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April marks Parkinson's disease Awareness Month

Parkinson's disease affects seven to 10 million people worldwide. Of those affected, 1 million are in the United States with 60,000 new cases diagnosed yearly.

The Parkinson's Disease Foundation defines the disease as a chronic and progressive movement disorder that involves the malfunction and death of vital nerve cells in the brain, called neurons. Some of these dying neurons produce dopamine, a chemical that sends messages to the part of the brain that produces movement and coordination. As the disease progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally.

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Some studies cite Parkinson's as occurring at a rate of one and a half to two times more frequently in men than women. The disease usually strikes at ages 60 or over, although it can begin at a much earlier age. Diagnosis may be especially difficult in the early stages.

The four main symptoms are: shaking or tremors; slowness of movement (the hallmark of the disease); stiffness or rigidity of the arms, legs or trunk; and balance problems resulting in a feeling of instability and falling backwards. These comprise the motor symptoms and are classic, yet many other symptoms may be exhibited such as loss of smell, small handwriting, reduced arm swing on the affected side (early), trouble sleeping (including acting out dreams), constipation, a soft or low voice, dizziness or fainting, a blank face or stare, and change in posture (such as stooping over), and lastly, depression and anxiety.

Parkinson's is a progressive and degenerative disease, meaning symptoms worsen over time. If you or a loved one have symptoms that are being noticed by yourself or others, talk to your Primary Care physician and request a referral to a neurologist or a specialized movement disorders neurologist.

Although the cause of Parkinson's is unknown, there are several theories that it is related to free radical damage, environmental toxins, accelerated aging or a genetic predisposition (although most cases do not have a genetic link or associated family history).

Diagnosis may be difficult due to the symptoms possibly being similar to those in other disease processes such as Lewy Body dementia, normal pressure hydrocephalus or other less common neurologic diseases. The diagnostic process may take time because there is currently not one test that can confirm or rule out this disease.

Medications aimed at controlling the Parkinson's replace lost dopamine and mimic dopamine in the brain. While these medications can decrease the symptoms, they do not cure or slow the disease progression and over time become less effective. Surgery may be used as treatment, but again, not as a cure. Deep Brain Stimulation therapy is directed at easing movement problems.

While medications can dramatically help symptoms, some complain of side effects. And the drugs can be complicated to manage and be challenging for those suffering from Parkinson's and their caregivers. These medications must be given at precise times. It is estimated that one in every three people with this disease who are admitted to the hospital do not get their medications in a timely fashion. The National Parkinson's Foundation has "Aware In Care Kits" to take to the hospital to educate health care workers, including reminder slips.

Non-pharmacologic interventions are recommended to provide the highest quality of life. Nutrition, exercise and sleep are important in maintaining a healthy lifestyle. Physical therapy, occupational therapy and speech therapy can help deal with the challenges of movement and voice difficulties. Support groups and complementary therapies have been found to help those affected with Parkinson's and their loved ones maintain a positive attitude. Tai Chi and yoga can help maintain balance. Dance and music therapy have been successful with movement and speech problems.

Living with this disease is challenging. Support, education and resources can facilitate adjustment and an increased quality of life. Resources for support groups can be found by calling 800-473-4636. Locally, a support group meets on the fourth Thursday of the month from 2 to 3:30 p.m. at Carroll Hospital Center. Call Julie Lee at 410-871-6164 for more information.

Jill Rosner is a registered nurse, certified geriatric care manager and owner of Rosner Healthcare Navigation. She provides patient advocacy and care management services to clients with health and aging issues. Contact her at JillRosnerRN@aol.com.

Additional Parkinson's Disease Resources

NPF National Parkinson's Foundation: awareincare.org

APDA American Parkinson's Disease Association: apdaparkinson.org

PDF Parkinson's Disease Foundation: pdf.org

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MJF Michael J. Fox Foundation: http://www.michaeljfox.org

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