and your doctor work to find the
medication regimen from which you derive the greatest benefit).
If eyelid closure remains a problem after medications have been optimized, then
injection of botulinum toxin, also called botox, every 3-4 months in the muscles
around the eyelids has been found to be a very effective treatment.
In rare cases, botulinum toxin may be ineffective, and it may be helpful to consult
a movement disorder specialist (MDS), a neurologist with expertise in movement
disorders like Parkinson’s disease. An MDS can help determine whether the
diagnosis is correct. Sometimes blepharospasm can be confused with another
condition called “apraxia of eyelid opening.”
Sleep
We all know how critical a good night’s sleep is to our health and well-being.
However, for those with PD, sleep becomes even more important as the body
needs more time to restore and repair itself. Not surprisingly, sleep-related
symptoms are reported by more than 75% of people with PD. The following are
the most common complaints:
· Difficulty falling and staying asleep
· Excessive daytime sleepiness
· Talking or yelling out while asleep
· Vivid dreaming
· Leg movements, jerking, cramping
· Difficulty turning over in bed
· Waking up to go to the bathroom
Excessive Daytime Sleepiness
Sleepiness during the day is seen in about 30-50% of patients with PD and it is
more prominent as the disease advances. Daytime sleepiness may arise in
patients with PD for many reasons including:
· Poor night’s sleep
· Dopaminergic medications, especially dopamine agonists (Mirapex and
Requip) may cause daytime sleepiness.
Did you know dopaminergic medications like Requip can
cause sudden "sleep attacks" while driving, which is a
potential cause of motor vehicle accidents?
How is daytime sleepiness treated?
You may have to make certain lifestyle modifications such as:
· Establish good sleep hygiene, which includes a set bedtime and wake-up time.
· Get exposure to adequate light during the day and darkness at night.
· Indoor lighting may not be sufficient to promote a normal circadian rhythm.
· Avoid sedentary activities during the day.
· Participate in activities outside the home, as they may be helpful in providing
stimulation to prevent daytime dozing.
· Get physical exercise appropriate to your level of functioning, which may also
promote daytime wakefulness.
· Strenuous exercise, however, should be avoided for 3 to 4 hours before sleep.
· Patients with excessive daytime sleepiness should be warned not to drive
while sleepy. The occurrence of motor vehicle accidents is increased during
periods of drowsiness and may be associated with sudden onset of sleep (sleep
attacks).
· If you are on a dopamine agonist and you experience daytime sleepiness or
sleep attacks you will need to talk to your doctor about possibly decreasing the
dose.
· You might also want to decrease your intake of stimulants like caffeine,
modafinil (Provigil) and methylphenidate (Ritalin). Talk to your doctor before
making any major lifestyle modifications.
Problems with Sleep at Night
There are several problems that PD patients may experience during the night.
For example:
· Obstructive sleep apnea
· Restless legs syndrome
· REM sleep behavioral disorder
· Return of the tremor and rigidity during the night
· Patients may have a combination of a few sleep problems
Sleep apnea
Sleep apnea can be seen in up to 40% of patients with PD. The common
symptoms include:
· Loud snoring
· Restless sleep
· Sleepiness during the daytime
· Pause in breathing during night sleep
Obstructive Sleep Apnea (OSA)
Obstructive sleep apnea (OSA) is the most common category of sleepdisordered breathing.
· The muscle tone of the body ordinarily relaxes during sleep and at the level of
the throat the human airway is composed of collapsible walls of soft tissue, which
can obstruct breathing during sleep.
· What is interesting is that unlike the general population, patients with PD with
sleep apnea are not overweight.
·
How is sleep apnea diagnosed?
A patient may participate in a “sleep study” or polysomnogram where the
patient’s amount of pauses in breathing and oxygen level in blood are monitored
throughout the night at a sleep clinic.
·
How is sleep apnea treated?
Continuous positive airway pressure (CPAP) is the most consistently effective
treatment for obstructive sleep apnea. CPAP is a machine connected to a
facemask that is worn by the patient through the night and controls the pressure
in one’s throat to prevent the walls of the throat from collapsing, thus creating
better quality of sleep.
REM – sleep behavioral disorder
REM is a normal part of the sleep during which people dream. Usually the only
part of the body that is moving during REM is the eyes, thus the name rapid–eye
movement sleep.
· Patients with rapid-eye movement behavior disorder (RBD) do not have the
normal relaxation of the muscles during their dreams. Therefore, they act out
their dreams during rapid-eye movement(REM) stage sleep.
· During RBD patients may: shout, kick their bed partner, grind their teeth and
sometimes in moderate to severe RBD may have aggressive, violent behaviors,
like getting out of bed and attacking their bed partner.
· About half of people with PD suffer from RBD — which may develop after or
along with the disease, or in most cases, actually precedes the PD diagnosis by
5-10 years.
What is the treatment for RBD?
Environmental adjustments to protect the patient and bed partner from injury
are important. This may include padding the floor, using bed rails, or sleeping in
separate rooms.
· Clonazepam has been shown in large case series to improve RBD in 80% to
90% of patients. The dose of clonazepam required is low, usually from 0.5 mg to
1.0 mg.
· The adverse effects of clonazepam include nocturnal confusion, daytime
sedation, and exacerbation of obstructive sleep apnea, if present. It is available
in generic form and is not expensive.
· Melatonin in doses up to 12 mg at night one hour before bedtime was shown
to improve RDB in a small study.
· Adverse effects reported include: morning headaches, morning sleepiness,
and delusions/hallucinations.
·
Return of the usual Parkinsonian symptoms at night
It is not unusual for tremor and rigidity to return in the middle of the night
Many times, patients take their last dose of anti-Parkinsonism medication
before going to sleep, which lasts only up to 5-6 hours.
Some of the signs that Parkinsonian symptoms are causing the patient to
wake up are:
· Waking up at the same time in the middle of the night
· Frequency of urination because of the rigidity of the bladder and lack of
dopamine
· Feeling tremor or rigidity coming back,
· Inability to turn in bed.
·
·
How are Parkinsonian symptoms treated at night?
Using a long acting dopaminergic medications like Sinemet CR and Requip XL
had been helpful in alleviating Parkinsonian symptoms in the middle of the night.
· It is not unusual for some patients to take additional Sinemet 25/100 mg ½ tab
– 1 tab in the middle of the night to help decrease the rigidity and fall back to
sleep.
·
Tips for Getting a Good Night's Rest
Maintain a regular sleep schedule; get up and go to sleep the same time every
day.
· Get plenty of bright light exposure, particularly natural daytime light.
· Decrease fluids several hours before bedtime.
· Go to the bathroom before getting into bed to sleep.
· Use your bed only for sleeping and intimacy with your partner.
· Set the thermostat for a slightly cool bedroom temperature for sleeping.
· Make a regular, relaxing bedtime routine a habit.
· Lie down to sleep only when sleepy.
· If you are unable to sleep after 15 minutes, get out of bed and engage in a
relaxing activity like listening to music, meditation or reading until you are sleepy.
· Keep lighting and noise at comfortable levels when trying to sleep.
· Sleep as much as needed to feel refreshed, but avoid spending too much time
in bed.
·
What to Avoid Before Bedtime
Alcohol, caffeine and other stimulants such as nicotine
Heavy late-night meals (although a light snack at bedtime may be helpful)
· Heavy exercise within 6 hours of bedtime
· Thoughts or discussions before bedtime about topics that causeanxiety, anger
or frustration
· Clock Watching
·
·
Tips for Getting into Bed
1. Approach the bed as you would a chair; feel the mattress behind both legs.
2. Slowly lower yourself to a seated position on the bed, using your arms to
control your descent.
3. Lean in your forearm while you allow your trunk to lean down to the side.
4. As you trunk goes down, the legs will want to go up like a seesaw.
5. DO NOT put your knee up on the mattress first. In other words, don’t “crawl”
into bed.
Tips for Getting Out of Bed
1. Bend knees up, feet flat on the bed.
2. Roll onto your side toward the edge of the bed by letting the knees fall to that
side. Reaching across with the top arm. Turn your head and look in the direction
you are rolling.
3. Lower feet from the bed as you push with your arms into a sitting position.
Barton Bed (Lateral) Transfer Solutions
If getting in or out of bed becomes too difficult and your caregiver is unable to lift
you in and out of bed there is now a tangible solution. Barton Medical Institution has
several bed options,which enable a “No Lift” approach.
Tips for Rolling or Turning Over in Bed
1. Bend your knees up with feet flat.
2. Allow knees to fall to one side as you begin to roll.
3. Turn your head in the direction you are rolling and reach top arm across the
body.
4. Some PD patients find that “silk sheets” help them move better in bed.
Tips for Scooting Over in Bed
1. Bend your knees up with feet flat.
2. Push into the bed with feet and hand to lift your hips up off the bed. Then shift
hips in the desired direction.
3. Finish by repositioning feet in the direction your hips moved.
Safety at Home
Parkinson’s disease can eventually lead to slow or delayed balance responses.
For example, it may cause tripping episodes due to the shuffling walking pattern.
In addition, sometimes a person may experience “freezing” episodes that can
lead to a sudden loss of balance and result in falling. Your doctor may
recommend a Home Safety Evaluation in which an Occupational Therapist will
come to your home and provide tips to make your home safer.
In this section, we will explore ways to create a safer home environment thereby
helping patients with PD reduce the likelihood of falling and injury.
Freezing
One safety challenge many patients with advanced PD face is “freezing”.
Freezing is the temporary, involuntary inability to move.
· For example, one’s feet may seem to stick to the floor or one may be unable to
get up from a chair.
· The problem can occur at any time and some people are more prone to
freezing episodes than others.
· Some freezing of gait happens mostly when patient is due for the next dose of
dopaminergic medications and that phenomena called “ off” freezing.
· Usually, increase of the dopaminergic medications in order to avoid an “off”
state can help alleviate the freezing of gait.
The cause of freezing is unknown.
Freezing creates a danger of falling because the beginning and end of a
freezing episode are unpredictable.
· The unpredictability coupled with efforts by well-meaning companions to force
the person to move may cause the person with Parkinson’s disease to lose
balance and fall.
·
·
Facts about Falls Related to PD
• Approximately 38 percent of people with PD fall each
year
• Falls in PD occur mostly when turning or changing
directions and is often related to a “freezing episode”
• Not all people with PD experience freezing episodes, but
those who do are at a much higher risk of falling
Many patients with freezing may notice that different tricks while walking help
alleviate a freezing episode:
· Marching
· Shifting the weight of the body from one leg to another
· Listening to rhythmical music and stepping with the rhythm
· Stepping over an imaginary line in front of them
· Using a mobile laser device that creates a line in front of the patient to step
over.
Bathroom Safety Tips
Most falls take place in the bathroom because of: difficulty getting on/off the
toilet; in/out of the tub; difficulty seeing due to poor lighting; slipping on wet
surfaces; tripping on throw rugs; or getting dizzy while standing from the toilet to
the sink.
The following are some guidelines to help you stay safe in the bathroom and
prevent falls:
Bath bench or shower stool
·
·
These devices are useful for sitting on when bathing or showering.
They can also be used to sit up on when washing at the sink if you get dizzy.
Elevated toilet seat
·
·
Getting off the toilet may be difficult unless you have adequate leg strength.
Using an elevated toilet seat will help get up safely and with less effort.
Grab bars
These bars attached to the walls of the tub or shower area or on the wall near
the toilet can help provide a safe hand-hold when getting in and out of the
tub/shower or on/off the toilet.
·
Hand-held shower
Install a hand-held shower and lower your hot water temperature to less than
120 degrees.
· A hand-held shower allows you to safely sit on a shower bench while bathing.
· Lowering the water temperature of the hot water heater will prevent accidental
burns.
·
Light Switch
·
·
·
A light switch next to the door will prevent you from walking into a dark area.
Always put the light on before entering the bathroom.
A nightlight in the bathroom is helpful to light the room at night.
Rubber mat or non-skid decals
The surface of the tub or shower can be slippery. A bath mat or non-skid
decals can prevent slipping on wet surfaces.
·
Rug
All throw rugs should have rubber backing and if carpeted, carpets should be
secure and wrinkle free.
· Keep floors clean and free of debris.
· Bathroom floors should be unwaxed and should not have chemicals on them
that may cause tripping and falling.
·
Shelving
Installing a shelf in the tub or shower area prevents bending to pick up items.
Shelving works best when items can be stored between the level of the
shoulders and knees.
· Items stored between the knees and shoulders are easier to reach.
·
·
Toilet frame
You could also install a sturdy toilet frame to provide stability and safety when
getting on and off the toilet.
· This also helps to stabilize you when you are balancing yourself to manage
your clothing.
·
Tub Rail
If you do not have access to a shower and use a tub for bathing, install a tub
rail for support and safety when getting in and out of the tub.
·
Kitchen Safety Tips
The kitchen can be a difficult place to navigate safely for patients with PD. The
following are a few tips on how to use your kitchen in safer, more manageable
ways.
Cabinet handles
Use longer cabinet handles versus knobs because handles make it easier to
open and close cupboard doors.
·
Drawers
Install sliding drawers to store commonly used items to avoid the need to
reach or bend over too far to look in the back of the drawer.
·
Faucet
·
A single handle faucet is easier to control and turn on and off.
Items for Cooking
Place commonly used items for cooking such as spices near the stove to
avoid reaching over the stove which may cause burns.
·
Potholders
Install a fixture on the wall to keep commonly used pots and pans to ease
reach on preparation for cooking tasks.
·
Reacher
·
·
Use a long-handed reacher for lightweight items on high shelves.
Additional shelves and hooks can be used under cabinets.
Smoke Alarm
·
Install a smoke alarm to alert you of fire danger.
Bedroom Safety Tips
Your bedroom is your safe haven. The following suggestions can help ensure
that you stay safe in your bedroom.
Bed is appropriate height
·
·
Make sure your bed is easy to get in and out of in terms of height.
The average height is 22 inches.
Bedside commode or urinal
Consider purchasing a bedside commode or urinal if the bathroom is not close
to your bedroom.
·
Clothing is accessible
Clothing rods should be at a height that is easy to reach.
· Install lighting in the closet.
· Make sure to store clothing in dressers that will allow access without stooping
or bending.
·
Edges of carpet and rugs are secure
Carpets and rugs should be smooth so as to create a safe walking surface and
minimize falls.
·
Flashlight by bedside
Keep a flashlight by your bedside in case of a power outage or in the event
you need to go where a nightlight is not available.
·
Lamps or light switches are near bed
Lamps should be where they can be easily turned on/off so that you don’t
need to walk around in the room in the dark.
·
Night-light
Using a nightlight in your bedroom to light your way from the bedroom to the
bathroom is particularly important, as many patients with PD have to get up
frequently at night.
·
Smoke Alarm
·
Install a smoke alarm to alert you of fire danger.
Telephone/Clock by bedside
Keep a telephone and clock by your bedside to avoid having to get out of bed,
thus minimizing your chances of falling — especially during the night.
·
Living Room Safety Tips
Since the living room is a common place to relax and entertain friends it is
important that it be a safe environment. The following are a few suggestions on
how to safety-proof your living room if you or someone you love is living with PD.
Did you know older adults require two-to-three times
more lighting than younger adults?
All furniture is secure, sturdy and does not swivel.
· Adequate lighting for reading to minimize eye-strain.
· Adequate space to move around furniture
· Adjustable blinds or shades to regulate glare.
· All pathways and walkways are free of clutter including throw rugs to minimize
the risk of falling.
· All cords including, but not limited to, phone cords and extension cords are out
of the flow of foot traffic.
· Install a smoke alarm to alert you of fire danger.
·
Stairway Safety Tips
Adequate lighting on steps
· Apply brightly colored tape to the top and bottom steps to signal beginning and
end of the steps.
· Apply non-skid surfaces to the steps.
· Install a ramp over the steps if unable to safely climb steps.
· If unable to use a walker, cane or mobility aid on steps, place a second aid at
the top or bottom for safety.
·
Install handrails on at least one side of the steps. Handrails two to three inches
from the wall permit good grasp.
· Keep steps clutter free.
·
What Cognitive Changes Occur with PD?
The term “cognitive” refers to thinking or the processes involved in knowing or
putting together information.
· It includes a variety of mental skills such as attention, problem-solving,
memory, language, visual-perceptual skills, and other aspects of reasoning and
general intellect.
· Many persons with PD complain of slowness in thinking and difficulty with
word-finding.
· Research has found that mild symptoms of cognitive impairment occur in PD
patients.
· Some patients report mild improvements in motivation and concentration after
taking anti-Parkinsonian medications.
· These medications, however, do not typically improve other aspects of
memory and thinking abilities.
·
While approximately 50% of patients with PD will
experience some form of cognitive impairment, not all
individuals will be diagnosed with full-blowndementia.
In general, mental and motor decline tend to occur in parallel as the disease
progresses. Significant cognitive impairment in PD is often associated with:
· Caregiver distress
· Worse day-to-day function
· Diminished quality of life
· Poorer treatment outcomes
· Greater medical costs due to nursing home placements
· Increased mortality
1) Attention:
Difficulty with complex tasks that require patient to maintain or shift their
attention.
· Problems with mental calculation of numbers or concentration during a task.
·
2) Speed of Mental Processing:
·
·
·
Just as movement can be slowed in PD, thinking abilities can too.
This slowing in thinking is often associated with depression in PD.
These problems can be seen as a delay in responding to verbal or behavioral
stimuli, taking longer to complete tasks, and difficulty retrieving information from
memory.
3) Problem-solving or executive function:
Trouble planning and completing activities
Difficulties in generating, maintaining, shifting and blending different ideas and
concepts.
· More concrete in approach to tasks.
· Patients with these deficits often benefit from regular cues or reminders and
greater structure of activity.
·
·
4) Memory deficits:
The basal ganglia and frontal lobes of the brain may be damaged in PD and
are the areas of the brain important in organization and recall of information.
· Difficulty with common tasks such as making coffee, balancing checkbook,
etc.
· Patients with full-blown dementia will experience both short-term and longterm memory impairment.
·
5) Language abnormalities:
Many PD patients complain of word-finding problems, or the “tip of the tongue”
phenomenon.
· Problems in naming or misnaming objects seen in the middle to late stages of
PD.
· Difficulty with language when under pressure or stress.
· Difficulty comprehending complex sentences where the question or
information is included with other details.
· Many patients experience problems with production of language
anddysarthria.
·
6) Visuospatial difficulties
Can be seen in different stages of PD.
During the early stages of PD, patients may have difficulty with measuring
distance and depth perception, which may interfere with the patient’s ability to
park the car or remember where the car is parked in the parking lot.
· During the later stages of PD, in combination with dementia, some patients
can experience problems with processing information about their surroundings or
environment.
· Subtle visual-perceptual problems may contribute to the visual misperceptions
·
·
or illusions that are often seen in PD.
· Patients are usually susceptible to visual misperceptions or illusions in lowlight situations (i.e. nighttime) and if they are experiencing other visual problems
like macular degeneration.
Many persons with PD complain of slowness in thinking and difficulty with wordfinding.
· At their most severe, patients may experience problems telling apart nonfamiliar faces or in recognizing emotional expressions on another person’s face.
How are Cognitive Deficits Diagnosed?
Cognitive disorders are commonly assessed and diagnosed by:
· Interviewing the person with PD.
· Asking family members or caregivers about their observations.
· Administering cognitive screening tests such as the Mini-Mental State
Examination (MMSE) or Montreal Cognitive Assessment(MOCA).The neurologist
will ask questions that evaluate the person’s understanding of where and who
they are, the date and year, attention, memory, language and problem solving
skills.
· The neurologist may refer the patient to a clinical neuropsychologistfor a more
detailed assessment.
· A neuropsychological assessment can be an important diagnostic tool for
differentiating PD from other dementing illnesses such as Alzheimer’s disease
(AD), stroke or dementia.
·
Depression
Mental health is extremely important in Parkinson’s disease (PD). Although
common in other chronic diseases, research suggests that depression
andanxiety are even more common in PD. It is estimated that at least 50 percent
of those diagnosed with PD will experience some form of depression during their
illness, and up to 40 percent will experience an anxiety disorder.
In fact, new research from NPF’s 2012 Parkinson’s Outcomes Project found that
taken together, mood, depression and anxiety have the greatest impact on health
status, even more than the motor impairments commonly associated with the
disease. However, previous studies have also shown that treating depression is
one of the most significant ways to decrease disability and improve quality of life.
Fortunately, there are very effective treatments for depression. In this section we
will explore depression and how it is diagnosed and treated.
NPF recommends that people with Parkinson’s disease…
· get screened for depression at least once a year.
discuss changes in mood with their healthcare professional and doctor.
bring a family member to doctor’s appointments to discuss changes in their
mood.
·
·
What Causes Depression?
Depression is a mood disorder in which overwhelming feelings of sadness, loss
and hopelessness interfere with a person’s ability to function at home or work.
There are many causes of depression, including psychological, biological and
environmental factors. But in people with Parkinson’s disease (PD), an
imbalance of certain neurotransmitters (brain chemicals) that regulate mood is
thought to play a major role. Liketremor and other motor symptoms of PD,
depressive symptoms can be improved with medications. The following factors
can contribute to the development of depression in Parkinson’s.
Psychological factors
Negative thoughts. Negative thoughts and attitudes about living with a
chronic illness can lead to feelings of sadness, helplessness and hopelessness.
Dwelling on these feelings may make a person more vulnerable to depression.
· Social isolation. The lack of a supportive social network that results from a
more restricted lifestyle, such as early retirement or loss of independence, can
make depression more likely.
·
Biological Factors
History of mental health issues. Research suggests many Parkinson’s
sufferers experience depression or anxiety two to five years before the diagnosis
of PD, which may mean that depression is not simply a psychological reaction to
the illness, but a part of the underlying disease process.
· Changes in the brain. Parkinson’s disease and depression affect the same
physical parts of the brain involved in thinking and emotion. Also, both conditions
affect the levels of three important neurotransmitters (dopamine, serotonin and
norepinephrine) that influence mood and movement.
·
Environmental Factors
Severe stress. People who are diagnosed with a chronic illness often get
depressed. For some people, the ongoing distress of coping with such a life crisis
triggers the disorder.
· Side effects from drugs. Certain prescription drugs can cause symptoms that
mimic depression.
·
What are the Symptoms of Depression?
Symptoms of depression will differ from person to person and can range in
severity from mild to severe. Although people experience depression in many
different ways, there are common symptoms everyone should be aware of. They
include:
· Feelings of guilt, worthlessness or helplessness
· Thoughts of death or suicide
· Decreased interest or pleasure in favorite activities
· Poor attention and concentration problems
· Sleep changes (insomnia or oversleeping)
· Feeling slowed down or restless inside
· Feelings of hopelessness, pessimism or self blame
· Changes in appetite
· Low energy or fatigue
· Ongoing aches and pains, headaches, cramps or digestive problems that do
not ease with treatment
Note: Depression can also be a little different in people with Parkinson’s than it is
in the general population. For people with PD, depression may include anxiety
and stronger symptoms of pessimism and restlessness.
What are the Treatment Options for Depression?
Just as the symptoms and causes of depression can differ from person to
person, so too can suitable treatment approaches. There are two main types of
treatment options for depression: antidepressant medications and psychological
counseling (psychotherapy). NPF recommends a holistic, comprehensive approach
to depression. Although antidepressants are often effective in reducing
symptoms, they should seldom be used alone. In most cases, the best approach
is a combination of antidepressant medication, counseling, exercise and social
support.
The following are treatment options for depression.
Medication Therapy
Most people with depression are treated with a class of drugs calledselective
serotonin reuptake inhibitors (SSRIs). They include:
· fluoxetine (Prozac®)
· sertraline (Zoloft®)
· paroxetine (Paxil®)
· citalopram (Celexa®)
· escitalopram (Lexapro®)
In addition, there are several non-SSRI antidepressants used to treat depression.
They include:
· venlafaxine (Effexor®)
· mirtazapine (Remeron®)
· buproprion (Wellbutrin®)
· tricyclic antidepressants (Amoxapine)
These medications work equally well, though they differ slightly in their side
effects and interactions with other medications. But individuals do not react the
same way to these drugs, so if one trial of antidepressantmedication fails,
another medication, or combination of medications, as well as complementary
treatments should be tried until symptoms are under control. It can take some
trial and error to find the right treatment.
Note: People with PD who suffer from mental health comorbidities should not be
given amoxapine. If they are taking an MAO-B inhibitor for their PD, the current
practice is to avoid concurrent tricyclic, SSRI, or SNRI (serotonin and
norepinephrine reuptake inhibitor) antidepressants . There is some controversy
on this point, and some neurologists and neuropsychologists are comfortable
prescribing an MAO-B inhibitor concurrently with antidepressants if done under
their close supervision. For hallucinations and delusions, PD patients shouldn’t
take anyneuroleptics except for quetiapine or clozapine.
Anxiety
Mental health is important in PD, like any other chronic disease. While mood
changes can play a part in various types of mental illnesses, non-motor problems
can also play a key role. Most commonly, mood changes involve depression and
or anxiety. It has been thought that up to 50% of PD patients experience a mood
disturbance at some point during their illness. Though depression and anxiety
are commonly reported in patients with other chronic diseases, some research
suggests that they are even more common in PD.
In this section we will explore anxiety and how it can be diagnosed and treated,
thus leading to a greater quality of life.
What Causes Anxiety?
While anxiety is less well studied, it may be as common as depression in those
with PD. Up to 40% of patients experience some form of anxiety, most
commonly:
· Generalized Anxiety Disorder
· Anxiety Attacks
·
·
Obsessive-Compulsive Disorder
Social Avoidance
There are many different ways that a person can
experience anxiety. As many as 2 out of 5 patients with PD
will experience one of these forms during the course of
their illness.
Psychological Factors
There are common fears and worries that go along with anxiety in PD.
One is a fear of being unable to function, particularly during a sudden “off”
period. This sometimes leads to a need to be with someone at all times and a
fear of being left alone.
· Another is a concern about being embarrassed—often related to having
people notice symptoms of PD in public.
·
·
Biological Factors
Many of the brain pathways and chemicals linked with depression in PD are
also likely related to anxiety.
· PD patients also have abnormalities in GABA, a brain chemical closely linked
with anxiety and which one class of anti-anxiety medications can target.
· In some cases, anxiety is directly related to changes in motor symptoms.
Especially in patients who experience “off” periods can develop severe anxiety
during these states sometimes to the point of full-blown anxiety attacks.
·
What are the Symptoms of Anxiety?
There are different forms of anxiety common in PD. The following is a list of
symptoms associated with each form:
1. Generalized Anxiety Disorder
Generalized anxiety is a feeling of nervousness and thoughts of worry most of
the time.
· The worrying is in excess of what patients would normally expect and often
feels out of control.
· Physical symptoms are also common including: butterflies in the stomach,
trouble breathing or swallowing, racing of the heart, sweating and increased
tremors.
·
2. Anxiety Attacks
Anxiety attacks usually start suddenly with a sense of severe physical and
emotional distress.
· Patients may feel as if they cannot breathe or are having a heart attack. A
common worry is that a medical emergency is happening.
· These episodes usually last less than an hour, particularly when associated
with “off” periods though they can last for longer periods of time.
·
3. Social Avoidance
Social avoidance involves avoiding social situations secondary to a fear of
having Parkinson’s symptoms in public such as tremor, trouble walking etc.
· Exposure to these situations can lead to severe anxiety, which goes away
when removed from the situation.
·
4. Obsessive-Compulsive Disorder
People with OCD may be plagued by persistent, unwelcome thoughts or
images, or by the urgent need to engage in certain rituals. They may be
obsessed with germs or dirt, and wash their hands over and over. They may be
filled with doubt and feel the need to check things repeatedly.
· Repetitive behaviors such as hand washing, counting, checking, or cleaning
are often performed with the hope of preventing obsessive thoughts or making
them go away. Performing these so-called "rituals," however, provides only
temporary relief, and not performing them markedly increases anxiety.
·
What are the Treatment Options for Anxiety?
Medication Therapy
SSRIs
Newer antidepressants such as SSRIs are typically the first medication used.
All of these medications have been shown to be helpful for one or more
anxiety disorder.
·
For patients with anxiety attacks, very low dosages should be used at first, as
there is evidence that these medications can actually increase attacks when first
started at higher dosages.
· An added benefit of using SSRIs is that they can also help with thedepression
that often goes along with the anxiety.
·
·
Benzodiazepines
Benzodiazepines should be used with caution in older
patients with PD or in those with dementia. If used
regularly, they should never be stopped suddenly to avoid
serious withdrawal symptoms.
An older class of medications called benzodiazepines is used to treat anxiety
disorders and target the brain chemical GABA.
· Most of these medications have been around for many years including:
· diazepam (Valium®)
· lorazepam (Ativan®)
· clonazepam (Klonopin®)
· alprazolam (Xanax®)
· They can be very effective for anxiety, sometimes working better than
antidepressants.
· They take effect very quickly, often providing some relief after a single dose,
though they have to be taken regularly for a lasting effect.
· These medications can also help with other symptoms of PD, including certain
types of tremor, muscle cramping and sleep changes.
· Major drawbacks of using benzodiazepines include memory difficulties,
confusion, increase in balance problems and tiredness.
· These medications should not be stopped suddenly once they have been
taken regularly, as patients can have uncomfortable and serious withdrawal
symptoms.
·
Psychosis
Psychosis is usually linked to major psychiatric illnesses, such asschizophrenia.
However, it may also be seen with a variety of general disorders and conditions.
In PD, psychosis is another symptom or complication of PD and doesn't mean
that the individual is suffering with a new psychiatric illness.
In this section, we will explore psychosis and how it can be diagnosed and
treated, thus leading to a greater quality of life.
What are the Causes of Psychosis?
1. Side effects of PD medications
In the majority of PD cases, psychosis occurs as a side effect of drug therapy.
All PD medications can potentially cause psychosis
· Classic PD medications (i.e. Sinemet and dopamine agonists) are designed to
increase dopamine levels and thereby, improve motor symptoms. However, by
·
·
boosting the dopamine supply, these medications can inadvertently produce
psychosis.
· Other medications used to treat PD can also cause psychosis a little bit more
often by lowering levels of acetylcholine and shifting the balance with dopamine.
These medications include anticholinergics(i.e. Artane ® and Cogentin ®) and
Amantadine.
2. Dementia
Psychosis can result from the basic chemical and physical changes that occur
in the brain, regardless of other factors such as PD medications.
· This is most commonly seen in cases of PD with dementia.
· A diagnosis of dementia with Lewy bodies should be considered if both
psychosis and dementia occur early in the disease process.
·
3. Delirium
·
Delirium is best described as a reversible change in one’s level of attention and
concentration that results from a general medical condition or metabolic
abnormality.
· It usually develops over a short period of time (hours to days) and resolves
following treatment of the underlying condition.
· Delirium can be characterized by: altered consciousness or awareness,
disorganized thinking, unusual behavior and/orhallucinations.
· These widespread symptoms make it very difficult to differentiate delirium from
other conditions, such as dementia or drug-induced psychosis.
· PD patients have a higher risk of delirium when admitted to the hospital, due
to the new settings for the procedure or surgery, which may be unrelated to their
PD diagnosis.
· In order to diagnosis delirium, the patient must experience a change in their
level of concentration or attention. Common causes of delirium include:
Infection such as urinary tract infection or pneumonia
· Imbalance of sodium, potassium, calcium and/or other electrolytes balance
·
·
Stroke
Heart disease
· Liver disease
· Fever
· Vitamin B12 deficiency
· Head injury
· Sensory changes such as hearing loss and visual change
In addition to medical conditions and changes, many commonly used
drugs and chemical agents can also cause delirium, including:
· Anticholinergic medications including diphenhydramine hydrochloride (Benadryl
®), trihexyphenidyl (Artane ®), Benztropine (Cogentin ®), ranitidine (Zantac ®)
and oxybutynin (Ditropan ®)
· Narcotics containing codeine or morphine
· Antibiotics
· Insulin
· Sedatives
· Steroids
· Nonsterodial anti-inflammatory drugs (NSAIDS) including Aleve ®, Motrin ®)
and Advil ®
· Anti-seizure medications
· Alcohol
· Recreational drugs
What are the Symptoms of Psychosis?
Hallucinations
Hallucinations are best described as deceptions or tricks played by the brain
that involves the body’s senses. Hallucinations can be seen (visual), heard
(auditory), felt (tactile), smelled (olfactory) or even tasted (gustatory).
· Although, they may appear to be very real to the individual, they cannot be
seen, heard, felt, smelled or tasted by another person.
· Although, all 5 types of hallucinations can potentially occur with PD, visual
hallucinations are by far the most common.
· Auditory hallucinations are uncommon yet reported by a small percentage of
patients.
· Olfactory, tactile and gustatory forms are extremely rare in PD.
· It is important to discuss all possible symptoms with your clinician, no matter
how minor, rare or bizarre.
· LOW dopamine levels cause PD symptoms
· HIGH dopamine levels cause psychosis
·
Type of
Hallucination
Example (s)
Visual
Seeing a furry creature run by your feet or seeing a deceased
love one sitting in the room.
Auditory
Smelling an unpleasant odor that is not related to another
source.
Tactile
Feeling imaginary bugs crawling on your skin.
Gustatory
Tasting a bitter or abnormal taste in your mouth that is not
related to another source.
2. Delusions
Delusions are defined as fixed thoughts or ideas that are often illogical,
irrational and dysfunctional.
· The individual will wholeheartedly believe these thoughts or ideas even though
they are not based on reality.
· There are many types of delusions. The most common types reported in PD
are described below:
·
Type of
Delusion
Belief(s)
Behavior
Jealousy
The belief that your partner is
unfaithful.
Jealousy, false accusations,
paranoia, aggression, social
withdrawal
Persecutory
The belief that you are being
attacked, harassed, cheated
and/or conspired against.
Paranoia, suspiciousness, agitation,
aggression, defiance, social
withdrawal
Somatic
The belief that your body
functions in an abnormal
manner or an unusual
obsession with your body
and/or health.
Anxiety, agitation, reports of
abnormal or unusual symptoms,
extreme concern regarding
symptoms, frequent visits with the
clinician
What are the Treatment Options for Psychosis?
Treatment of psychosis in PD can be challenging.
To ensure proper treatment, the underlying cause must first be identified.
· The clinician must determine if the psychotic symptoms are related to
medication side effects, dementia or delirium. Again, this can be difficult as these
·
·
three conditions can overlap and produce similar symptoms.
· Blood work and other forms of testing may be necessary. Once a probable
cause is determined, treatment can begin.
Treatment of Psychosis Caused by PD Medications
PD medications relieve motor symptoms by increasing dopamine in the brain.
· Consequently, elevated dopamine levels can trigger psychosis. For this
reason, treatment often becomes a balancing act.
· On one side of the scale, high dopamine levels are needed for adequate
control of PD motor symptoms.
· However, on the other, dopamine levels need to be reduced to alleviate
psychosis. This can be a complicated process and often requires a 3-step
approach.
·
STEP 1: Assessment and Plan
The first step in any treatment process is to assess the problem.
· It must first be determined if the psychotic symptoms are benign or
problematic.
· Some clinicians will choose to postpone treatment if the symptoms are
infrequent, non-threatening and if the patient “retains insight”.
· Other clinicians will start treatment based on the theory that psychosis will
continue to get worse overtime.
· In addition, the clinician should consider the stage of PD, prior history of
psychotic symptoms and social factors.
·
STEP 2: Adjust or Reduce PD Medications
The next standard step of the treatment process is to adjust prescribed PD
medications.
· The goal of this step is to improve psychosis without worsening PD motor
symptoms.
· The clinician may decide to skip this step and proceed to step 3 if the patient is
unable to tolerate potential worsening of PD symptoms.
· The following recommendations have been made for reducing or discontinuing
PD medications for the management of psychosis: Reduce or discontinue
medications in the following order until psychosis resolves:
· Anticholinergic medications (Artane, Cogentin)
· Amantadine
· Dopamine agonists (Mirapex®, Requip®, Permax®, Parlodel®)
· COMT inhibitors (Comtan®)
· Selegiline
·
If psychosis does not resolve, reduce Sinemet doses
There are a variety of techniques and measures that can be performed when
adjusting PD medications.
· This approach generally improves psychotic symptoms. However, if motor
symptoms become worse, PD medications may need to be restarted or
increased, with Sinemet being the core of therapy, and Step 3 started.
·
·
STEP 3: Initiation of Antipsychotic Therapy
Antipsychotic agents are also designed to balance abnormal chemical levels in
the brain.
· They work by reducing excess dopamine thereby, alleviating psychosis. Up
until the 1990’s, the use of antipsychotics in PD had been controversial. This was
because older, also known as “typical”, antipsychotic medications were found to
cause dramatic worsening of Parkinsonian motor symptoms.
· Fortunately, newer medications have become available that are better
tolerated by PD patients. This newer class of medications is referred to as
“atypical” antipsychotics.
· There are two “atypical” antipsychotic medications that are considered safe for
PD patients. They cause limited worsening of Parkinsonian symptoms while
treating psychosis. These medications are clozapine (Clozaril ®) and quetiapine
(Seroquel ®).
·
Clozapine
Clozapine was once considered the best antipsychotic medication for PD
patients.
· However, due to a rare yet serious side effect known as agranulocytosis, it is
now primarily used if quetiapine is not tolerated or effective.
· Agranulocytosis is a reduction in white blood cells, which interferes with the
body’s ability to fight infection.
· Patients on clozapine are required to get weekly blood tests for the first six
months and then every two weeks to monitor white blood cell levels.
·
Quetiapine
Quetiapine is similar to clozapine in its ability to reduce psychosis without
causing significant worsening of motor symptoms. However, it does not cause
agranulocytosis and is therefore, the first choice for many clinicians.
·
Risperidone and Olanzapine
Risperidone (Risperdal ®) and olanzapine (Zyprexa ®) are two additional
“atypical” antipsychotic agents.
· Unlike clozapine and quetiapine, these drugs may carry a greater risk for
aggravating Parkinson's symptoms.
·
Geodon and Abilify
Furthermore, there are two new antipsychotic agents on the market that are
currently being studied to determine their effectiveness and safety for PD
patients. These agents are geodon (Ziprasidone ®) and abilify (Aripiprazole ®).
·
The treatment goal for each step throughout this process is
to achieve a healthy balance between PD symptom control
and management of psychosis.
*It is important to be familiar with antipsychotic medications as many of them can cause
worsening of motor symptoms and should not be prescribed for PD patients. Some of
these medications, such as Haldol, are commonly prescribed in the hospital setting for
patients who are agitated or anxious. If Haldol is prescribed, it should be given through
an IV. This is the only form of Haldol that does not appear to worsen Parkinsonism.
Notify all treating clinicians that older antipsychotics (those medications highlighted in
red) should be avoided if possible.
*People with PD who suffer from mental health comorbidities should not be given
amoxapine. If they are taking an MAO-B inhibitor for their PD, the current practice is to
avoid concurrent tricyclic, SSRI, or SNRI antidepressants. There is some controversy on
this point, and some neurologists and neuropsychs are comfortable prescribing an
MAO-B inhibitor concurrently with antidepressants if done under their close
supervision. Forhallucinations and delusions, PD patients shouldn’t be on any
neuroleptics except for quetiapine or clozapine.
How does PD Affect Sexual Health?
What are the facts about sexual dysfunction?
Sexual dysfunction in PD is common, affecting men more often than women.
· It remains under appreciated as patients, spouses and health care providers
may not be comfortable with a frank discussion of sex.
· Many factors contribute to good sexual health and it stands to reason that the
combination of aging, general physical decline associated with PD, and other
medical conditions will undermine sexual interest and performance.
· In PD, sexual dysfunction may arise as a primary symptom. In addition,
physical immobility in bed, sleep disturbances, depressionand disturbances in
·
thinking can impact sexual desire in men and women.
· PD itself may cause sexual dysfunction as a result of the loss ofdopamine, the
principal neurochemical mediator of reward and pleasure in the brain.
· Sexual health should be as much a part of the conversation between the
person with PD and his or her health care team as any other health matter.
· Various medications, including antihistamines, antidepressants,benzodiazepines,
and drugs for high blood pressure and excessive alcohol or tobacco use can also
contribute to sexual dysfunction.
· Fortunately, most anti-PD drugs are not associated with impotency or loss of
libido, with the exception of the anticholinergics.
To the contrary, the dopamine agonists have been associated with disorders of
impulse control such as:
· Uncontrolled gambling
· Uncontrolled shopping
· Uncontrolled eating,
· Obsessive compulsive tendencies such as cleaning and organizing
· Hypersexuality.
· Patients with PD who are taking dopamine agonists and have developed
hypersexualty should discuss it with their neurologist. Usually decreasing the
dose or complete discontinuation of dopamine agonists resolves the problems of
impulse control.
How does PD play a part in Erectile Dysfunction in
men?
Male impotence, otherwise known as erectile dysfunction (ED), refers to
difficulty with achieving and maintaining an adequate erection.
· The release and widespread use of treatments for ED has proved helpful in
many cases.
· While these medications are contraindicated in certain heart conditions, they
are generally safe to use in combination with antiparkinson’s medications and
more effective in younger age groups.
· As with other non-motor symptoms, the doctor or other health care provider
should consider other causes of impotence and decreased libido, including poor
circulation to the genitals that commonly occurs in diabetes and peripheral
vascular disease, enlarged prostate,depression and other medical conditions.
· Erectile dysfunction warrants a thorough evaluation so the physician or other
health care provider can look for all possible causes, especially diabetes (which
can cause autonomic neuropathy) and other disorders listed above.
· The general physician and urologist should conduct a complete physical
examination.
· The list of drugs available to treat ED has been upgraded in the last decade
from those that must be injected into the penis to oral preparations.
·
How is Sexual Health in Women with PD affected?
In women, Parkinson’s disease may impact libido (the desire to have sex)
more than performance.
· PD may affect fertility. However, several young women have successfully
carried pregnancies to term and delivered healthy babies.
· Taking levodopa during pregnancy has not been shown to have negative
effects on the development of the fetus.
· However, taking amantadine and selegiline has shown negative effects on
fetal development.
· The onset of PD during the perimenopausal years of hormone fluctuations can
be particularly challenging because hot flashes and drenching sweat could be
part of the wearing-off phenomena as well as just part of the normal symptoms of
being perimenopausal.
· It is important to work with a gynecologist and a neurologist to best combine
hormone replacement therapy and antiparkinson’s medication
·
What is the Impact of Sexual Problems on People
with PD and their Partners?
There may be a frustration and sexual inadequacy in intimate relationships or
a more pervasive loss of self-esteem.
· While some couples easily accept limitations or cessation of sexual activity
caused by chronic illness, others alteration of sexual functioning can cause a
significant emotional crisis.
· It is important to remember that sexual functioning is only one dimension of
sexuality and intimacy.
· Sexuality and intimacy can be a time of gentle relaxation for patients, when
sharing and touching can improve their sense of well-being.
· Depression is a very important contributing factor for the subjective sense of
dissatisfaction with sexuality.Similarly, sexually dissatisfied patients are usually
found to be more depressed than sexually satisfied patients, especially men.
·
Therapeutic Recreation Implications
Parkinson's disease can affect many aspects of a person's daily life. However,
with careful planning and activity moderation, the effects of Parkinson's can
become much less stressful and intrusive.
The following suggestions offer guidance to overcome some of the difficulties
associated with the disease.
· Plan periods of rest. Be sure to get plenty of rest. You may need to plan at
least one rest period every day. If you have swelling in your feet or ankles,
elevate your legs when you are resting or sitting for prolonged periods. Avoid
working long days. Rest between recreation and leisure activities.
· Conserve your energy. Using less energy with daily tasks can help you have
more energy to do more activities during the day. You may need to cut down on
some of your activities or use energy-saving devices or techniques. If daily self
care or home care activities are too tiring, discuss this with your doctor.
Energy Conserving Tips for Those With
Parkinson's Disease
Simplify your tasks and set realistic goals. Don't think you have to do things
the same way you've always done them.
· Plan your activities (chores, exercise, and recreation) ahead of time. Space
them out throughout the day. Do not schedule too many things to do in one day.
Do the things that take more energy when you are feeling your best.
· If needed, rest before and after activities.
· If you become tired during an activity, stop and rest. You may need to finish it
on another day or when you feel less tired.
· Do not plan activities right after a meal. Rest 20-30 minutes after each meal.
· Ask for help. Divide the tasks among family and friends.
· Get a good night's sleep and elevate your head when sleeping. Be careful not
to nap too much during the day or you might not be able to sleep at night.
· If your doctor says it's ok, you may climb steps. You may need to rest part of
the way if you become tired. Try to arrange your activities so you do not have to
climb up and down stairs many times during the day.
· Avoid extreme physical activity. Do not push, pull, or lift heavy objects (more
than 10 pounds) that require you to strain.
·
Examples of Activities
What beneficial activities are offered through the MAPC Recreation Therapy
Program?
In order to meet the individual needs of the movement disorder population, a variety of
activities are offered through the Muhammad Ali Parkinson Center (MAPC). These activities
have been specifically adapted for people with movement disorders and are taught by
professionals who have significant knowledge and experience in this area.
Exercise for people with Parkinson's disease has been known to be disease modifying,
meaning exercise may positively change the course of the disease. Current research in
exercise with Parkinson's disease is exploring whether or not exercise may be
neuroprotective, slowing or stopping disease progression. The MAPC is involved in such an
exercise research study.
All of the exercises in each of the following different classes can be performed at the seated
level to meet the abilities of each individual.
View the current class schedules by clicking on the class you are interested in.



















Exercise/The Art of Moving
This exercise class is specifically designed for people with Parkinson's disease to
increase flexibility, strength, balance and coordination and to also improve
communication, voice power and speech clarity. The program is suitable for
participants dealing with any of the limitations associated with Parkinson's
disease.Learn more...
Tai Chi
Tai Chi is a series of individual dance-like movements linked together in a
continuous, smoothly flowing sequence. The easy to learn steps are progressive and
choreographed, and they are coordinated with deep breathing exercises.
Golf Clinic
Since you were diagnosed with Parkinson's disease has your golf game suffered or
have you stopped playing golf all together? If so, then this 4 week golf clinic is for
you.
Expressive Art Workshop
Come and help us raise awareness about Parkinson's disease in a very positve and
innovative fashion. Just unleash your creative side, pick your most positive colors
and paint away with us! We already share a passion; now we can share a
meaningful mission!
Dancing
Put on your dancing shoes and head out to the dance floor. The program is
modeled, in part, on the Dance for PD program developed by the exemplary Mark
Morris Dance Company. In chairs, at a barre or standing, professionally-trained
dance instructors will help explore elements of modern dance, ballet, tap, folk and
social dancing. Enjoy the movement and music in ways taht are fun, energizing,
engaging and creative.
Movement Class
An introductory course that promotes muscle awareness, increased range of motion
and explores the physicality of the body.
EZ Latin or Latins Salsa for Beginners
This beginners' course is easy and fun. You'll be amazed how quickly you'll be
partner dancing. It's so easy you will be able to dance the basics of each dance in
just 5 minutes.
Tremble Clefs
Tremble Clefs is a nation-wide singing program for people with Parkinson's disease
and their partners.
Voce Unidas Spanish Singing Group
This singing group is open for people with Parkinson's disease and their caregivers.
Comadres/Compadres

Biweekly group for Hispanics with Parkinson's disease and their caregivers offered in
Phoenix and Tempe.


Pole Walking
Walking rates high as a great form of exercise; it’s easy, everyone knows how to do
it, it can be done most anywhere, and requires little equipment. But what happens if
we add walking poles?
PWR!MOVES
Participants will learn how to use high effort, muscle activations for bigger, better
posture, balance and everyday FUNction such as walking, turning, rising from a
chair, or floor, buttoning, and speaking.
Yoga for Every Body, Mind, and Soul
Yoga practice encompasses physical movement, breath development, and mental
focus, or mindfulness.




General Tips for those living with
Parkinson’s Disease
Getting Dressed With Parkinson's Disease
Get dressed while sitting in a chair that has armrests -- this will help you keep
your balance.
· Roll from side to side to get pants over your hips. You can do this while sitting
in a chair or lying down on your bed.
· Wear clothes that are loose fitting and have elastic waistbands.
· Choose wrap-around clothing instead of the pullover type. Also choose
clothing that opens in the front, not the back so you don't have to reach behind
you.
· Wear clothing with large, flat buttons, zippers, or Velcro closures.
· Use a button hook to button clothing.
· Use a dressing stick if you have shoulder weakness to get your coat or shirt on
or off.
· Use a zipper pull or attach a leather loop on the end of the zipper to zip pants
or jackets.
· Wear slip-on shoes or buy elastic shoelaces that allow you to slip your shoes
on and off without untying the laces. Use devices such as a sock donner and
long-handled shoehorn for additional assistance.
·
Bathing With Parkinson's Disease
Use a shower chair if necessary.
· Use a hand-held hose for showering and bathing.
· Use a long-handled sponge or scrubbing brush.
· Use soap-on-a-rope, bath mitts, or sponges with soap inside or a soft soap
applicator instead of bar soap.
· Use lukewarm water, as very hot water can cause fatigue.
· Sew straps on towels to make them easier to hold while drying.
· Place a non-skid rug on the floor outside the tub to dry your feet so you don't
slip.
· Put a towel on the back of your chair and rub your back against it to dry. Or,
use a terry cloth robe instead of a towel to dry off.
·
Going to the Bathroom With Parkinson's Disease
If needed, use a bedside commode.
In the bathroom, use an elevated toilet seat and/or safety rails to assist
standing from a low surface.
Grooming With Parkinson's Disease
· Do all of your grooming (shaving, drying your hair, etc) while sitting.
· Use hairbrushes and combs with built-up handles or handles with finger loops.
· Use toothbrushes with built-up handles or use an electric toothbrush.
·
·
Eating, Drinking, and Parkinson's Disease
Don't rush your meals. Allow the extra time you need to finish your meal. Rest
your elbows on the table to provide more motion at your wrist and hand.
· Sit with your knees and hips bent at a 90-degree angle in a straight-back chair.
· Use utensils with built-up, lightweight handles, or use a "spork" -- a spoon and
fork in one. Use a rocker knife for cutting food.
· Use a non-skid mat to stabilize objects on the table.
· Use a plate guard or plate with a raised lip to prevent food from spilling.
· Use a long straw with a non-spill cup or use a plastic mug with a large handle.
Cooking With Parkinson's Disease
· Use the back burners and keep pot handles turned inward.
To Prevent Drooling or Salivating
· Suck on hard candy, lozenges, or gum to control excess saliva
· Use a straw when drinking to strengthen the muscles of the lips, mouth, and
throat.
Writing Tips for Parkinson's Disease
· Use large print, instead of script writing. Try using weighted pens or pencils
and wrap black electrical tape around the barrel for additional grip.
·
Use magic markers and large tablet on an easel.
If you have difficulty using writing utensils, try typing notes or letters on a
computer or typewriter.
·
·
Parkinson's Disease and Shopping
Call ahead to make sure the store has the item you need.
Call ahead to reserve a wheelchair or tri-wheel cart if you aren't planning to
bring your own.
· Call a taxi or ask a friend or family member to drive you.
·
·
Cleaning Tips for Those With Parkinson's
Use long handles on sponge mops, cleaning brushes, dust pans, brooms, or
window washers.
· Sit to fold laundry, wash dishes, iron clothes, use the sweeper, mop the floor,
or to plug in appliances at low outlets. Adapt counters so that you can reach
them from your wheelchair or from a sitting position.
·
Sitting and Standing
Bend slowly at the waist and touch your toes before trying to rise from a
seated position.
· Once standing, remain in place for a few seconds before trying to walk. This
will help you regain your balance.
· Place an additional cushion or book to add height to your chairs and add
firmness, this will help you to decrease the distance when sitting or standing.
· To make it easier to get out of bed, tie a sheet to the bed post and knot the
other end so you can grasp the sheet to rise to a sitting position.
·
Easing Cramps, Spasms, or Tremors Due to Parkinson's
·
Massage (or have someone else massage) your legs nightly to relieve leg
cramps.
· Take warm baths and use heating pads to help relieve muscle spasms and
ease cramps.
· Use mineral ice to relax sore joints and muscles.
· Squeeze a small rubber ball to reduce hand tremors.
· At first indication of a tremor, if possible, try lying on the floor, face down, and
relaxing your body for five to 10 minutes.
Parkinson's Disease and "Freezing"
Count your steps as you walk.
Rock in place from foot to foot to get moving again if you become frozen.
Have someone place their foot in front of you, or visualize something you need
to step over, to get moving again.
·
·
·
Other Tips for Those With Parkinson's Disease
Purchase a small battery-powered alarm pillbox to help you remember
yourmedication schedule.
· Use a speaker phone or telephone headset to ease the problem of hand
tremors while talking on the phone.
· Install an intercom system or purchase walkie-talkies to make contact within
the home easier.
·
References
http://www.webmd.com/parkinsons-disease/guide/parkinsons-dailyactivities
http://www.thebarrow.org/Neurological_Services/Muhammad_Ali_Parkin
son_Center/211553
http://www.parkinson.org/home.aspx
Eye Diseases
Cataracts
A cataract is a clouding of the lens in the eye which affects vision. What is the
lens? The lens lies behind the iris and the pupil. It is a clear part of the eye that
helps to focus light, or an image, on the retina. The retina, being the lightsensitive tissue at the back of the eye, is in charge of changing the light into
nerve signals that are sent to the brain through the optic nerve. The lens must be
clear for the retina to receive a sharp image. If the lens is cloudy from a cataract,
the image you see will be blurred.
What do we mean by cloudy? The lens is made of mostly water and protein. The
protein is arranged in a precise way that keeps the lens clear and allows light to
pass through it. However, as we age, some of the protein may clump together
and start to cloud a small area of the lens. Over time, the clouding of the lens or
cataract may grow larger, making it harder to see.
How can cataracts affect my vision?
Age-related cataracts can affect your vision in two ways:
1.
Clumps of protein reduce the sharpness of the image reaching the retina.
2.
When a cataract is small, the cloudiness affects only a small part of the
lens. You may not notice any changes in your vision. Cataracts tend to form
slowly, so vision gets worse gradually.
3.
The clear lens slowly changes to a yellowish/brownish color, adding a
brownish tint to vision.
4.
If you have advanced lens discoloration, you may not be able to identify
blues and purples.
The risk of cataract increases as you get older. People can have an age-related
cataract in their 40s and 50s but most cataracts at this age are small and do not
affect vision. However, after the age of 60 most of the cataracts steal vision.
Other risk factors are: Certain diseases such as diabetes, personal behavior
such as smoking and alcohol use, the environment such as prolonged exposure
to sunlight.
What are the symptoms?
The most common symptoms of a cataract are:
·
Cloudy or blurry vision.
·
Colors seem faded.
·
Glare. Headlights, lamps, or sunlight may appear too bright. A halo may
appear around lights.
·
Poor night vision.
·
Double vision or multiple images in one eye. (This symptom may clear as
the cataract gets larger.)
·
Frequent prescription changes in your eyeglasses or contact lenses.
How is a cataract detected?
Cataract is detected through a comprehensive eye exam that includes:
1.
Visual acuity test: This eye chart test measures how well you see at various
distances.
2.
Dilated eye exam: Drops are placed in your eyes to dilate the pupils. Your
eye care professional uses a special magnifying lens to examine your retina and
optic nerve for signs of damage and other eye problems. After the exam, your
close-up vision may remain blurred for several hours.
3.
Tonometry: Measuring the pressure inside the eye. Numbing drops may be
applied to your eye for this test.
How to treat a cataract
The symptoms of early cataract may be improved with new eyeglasses,
brighter lighting, anti-glare sunglasses, magnifying lenses, etc. When these
measures do not help, surgery is the only effective treatment. With surgery, the
cloudy lens is removed and replaced with an artificial lens. A cataract needs to
be removed only when vision loss interferes with your everyday activities, such
as driving, reading, or watching TV.
Glaucoma
Glaucoma is caused by a number of different eye diseases which in most
cases produce increased pressure within the eye and gradually steal sight
without warning. There may be no symptoms in the early stages of the disease
and half of the people affected by glaucoma may not know they have it. Over
time, it causes damage to the optic nerve because the elevated pressure in the
eye needs to be released somehow and relies on the weakest point of the eye
which is the optic nerve.
Sink analogy: Think of your eye as a sink, in which the faucet is always
running and the drain is always open. The aqueous humor is constantly
circulating through the anterior chamber. It flows between the iris and the lens
and, after nourishing the cornea and lens, flows out through the trabecular
meshwork (drain). When the trabecular meshwork becomes clogged, the
aqueous can’t leave the eye as fast as it is produced, causing the fluid to back
up. But the eye is a closed compartment so it can’t overflow; instead the backed
up fluid causes increased pressure to build up within the eye. Then the nerve
cells, found in the sclera at which the optic nerve leaves the eye, become
compressed, causing them to become damaged and, eventually, die. The death
of these cells results in permanent visual loss.
Glaucoma is the leading cause of blindness and unfortunately
approximately 10% of people with glaucoma who receive proper treatment still
experience loss of vision. There is no cure (yet) for glaucoma and vision loss
cannot be regained, however with medication and/or surgery it is possible to halt
further loss of vision. Also, glaucoma is a chronic condition, which means that it
has to be monitored for life.
Everyone is at risk for glaucoma, from babies to senior citizens. Older people are
certainly at a higher risk for glaucoma but babies can be born with it
(approximately 1 out of every 10,000 babies born in the United States). Young
adults can get glaucoma, too. African-Americans in particular are susceptible at a
younger age.
There may be no symptoms to warn you. With open angle glaucoma, the
most common form, there are virtually no symptoms. Pain is not associated with
increased eye pressure and vision loss begins with peripheral vision. However,
many people do not notice anything until significant vision is lost. Therefore, the
best way to protect your sight from glaucoma is to get tested, and if you do have
it, treatment can begin immediately.
Statistics
·
Over 3 million Americans have glaucoma but only half of those know they
have it.
·
Approximately 120,000 are blind from glaucoma.
·
About 2% of the population ages 40-50 and 8% over 70 have elevated
Intraocular Pressure (IOP).
·
Glaucoma is the second leading cause of blindness in the world.
·
Glaucoma is the leading cause of blindness among African-Americans.
·
Glaucoma is 6 to 8 times more common in African-Americans than
Caucasians.
Risk Factors
·
Age. Everyone older than 60 is six times more likely to get glaucoma. For
blacks, however, the increase in risk becomes apparent earlier, after age 40.
·
Race. Blacks and Hispanics are significantly more likely to get glaucoma
than are whites. Asian-Americans are at a higher risk of angle-closure glaucoma,
and Japanese-Americans are more prone to low-tension glaucoma.
·
Family history of glaucoma. Increases risk four to nine times.
·
Medical conditions. Diabetes, hypertension, heart disease, retinal
detachment, eye tumors, chronic uveitis and iritis increase the risk of developing
glaucoma. Certain types of eye surgery may trigger secondary glaucoma.
·
Physical injuries.
·
Nearsightedness.
·
Prolonged corticosteroid use.
·
Eye abnormalities.
Sources:
http://www.nei.nih.gov/health/cataract/cataract_facts.asp
http://biomed.brown.edu/Courses/BI108/2006108websites/group02glaucoma/glaucoma.html
Age-Related Hearing Loss (Presbycusis)
Presbycusis
Age-related hearing loss, or presbycusis, is the slow loss of hearing that
occurs as people get older. Tiny hairs inside your ear help you hear by picking up
sound waves and changing them into the nerve signals that the brain interprets
as sound. Hearing loss occurs when the tiny hairs inside the ear are damaged or
die. The hairs cells do not regrow, so most hearing loss is permanent. Most
commonly, presbycusis is caused by changes in the inner ear that occur as you
grow older. However, family history, a repeated exposure to loud noises, and
smoking are factors that contribute to age-related hearing loss. Hearing loss can
result in both physical (not hearing a fire alarm) and psychological (social
isolation) problems.
Symptoms
Symptoms include:
·
Certain sounds seem overly loud.
·
Difficulty hearing thins in noisy areas.
·
High-pitched sounds such as “s”, “t”, or “th” are hard to distinguish from
one another.
·
Men’s voices are easier to hear than women’s (low-frequency sounds vs.
high-frequency sounds).
·
Ringing in the ears.
Signs and Tests
A complete physical exam is performed to rule out medical conditions that
can cause hearing loss. Hearing tests, like audiometry, can help determine the
extent of hearing loss. Audiometry provides a more precise measurement of
hearing. To test air conduction, you wear earphones attached to the audiometer.
Pure tones of controlled intensity are delivered to one ear at a time. You are
asked to raise a hand, press a button, or otherwise indicated when you hear a
sound. The minimum intensity (volume) required to hear each tone is graphed.
An attachment called a bone oscillator is placed against the mastoid bone to test
bone conduction.
Treatment
There is no known cure for presbycusis so treatment is focused on
improving your everyday function:
·
Hearing aids
·
Telephone amplifiers and other assistive devices
·
Sign language (for those with severe hearing loss)
·
Speech reading (such as lip reading and visual cues to aid
communication)
·
A cochlear implant (recommended for certain people with very severe
hearing loss. Surgery is done to place the implant, which makes sounds seem
louder but does not restore normal hearing).
Sources:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002040/
Diabetes
Diabetes is referred to by the medical world as, 'Diabetes Mellitus,' and is a set of
diseases where the person's body is unable to regulate the amount of sugar in
their blood. The particular form of sugar that the person with diabetes is unable to
regulate is called, 'glucose,' and is used in the body to give the person energy in
order to do things in daily life such as walking, running, riding a bike, exercising,
or other tasks. From food that people eat, the liver produces glucose and puts it
into their blood.
In persons without diabetes, glucose levels are regulated by a number of
hormones including one known as, 'Insulin.' An organ called the, 'Pancreas,'
produces insulin, and also secretes additional enzymes which aid in the digestion
of food. Insulin helps the movement of glucose through a person's blood into
different cells, including muscle, fat, and liver cells so it can be used to fuel
activity. Persons with diabetes are unable to move glucose from their blood into
their cells. The result is that the glucose remains in their blood, and damage
occurs to the cells that need glucose for energy to perform activities, as well as
harming tissues and organs that are exposed to increased amounts of glucose
that has not been sent to the cells it should have gone to.
Type 1 Diabetes
Type 1 Diabetes occurs when the body produces insufficient amounts of
insulin, or stops producing insulin altogether; the body does not produce enough
insulin to regulate the amount of glucose in the person's blood. Approximately
ten-percent of persons with diabetes in America have Type 1 Diabetes, and it is
commonly recognized in people when they are in childhood or during their
teenage years. Former names for Type 1 Diabetes include, 'Juvenile-Onset
Diabetes,' and, 'Insulin-Dependent Diabetes Mellitus.' Persons who are older can
develop Type 1 Diabetes due to destruction of their pancreas. Things such as
damage caused by disease or alcohol, or having the pancreas removed during
surgery or a progressive failure of pancreatic beta cells that produce insulin can
cause Type 1 Diabetes. Persons with this form of diabetes need insulin treatment
on a daily basis in order to remain alive.
Type 2 Diabetes
Type 2 Diabetes occurs when a person's body becomes either partially, or
completely, unable to use insulin. Their pancreas may still secrete insulin, but
they have become what the medical field refers to as, 'Insulin-Resistant.' Their
body attempts to fight this resistance by producing even more insulin. A person
who is insulin-resistance develops Type 2 Diabetes once they cannot continue to
secrete enough insulin to meet the body's demands.
Approximately ninety-percent of persons with diabetes have Type 2 diabetes,
which is usually recognized when the person is an adult; commonly when they
are over forty-five years of age. Other names this form of diabetes has been
known by include, 'Non-Insulin Dependent Diabetes Mellitus,' or, 'Adult-Onset
Diabetes Mellitus.' These other names are no longer appropriate because
persons who are younger have this form of diabetes, and persons with Type 2
diabetes may also need to use insulin. Control of Type 2 Diabetes usually
involves weight loss, diet, oral medications, and exercise.
Complications of Diabetes
Type 1 and Type 2 diabetes eventually lead to excessive levels of sugar in the
blood; this condition is referred to as, “Hyperglycemia”.
Hyperglycemia: It damages the body in several ways, including damage to a
person's kidneys, nerves, eyes, and blood vessels. The damage done through
Hyperglycemia to a person's kidneys is known as, 'Diabetic Nephropathy,' and is
a leading cause of kidney failure. The damage done to a person's nerves is
referred to as, 'Diabetic Neuropathy,' and causes foot wounds and ulcers,
commonly leading to either foot or leg amputations. Damages to a person's
Autonomic Nervous System can lead to a condition known as, 'Gastroparesis,' or
paralysis of their stomach; it can also cause chronic diarrhea, and an inability in
the person's body to control heart rate and blood pressure as they change
posture. 'Diabetic Retinopathy,' is the medical name for damage done to a
person's retinas in their eyes, and is a leading cause of blindness.
Diabetes can accelerate the formation of fatty plaque deposits inside a person's
arteries or, 'Atherosclerosis,' leading to a clot or blockages. Results of the
formation of these deposits can include a decrease in the circulation in the
person's legs and arms called, 'Peripheral Vascular Disease,' or even a heart
attack or stroke. Diabetes presents people who have it with a predisposition for
such things as high cholesterol, high triglyceride levels, and high blood pressure.
These conditions alone increase the risk of heart disease, blood vessel
complications, and kidney disease; along with Hyperglycemia, the risks are even
greater.
There are a number of infections that are associated with Diabetes which are
often times more dangerous for a person who has diabetes due to their body's
reduced ability to fight infections. For a person with diabetes, an infection may
make control of glucose levels more difficult, delaying recovery from an infection.
Hypoglycemia: It occurs when a person with diabetes has a blood sugar level
that is too low, which happens occasionally. When the person misses a meal, or
exercises more than they usually do, or takes too much insulin or medication;
drinks too much alcohol, or takes certain other medications in other conditions they may become Hypoglycemic. The symptoms of Hypoglycemia include hand
tremor, headaches, sweating, feeling dizzy, and poor concentration. Persons
experiencing Hypoglycemia may faint, or experience a seizure if their blood
sugar level becomes too low.
Diabetic Ketoacidosis involves uncontrolled Hyperglycemia and is a serious
condition. It is usually caused by a highly inadequate level of insulin in a person's
body which, over time, causes a buildup in their blood of Ketones. Ketones are
acidic waste products, and are harmful to the body. Diabetic Ketoacidosis
commonly affects persons with Type 1 Diabetes who don't have good control of
their blood glucose levels. Trauma, infection, stress, missing medications such
as insulin, or even a stroke or heart attack can precipitate Diabetic Ketoacidosis.
Hyperosmolar Hyperglycemic Nonketotic Syndrome is another serious condition
that can affect persons with diabetes, and occurs when the person's blood sugar
becomes very high. Their body attempts to rid itself of the excessive amounts of
blood sugar through urinary output, which is increased significantly, often leading
to dehydration. Persons with this syndrome can become so dehydrated that they
may experience seizures, coma, or even die. Persons with Type 2 Diabetes who
are not making efforts to control their blood sugar levels and have become
dehydrated, are under stress, have experienced an injury, a stroke, or are taking
some medications such as steroids, are typically those who experience this
syndrome.
Gestational Diabetes: Gestational Diabetes occurs when a woman is
approximately halfway through pregnancy. Women who have this form of
diabetes are more likely to have larger babies than women who do not have
Gestational Diabetes. Women who experience Gestational Diabetes often find
that it simply goes away, once they have delivered the baby, although women
who have this form of diabetes are more likely to develop Type 2 Diabetes at a
later point in their life.
Causes of Diabetes
Type 1 Diabetes: Type 1 Diabetes is something that is believed to be an
autoimmune disease. The immune system in the person's body attacks the cells
within the pancreas which produces insulin. There may be a predisposition to the
development of Type 1 Diabetes in some families. There are some
environmental factors, including some viral infections which are common that can
also contribute to causing Type 1 Diabetes. Persons who are of Non-Hispanic,
Northern European descent most commonly develop Type 1 Diabetes, followed
by African Americans and Hispanic Americans. Persons of Asian descent rarely
have Type 1 Diabetes. Slightly more men than women have Type 1 Diabetes.
Type 2 Diabetes: is something that has strong genetic links, and tends to run in
families. Several of the genes involved have been identified; more are being
studied that may be related to causes of Type 2 diabetes. There are several risk
factors for developing Type 2 Diabetes. The risk factors include a high-fat diet,
consuming high amounts of alcohol, a sedentary lifestyle, high blood pressure,
high triglyceride levels, obesity, and Gestational Diabetes. Persons with a relative
who had either Type 2 diabetes or Gestational Diabetes are at greater risk of
developing Type 2 Diabetes. African Americans, Native Americans, Hispanic
Americans, and Japanese Americans are at greater risk of developing Type 2
Diabetes. The risk of developing Type 2 Diabetes increases at age forty-five, and
increases significantly after a person reaches age sixty-five.
Symptoms Common to Type 1 and Type 2
·
Fatigue
·
Unexplained Weight Loss
·
Excessive Thirst
·
Excessive Eating
·
Poor Healing of Wounds
·
Infections
·
Altered Mental Status
·
Blurry Vision
Treatment of Type 1 Diabetes
Treatment of Type 1 Diabetes nearly always involves daily injections of insulin,
usually in the form of a combination of short acting insulin. Insulin cannot be
taken orally; if it were, the insulin would be destroyed in the person's stomach
before it would be distributed in their bloodstream, which is where it is needed.
The majority of persons with Type 1 Diabetes administer insulin injections to
themselves. If someone else gives the person with diabetes their insulin
injections, it is still important that the person with diabetes know how to
administer the injection themselves in the event that another person is
unavailable.
Persons with diabetes learn how to inject insulin from a trained professional, who
will also show them how to store insulin; usually a Nurse who works with their
health care provider, or diabetes educator. People with Type 1 Diabetes
commonly inject insulin two or three times daily, usually around meal times. The
amount of insulin they use depends on their individual needs as determined by
their health care provider. There are some longer acting forms of insulin that are
usually injected once or twice a day. Some persons with Type 1 Diabetes have
the insulin they take administered continuously through an infusion pump in order
to receive adequate control of their blood glucose levels.
If a person has taken insulin it is important that they eat because insulin will lower
their blood sugar level whether they have eaten or not. If the person has taken
insulin and not eaten, they risk hypoglycemia, also referred to as an, 'Insulin
Reaction.' While persons with Type 1 Diabetes are learning how insulin affects
them there is a period of time where they are adjusting. The adjustment period
includes how different meals and exercise, as well as insulin affect them and
their blood sugar levels.
It is important to learn to keep blood sugar levels as even as possible. Equally
important is maintaining an accurate record of the person's insulin dosages and
blood sugar levels; health care providers will need this information in order to
provide treatment and management of diabetes for them. Pursuing a consistently
healthy diet that is right for their weight and size is just as important in the effort
to control the person's blood sugar levels.
Treatment of Type 2 Diabetes
Persons with Type 2 Diabetes may have the opportunity to lower their blood
sugar levels without the need for medication, if their HbA1c test results warrant
this opportunity. Losing weight and exercising are the best ways to lower blood
sugar levels in persons with Type 2 Diabetes. If a person with this type of
diabetes is presented with this opportunity, they may have from three to six
months before their blood sugar and HbA1c test is checked again. If the blood
sugar levels are still high in the results, the person will start taking oral diabetes
medication to control blood sugar levels.
While on oral medication for Type 2 Diabetes, it is important to lose weight if the
person is overweight, eat a healthy diet, and pursue appropriate exercise. The
person's health care provider will monitor their progress while they are taking oral
medication closely after they have started taking it to ensure that the proper dose
is being administered, and to make sure that side-effects are at a minimum.
The person's health care provider may choose to combine two forms of
medication in order to achieve blood sugar levels that are within an appropriate
range. Over time, persons with Type 2 Diabetes may need insulin injections in
order to achieve control of blood sugar levels. It is now becoming more common
for persons with Type 2 Diabetes to use a combination of insulin injections and
medication to control their blood sugar levels.
What is diabetic retinopathy?
Diabetic retinopathy is a complication of diabetes and a leading cause of
blindness. It occurs when diabetes damages the tiny blood vessels inside the
retina, the light-sensitive tissue at the back of the eye. A healthy retina is
necessary for good vision.
If you have diabetic retinopathy, at first you may notice no changes to your
vision. But over time, diabetic retinopathy can get worse and cause vision loss.
Diabetic retinopathy usually affects both eyes.
Sources:
http://www.disabled-world.com/health/diabetes/#ixzz2C23inErw
http://www.nei.nih.gov/diabetes/content/english/know.asp
Cardiovascular Diseases
Cardiovascular disease or cardiovascular diseases refers to the class of
diseases that involve the heart or blood vessels (arteries and veins).
Cardiovascular disease is the number one cause of death and disability in the
United States and most European countries. A definition of cardiovascular
disease doesn't include an age. In fact, early signs of cardiovascular disease
have been noted during surgeries performed on young soldiers wounded in
battle. It has been estimated that plaque build-up was seen in the arteries of
nearly 90% of the troops wounded in Vietnam.
The term 'cardiovascular disease' is used to cover a group of problems related to
the heart or the body's overall circulatory system. These problems include heart
attacks, strokes, arrythmias, congestive heart failure, ischemia, hypertension,
angina, and other dysfunctions.
The best way to prevent heart diseases are:
·
Quit smoking.
·
Lose weight.
·
Lower your cholesterol.
·
Lower your blood pressure.
·
Reduce stress.
·
Exercise regularly
Your risk of heart disease increases about 3-fold with each advancing decade.
Older age is considered a risk factor for heart disease after age 55 for women
and after age 45 for men. This is partly because many women younger than 55
have not yet gone through menopause and still have high levels of the female
hormoneestrogen in their blood. Estrogen produced by the body is thought to
help protect the heart. After menopause, however, the levels of estrogen in a
woman's body drop significantly. On average, women develop heart disease
about 10 to 15 years later than men.
Another reason that heart disease risk rises with age is because the buildup of
fatty plaques in the arteries is a lifelong process. As you get older, blockages in
the arteries get larger and may cause problems. These blockages can reduce the
amount of blood and oxygen that reaches the heart, causing chest pain or heart
attack.
Sources:
http://www.disabled-world.com/health/cardiovascular/#ixzz2CNLVR7uF
http://www.hearthealthywomen.org/am-i-at-risk/age-a-menopause/age-amenopause
Osteoporosis
Osteoporosis is a disease marked by loss of bone tissue and low bone mass.
Osteoporosis can lead to bone weakness and fragile bones. Persons who have
osteoporosis have a greater risk for fractures - most notably in the wrist, hip and
spine. Osteoporosis was once thought to be something experienced by older
women; however, damage from the condition starts earlier in life. Peak bone
density is achieved around the age of twenty-five, so it is important to build
strong bones by this age, ensuring that they will stay strong later in life. The
intake of calcium in adequate amounts is an important part of building strong
bones.
Approximately ten million people in America have osteoporosis. Around eighteen
million others have low bone mass, which places them at greater risk for
development of the condition. Approximately eighty-percent of persons affected
by osteoporosis are women. In persons who are age fifty and older, half of all
women and one in every eight men are predicted to experience an osteoporosis
related fracture during their life.
The World Health Organization states that the prevalence of osteoporosis among
American white women who are past menopause is estimated to be fourteenpercent in women between the ages of fifty and fifty-nine years. There is a
significant risk reported for persons of all ethnic backgrounds, although persons
from white and Asian racial groups are at greater risk of osteoporosis.
Causes of Osteoporosis
Osteoporosis occurs when an imbalance takes place between new bone
formation and old bone resorption. The person's body could fail to form new
bone, too much old bone can be reabsorbed, or both things may happen. There
are two essential minerals needed for bone formation; phosphate and calcium.
While a person is younger, their body uses these minerals in order to produce
bones. If their calcium intake is insufficient, or their body fails to absorb sufficient
amounts of calcium, their level of bone production and bone tissue can suffer.
Calcium is also essential for the proper function of other parts of the body, such
as the brain, heart and additional organs. In order to keep these critical organs
functioning, the person's body can reabsorb calcium from their bones for their
use, potentially making their bones weaker, resulting in fragile and brittle bones
which can break easily.
Symptoms of Osteoporosis
While a person is in the early part of the disease they may not experience any
symptoms. Later on in the course of the disease, they may experience dull pain
in their muscles or bones, notably in their lower back or neck. As time continues,
sharp pains may occur suddenly; the pain may not radiate, and can worsen
through activities which put weight on the area as well as being tender. The pain
usually subsides within a week, although it may linger for more than three
months.
Persons with osteoporosis might not remember a fall or additional trauma they
have experienced which has caused a broken bone. Spinal compression
fractures can result in a loss of height accompanied by a stooped posture
referred to as a, 'Dowager's Hump.' Other common places persons with
osteoporosis experience fractures include the hips or wrists, commonly from a
fall.
If you are past menopause and are experiencing consistent pain in your neck or
lower back you should consult a doctor for further evaluation. If you are at risk for
osteoporosis, you should consult a doctor for both medical assessment and bone
density screening. You should go to a hospital if you are experiencing severe
pain in your bones or muscles which limits your ability to function. You should go
to a hospital emergency room if you have sustained trauma or a fracture of your
hip, spine or wrist.
Treatment of Osteoporosis
Treatment of osteoporosis involves a focus on slowing down or ceasing mineral
loss while increasing bone density, as well as the prevention of fractures and
control of pain. Around forty-percent of women will experience a fracture related
to osteoporosis during their lifetime. Among persons who experience a fracture of
the spine, one in five will experience another one within a year. Osteoporosis
potentially leads to additional fractures, something referred to as a, 'Fracture
Cascade.' One of the goals of treatment is to prevent fractures.
Young adults are encouraged to achieved their peak bone mass through getting
enough calcium, about 1000 milligrams each day, in their diet through drinking
milk or calcium-fortified orange juice, and eating foods that are high in calcium.
Young adults should perform weight-bearing exercises like aerobics or walking,
as well as maintaining a normal body weight.
Persons who have hip, spinal or wrist fractures should see an Orthopedic
Surgeon for management. Additionally, they should be referred to a Physical and
Occupational Therapist in order to learn safe exercise methods. Persons with
spinal fractures, for example, would avoid things such as doing sit-ups, lifting
heavy objects, or touching their toes. Lifestyle modifications should be
incorporated into the person's treatment plan.
Studies have shown that exercises which require muscles to pull on bones cause
the person's bones to retain and maybe even gain density. Researchers have
found that women who walk a mile each day have four to seven additional years
of bone reserve than women who do not. Recommended exercises include riding
a stationary bicycle, walking, jogging, weight-bearing exercises, and using a
rowing machine. Prior to starting an exercise program be sure to review the
program with a doctor.
Prevention of Osteoporosis
The best defense against osteoporosis may be development of strong bones
during childhood and adolescence. The average woman has already acquired
ninety-eight percent of her skeletal mass by the time she is thirty years of age.
Building strong bones during childhood and adolescence can be the best
defense against developing osteoporosis later. The average woman has
acquired 98% of her skeletal mass by age 30 years. Four steps which may
prevent osteoporosis, although one step alone is not enough, include:
1) A balanced diet that is rich in calcium and vitamin D
2) Pursuit of weight-bearing exercise
3) Living a healthy lifestyle, avoiding excessive alcohol intake and smoking
4) Taking medication in order to improve bone density when it is appropriate
The progression of osteoporosis can be slowed, stopped or reversed with
adequate treatment. Despite this, some people experience severe disability due
to weakened bones. Hip fractures are common in persons with osteoporosis,
leaving approximately half of persons who break a hip without the ability to walk
independently. Fifteen-percent of women and five-percent of men have
experienced a hip fracture by the age of eighty.
Sources:
http://www.disabled-world.com/health/aging/osteoporosis/#ixzz2CNOxfEKk
Just embrace it, you’ll be old too
someday!REBECA!
Melisa
LOREN
Loren
Rebeca
Melisa