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Parkinson's Disease

Parkinson's disease belongs to a group of conditions called movement disorders. It is chronic, meaning that is continues throughout one's life. It is also progressive, meaning its symptoms grow worse over time.

The four primary symptoms of Parkinson's disease are:
Shaking or rhythmic movement (tremor), especially in the hands, often when they are at rest;
Stiffness of the limbs and trunk (rigidity), muscle tension, aching or weakness;
Slowness of movement (bradykinesia), having difficulty beginning a task and
Poor balance and coordination, having trouble walking.
The disease occurs when cells in an area of the brain called the substantia nigra begin to malfunction, weaken and die. These cells produce a brain chemical called dopamine. Dopamine is a neurotransmitter, which means it transmits messages between the parts of the brain that control movement and coordination.
Despite decades of intensive study, the cause of Parkinson's disease remains unknown. Below is a list of links to more information about Parkinson's disease. Parkinson's disease is a slowly progressive disorder of the central nervous system that affects movement, muscle control and balance. Although the exact cause of Parkinson's Disease is unknown, research has concentrated on genetics, environmental toxins, endogenous toxins and viral infection.

In Parkinson's, cells are destroyed in part of the brain stem - the substantia nigra, which sends out fibers to the corpus stratia, gray and white bands of tissue in both sides of the brain. Cells there release dopamine, one of three major neurotransmitters (chemical messengers) which help the body respond to stress. By the time symptoms develop, patients have lost 80 to 90 percent of their dopamine-producing cells.

Symptoms include tremors, slowed movement and postural instability. Other features include rigidity, flexed posture, freezing phenomenon and loss of postural reflexes. Patients can experience depression, sleep disturbances, dizziness and problems with speech, swallowing and sexual functioning.

Since medications and other conditions can cause Parkinson's-like neurologic symptoms, diagnosis is critical and misdiagnosis is frequent. Medical science lacks an accurate blood or imaging diagnostic test for Parkinson's, though tests can exclude other conditions. Diagnosis is based on an evaluation of symptoms best accomplished by a Parkinson's specialist.

The progression of the disease varies from individual to individual, so treatment is also individualized. Treatment focuses on relieving disabilities while minimizing side effects of medications. While there is no cure, therapies can minimize symptoms and maximize function and quality of life.

The usual treatment is a combination of levodopa and carbidopa (Sinemet). Levodopa, which treats neurochemical abnormality, revolutionized treatment. However, over the years, its effectiveness can decline and its side effects, such as motor complications, can increase. Adjusted dosage can help but additional medications may be required. Because of levodopa's complexities, young people with Parkinson's often start with other treatments, reserving levodopa for later in the disease. Patients have other treatment options, including surgery. Transcranial magnetic stimulation is also being studied.
Parkinson's can impair quality and length of life, so its diagnosis and symptoms can devastate an individual and family, and patients often face depression. However, excellent physical therapies, and educational and support resources are available. Research is steadily improving quality of life and symptom control.
The MediFocus Guidebook on Parkinson's Disease contains information that is vital to anyone who has been diagnosed with this condition.

You will learn about the causes, risk factors, common signs and symptoms, medical tests that are used to establish the diagnosis, and standard treatments. You will also learn about the latest clinical advances in the management of Parkinson's Disease as well as about the newest treatment options that are available.
The MediFocus Guidebook on Parkinson's Disease will also inform you about important new, exciting research in the area of Parkinson's Disease. You will also learn about the doctors, hospitals, and medical centers that are at the leading edge in conducting clinical research about Parkinson's disease.
Information about clinical trials, quality of life issues, a list of questions to ask your doctor, and a useful directory of organizations and support groups that can help patients with Parkinson's Disease complete this valuable Guidebook.
You won't find this combination of information anywhere else. It is easily accessible right here. We invite you to preview the MediFocus Guidebook on Parkinson's Disease so that you can decide if this comprehensive, trustworthy information may help you or someone you care about who has been diagnosed with Parkinson's

PARKINSON'S DISEASE: DIET AND NUTRITION
Eating the right food is important for any person, but for people with Parkinson's (PD) it is essential to maintain the right dietary intake. Difficulty with swallowing and chewing, or manipulating a knife and fork, are not excuses for eating the wrong foods. With medication having to be taken before or after meals, it is important to eat regularly and well, as this will not only help in digestion, but will aid the absorption of medication.
Medication and meals
It is usual to take medication 15-20 minutes before meals to assure more predictable absorption, or take tablets divided in half (i.e. same amount but cut in two). Take levodopa 30 minutes before meals if response fluctuations are worsening.
People with PD are often advised to take levodopa with meals. By reducing levodopa absorption, food may reduce side effects such as nausea on first exposure to levodopa medication but when people start experiencing motor (or movement) fluctuations, other factors need to be considered.
Unpredictability is a major feature of severe motor fluctuations. Although people experience the fluctuations every day, the timing of dramatic changes in motor disability, and the amount of 'on' and 'off' time per day, vary even if the medication regime is constant. Research is now indicating the role that food plays in this unpredictability.
Different food causes the stomach to empty at different rates, which means that the time taken for levodopa to get from the stomach to the part of the gut where it is absorbed will vary as well.
Another factor leading to unpredictable motor fluctuations is that the effect of the medication on symptoms may not correspond to the amount of levodopa in the bloodstream. This is because of the competitive effect of amino acids (found in protein) which are also in the blood.
Protein competes with or interferes with Sinemet or Madopar absorption at 2 sites: during absorption at the part of the gut nearest to the stomach, and as it passes from the blood to the brain. If a meal high in protein is eaten at the same time as medication is taken, less levodopa will be absorbed into the intestine and less absorbed across the blood/brain barrier.
For people on Sinemet or Madopar noticing fluctuations in mobility, protein manipulation may be helpful. For example, reducing protein earlier in the day may help avoid the unpredictable motor fluctuations and may aid the response to the medication. Having the day's protein meal in the evening may also be useful, as slow response to medication may not be as important as at other times of the day.
It would be most unwise for any person with PD to put them selves on a low protein diet without consulting their doctor or dietician. Problems such as weight loss, poor immunity and other complications from lack of sustenance could result if the diet is too low in protein.

WEIGHT LOSS
Weight loss is common in PD, in spite of increased caloric intake. A special program must be worked out with each person to determine individual needs.

CAUSES OF WEIGHT LOSS
• Tremor may use extra calories: energy is used while inactivity is increased.
• The desire for food may be reduced because of reduced sense of smell, nausea, depression and cognitive impairment.
• There may be changes in the brain thermostat for weight control, raising the metabolic rate.
• Damage to the hypothalamus can cause central appetite suppression.
• Tiredness and weakness in the arms can slow down speed of eating, making people give up before the meal is finished.
• Difficulty chewing and swallowing makes meal times tiring, as do poor-fitting dentures.

TYPES OF FOOD
High protein foods
• All meat — red and white, fish, sausages, preserved meats.
• Dairy products — milk, yoghurt, ice cream, cheese and egg whites.
• Legumes — kidney beans, lima beans, lentils, soya beans.
• Gelatin.
• Nuts of any kind, including peanut butter.
Some of these foods are essential in order to achieve a balanced diet. A very low protein diet is not balanced and can lead to deficiencies in zinc, iron and calcium, and other elements.

Foods low in protein
• Cereals — wheat biscuits, rice bubbles, corn flakes, semolina, rice, pasta, white bread (not enriched), tapioca, sago.
• Vegetables — green and yellow, cooked or raw, potatoes.
• Fruit — all fresh, tinned, stewed or dried.
• Soups — clear, vegetable, not creamed or containing lentils or peas.
• Spreads — honey, jam, Vegemite, marmalade, treacle.
• Sweets — boiled lollies, butterscotch, jelly beans, gum (very little nutritional value: included for interest and variety only).
• Fats — margarine, unsaturated oils, salad dressing, mayonnaise.
• Beverages — tea, coffee, soft drinks, cordial, soda water.
High fat foods (providing maximum calories)
• Oils, butter, margarine.
• Cream, sour cream, ice cream, mayonnaise, cheese.
• Peanut butter.
• Chocolate, Milo, Ovaltine, cocoa, drinking chocolate, full-cream milk.
• Eggs.
• Meats such as ham, luncheon meat and sausages.
• Biscuits, cakes and pastry.
High sugar foods
• Dried fruits.
• Chocolate.
• Honey, marmalade, jams.
• Fruit juice.
• Confectionery.
• Biscuits and cakes.


Energy supplements may be added to food without changing the taste.

Other dietary guidelines
Moderation and balance are the keys to any diet. Drink plenty of liquids throughout the day and remember that food that is difficult to swallow can be modified (e.g. moistened, minced or pureed). A qualified dietitian may need to be consulted.
• Eat a balance from all the food groups.
• Maintain calories at 25-30 calories per kilogram of body weight with additional calories if dyskinesias are present.
• Carbohydrate to protein proportion should be 4-5:1.
• Recommended daily protein allowance is 0.8 g/kg of body weight.
• Fibre and adequate fluids (6-8 glasses of water daily) are important in the control of constipation. Fibre is present in breads, vegetables, cereals, and fruit with the skin on.
• If calories are needed, they are best added in the form of complex carbohydrates and unsaturated fats; cholesterol consumption should kept lower than 300 mg daily.
• The benefits of multi-vitamins remain unclear. If a person is taking levodopa rather than Sinemet, only pyridoxine (B6)-free vitamins should be taken.
• Pay careful attention to daily calcium intake; 1000-1500 mg will help reduce the risk of broken bones from osteoporosis.
• Iron supplements may interfere with Sinemet absorption so should be taken separately.
• If appetite is poor, take smaller meals every 2-3 hours, perhaps with a little alcohol (if medically allowed).
• Broad beans contain dopamine; some people find they help in maximizing the effects of medication.
• Depression and cognitive impairment may reduce appetite.
• The sense of smell may also be reduced; stronger flavours and aromatic foods can be used to make food more interesting.
Swallowing difficulties
Your speech pathologist can give specific individual advice about swallowing difficulties and food management.
It is important not to eat soft food all the time (unless that is all you can manage safely), as the muscles in the jaw need exercise too. While each individual will have different problems and therefore different solutions, the following suggestions may help.
• Food that is soft and moist, with a good flavour and smell, tends to be easier to swallow: custards, jelly, pureed fruit, sauces, spices and herbs.
• Avoid foods which are hard, dry, crumbly or stringy.
• Avoid mixed consistencies (e.g. solid plus liquid).
• Be careful with foods which stick to the roof of the mouth or get caught around the mouth: dry mashed potatoes, tomato with skin on, biscuits, bran flakes, hard-boiled eggs.
• Thicker fluids (e.g. nectars, milk shakes) may be easier to control and swallow than thin, clear liquids, as they move more slowly.
• Keep food presentation appetizing: flavour, smell and appearance of food.
• Relax and enjoy your food. It is good to have a break between mouthfuls and take sips of water during the meal. This will not only help you relax but also allow you to clear your throat and mouth. You may need to swallow twice to clear each mouthful.
• Eat smaller portions more frequently, especially if time for meals is limited.
Possible problem foods
• Mixed textures, such as liquid with 'bits' in it (e.g. minestrone soup or watery mince).
• Flaky biscuits.
• Hard toast or nuts, chocolate, grains, seeds.
• Fresh white bread (try whole meal bread; it is easier to swallow).
Foods that may be easier to swallow
• Boiled milk.
• Mousse, custard, yoghurt, ice cream.
• Souffle, omelette.
• Casseroles.
• Soup.
• Fruit juice, pureed fruit.
• Pancakes (with syrup etc.).
• Rice.
• Well-cooked vegetables.
• Banana.
If you are using more and more liquid meals, it is important to keep up your energy intake. Your dietitian may recommend appropriate supplements and guidelines. You can make liquid foods thicker by using instant pudding, yoghurt, gelatine or instant potato powder.

Hints to avoid nausea and gastric upset
• Take medication with small amounts of food (usually not protein).
• Eat only when you are hungry.
• Eat foods which you know you enjoy.
• Avoid fatty food.
• Avoid spicy foods or gassy drinks.
• Avoid too much caffeine or nicotine.

Summary
Probably the most important point to remember is that good nutrition is based upon a balanced diet including a variety of foods from the main food groups, in particular, plenty of fruit, vegetables, complex carbohydrates, some protein and fluids. For people with PD, this may also involve a rearrangement of protein-rich meals. Maintaining a balanced diet helps to ensure a minimum of weight loss and a healthy outlook on life.


Complementary and Alternative Medicine and Parkinson Disease


By Melanie M. Brandabur, M.D., Medical Director, Parkinson’s Disease and Movement Disorders Center, Alexian Neuroscience Institute, Chicago-Hoffman Estates, Illinois, a National Parkinson Foundation Center of Excellence
In the last decade or so, great strides have been made in the treatment of Parkinson disease (PD). New dopamine agonists and COMT inhibitors have improved motor function, and several new medications will soon become available. The treatment of other symptoms that may be present in PD, such as depression and sleep disorders, also has improved.
A select group of patients may benefit from surgical therapy for PD. At a minimum, the addition of an exercise program is vital to maintaining good health.
Though significant, these developments are insufficient in treating every aspect of the disease. Unfortunately, there still exist many symptoms and medication side effects for which current “traditional” treatments are unsatisfactory or incomplete.
Because persons with PD generally tend to be well-educated and quite proactive about the care they receive, many have chosen to explore treatment options outside the realm of “Western” medicine. Alternative therapies have been slow to gain favor with some practitioners of more traditional medicine because there is little research to demonstrate their effectiveness. This is beginning to change, due in part to the establishment of The National Center for Complementary and Alternative Medicine, a government organization that will fund and carry out such studies. Many universities have established similar departments.
For some patients and caregivers, alternative or complementary approaches to treatment are completely novel. Others have been raised in cultures where the use of herbal medicines or acupuncture are commonplace. In fact, many of these modalities have been in use for thousands of years. In the treatment of PD, a number of complementary therapies, such as Yoga and Tai Chi, are well-established companions to traditional medications. Acupuncture and therapeutic massage also have become popular in some PD centers, as have herbal therapies and dietary supplements (though self-prescription of supplements can be dangerous in some cases).
The intention of this article is to provide a summary overview of various complementary therapies, and how some can be useful in the treatment of PD.

Diet
The choices we make about food – what we consume, its quality and quantity – are crucial to our health and well-being. Of course, conflicting information abounds concerning what constitutes a healthy diet: Are fats and carbohydrates “good” or “bad” dietary components? This may depend on which fad diet is currently in vogue. There is some agreement that it is generally wise to consume a varied diet high in fruits and vegetables and to avoid excessive saturated fats, especially trans-fats. There is also some evidence that the so-called Mediterranean diet, a diet high in monounsaturated fats, such as olive oil, may be beneficial in reducing blood pressure and cardiovascular disease. The diet also emphasizes fish, especially those high in Omega-3 fatty acids, such as salmon, and foods containing antioxidants.