Over the latter part of his life, Basil has been suffering from Parkinson's Disease and now requires round-the-clock care in a nursing home. Our family are constant visitors and we try to make this deeply distressing ailment as comfortable as possible for him.
Parkinson’s is a disease of the brain that affects the nerve cells involved in movement and in some cases, like Basil's, can lead to a particular type of dementia. I'd like to share this information with you to give you some idea of what the disease is and what it does, so that you can begin to understand this devastating illness and it's effects on the sufferer and their loved ones.
Parkinson's disease occurs when the cells in the brain that control movement are destroyed.
The Parkinson's Disease Society estimates there are about 120,000 people in the UK with the disease - that's one in 500 of the general population - and approximately 10,000 people are diagnosed each year.
Parkinson's is a progressive neurological condition that's usually diagnosed after the age of 60, although one in 20 people diagnosed will be under 40 at the time of diagnosis.
Parkinson's is caused by the loss of brain cells that produce an important neurotransmitter (a chemical that carries signals between the neurons in the brain) called dopamine, which enables us to perform smooth, coordinated movements. A person with Parkinson's will have symptoms once 80 per cent of these cells are lost.
Because Parkinson's disease attacks the part of the brain that controls our movements, it affects activities we take for granted, such as talking, walking, swallowing and writing. Symptoms include repetitive shaking, slowness of movement and muscle stiffness.
After several years, people with the disease may develop a shuffling walk without arm movement. Beginning an activity may be difficult, but once started people with Parkinson's move too fast and end up almost running. Parkinson Disease Dementia (PDD) is different from a similar disorder, known as Dementia with Lewy Bodies (DLB). DLB is characterized by fluctuations in alertness and attention, recurrent visual hallucinations, and parkinsonian motor symptoms like rigidity and the loss of spontaneous movement. In this disorder, the cognitive problems, such as hallucinations, tend to occur much earlier in the course of the disease and often precede the difficulties with walking and motor control
Managing Parkinson's disease
There's no cure, but a lot can be done to relieve symptoms, especially in the early stages. The aim is to replace the missing dopamine in the brain. This can be done with a drug called levodopa - a synthetic chemical that's converted into dopamine in the brain. Though this can be very effective there can be severe side effects with prolonged usage.
Because of these problems, doctors usually try to delay using levodopa, especially in younger people. Instead, they use other drugs that boost dopamine activity or mimic its effects, known as dopamine agonists. These drugs also have side effects and doses have to be carefully tailored to individuals needs.
Another option for people with more advanced Parkinson’s is injections of a drug called apomorphine which can 'rescue' people from sudden 'off' periods (episodes of greatly reduced mobility).
This drug can also be given as a continuous infusion for those with severe movement fluctuations. By giving this treatment it's possible to reduce the dose of levodopa that a person requires.
Occupational therapists and physiotherapists help people with Parkinson’s manage their condition by assisting with movement and providing advice on how to maintain independence in all aspects of everyday life. Speech and language therapists help with communication or swallowing difficulties.
Deep Brain Stimulation
Deep Brain Stimulation is a form of surgery that can be used to treat some of the symptoms of Parkinson’s. The surgery involves the implantation of a wire with four electrodes at its tip in one of four target sites in the brain. Then a small unit, which generates electrical signals for the stimulation, is implanted into the person’s chest.
When the stimulation is switched on, electrical signals are sent to the brain to stop or reduce the symptoms of Parkinson’s.
Although Deep Brain Stimulation is not suitable for everyone with Parkinson’s, it can provide significant improvement in an individual’s symptoms and quality of life.
Care for people with Parkinson’s
Carers play a vital role in the assistance of a person with Parkinson's disease. A carer might be a partner, daughter, father, son or a Parkinson’s disease nurse specialist (PDNS), dependent on the severity of the condition.
PDNSs work with patients to understand their individual requirements to help people with Parkinson’s take control of their condition from diagnosis onwards. For example, they provide clinical monitoring and medication adjustment, are a continuous point of contact for support and are a reliable source of information for people with Parkinson’s and their carers.
Support and advice
Parkinson's Disease Society
Helpline 0808 800 0303
Younger Parkinson’s Network
Helpline 0808 800 0303