Parkinson’s A Disease of Neurology, Psychology and Sociology

Parkinsons

Parkinson’s disease is best characterized by its symptoms such as the involuntary movements of muscles and progressive atrophy of nerve cells in particular areas of the brain. Medical scientists continue to attempt to understand the patho-physiology, etiology, and legitimate therapies for Parkinson’s disease. At the present this illness is considered to be of unknown origin.

brainFor the most part, Parkinson’s disease affects approximately one percent of the population between the ages of 50 and 65, however, this unfortunate illness can also rarely occur in younger people. Parkinson’s Disease is a neurological disorder that is slightly less frequent in women than in men.  The symptoms are brought on by a gradual degeneration of brain nerve cells in the section of the mid-brain that controls body motion & fine motor movements. Treatment entails a complete consideration of the different possible causes that may contribute to the onset of this disease. Likewise, the full health psychology assessment requires a thorough understanding of the biological, psychological, and socio-cultural factors that relate to the illness.

The body of an animal is indeed a remarkably sophisticated arrangement composed of various tissues, organs, and networks that function together conjointly and harmoniously. Correspondingly, the anatomy of a person maintains an internal homeostasis to ensure the proper functioning and continuity of existence. For example, any imbalance in the chemical nature may adversely affect the routine operation of any part eventually causing disease. If the imbalance originates from the brain, such as a chemical imbalance within the structure of the brain, the effect is more apparent and pronounced. Parkinsonism is the phrase that is used to refer to movement syndromes that are characterized by symptoms involving motor problems and these illnesses are categorized according to their origins. Parkinson’s Disease (PD) up to this point in time, is not entirely understood or comprehensively analyzed. The illness affects the nerve cells in the brain that produce dopamine. Parkinson’s disease symptoms include muscle rigidity, tremors, changes in speech and gait. After diagnosis, treatments can help relieve symptoms, but there is no cure.

The first signs of movement disorders are often barely observable: weakness possibly stiffness in one limb or a slight trembling of a hand when it is resting by the patient’s side. Ultimately, the shaking spreads and becomes more movementprominent, movements become slow, balance and coordination decline and muscles become increasingly stiff. As the disease progresses, the opposite hand, arm, leg, jaw, and other parts of the body begin to exhibit involuntary rhythmical trembling movements.  As the disease becomes quite severe, the mere initiation of exercise may be very difficult because the stiffness of the muscles associated with pain and fatigue becomes a dominant problem. Daily tasks such as tying shoelaces, zipping pants and buttoning shirts are very difficult, painful and exhausting exercises. Walking becomes persistently burdensome because the natural balance of the body is noticeably impaired. The face of the person afflicted with the disease is less expressive due to the muscles that promote spontaneous movement are stiff and rigid. Enunciation of words is affected making the sound of the voice monotonous in tone. Depression, cognitive disabilities, and emotional problems are common. However, medication can treat the symptoms and decrease the diseases intensity.

Biological Factors related to Parkinson’s Disease

Although medical scientists continue to have various and non-conclusive points of view related to the physio-pathology and causes of the disease, they are making progress towards goals of complete understanding and appropriate treatments. A useful understanding of the causes of Parkinson’s disease requires extensive knowledge in how distinct parts of the brain and central nervous system function.

The primary parts of the brain that may relate to the onset of Parkinson’s disease are located at the base of the forebrain in a specific section called the basal ganglia. From the basal ganglia various interconnections of neurons originate that are usually associated with the different motor functions of the body. As a pivotal part of the brain in basal gangliaprocessing information, the basal ganglia processes incoming signals and readily transmits these signals to the thalamus, a deeply-lying part of the brain.  The precise portion of the basal ganglia that accompanies the onset of illness is the substantia nigra that has two distinct parts, the pars compacta, and the pars reticula. In turn, the thalamus, sends back these signals to the cerebral cortex. The degeneration of dopaminergic neurons occurs in the pars compacta and is responsible for the onset of the symptoms. The principal neurotransmitter of basal ganglia is dopamine.

The relative importance of the brain communication to the onset of symptoms is that the signal or neurotransmitters are transported from one area of the brain to other parts via electrical impulses. These neurotransmitters move between nerve cells called synapses allowing information to be transferred from one neuron to another.

In Parkinson’s disease, the nerve cell of the pars compacta exhibits accelerated degeneration resulting in a measurable decrease in the production of dopamine and eventually leads to the onset of symptoms. The main reason and cause of the degeneration of the nerve cells of basal ganglia has not been thoroughly analyzed or discovered. These nerve cells of the basal ganglia degenerate slowly as a person ages, and this degeneration is considered a natural progression of growing older.

The causes of the unexpected nerve function linked to Parkinson’s disease are not known. However, there are conditions and medications that can create Parkinson’s disease-like symptoms.

  1. Blood vessel Illnesses. Although rare, strokes and hardening of the arteries can cause symptoms similar to Parkinson’s disease.
  2. Shy-Drager Syndrome is a rare degenerative disease that induces signs similar to Parkinson’s disease.
  3. The administration of anti-psychotic drugs to treat schizophrenia and severe paranoia is known to inhibit the function of dopamine causing parkinsonism-like side effects.
  4. MPTP, a synthetic heroin impurity can cause severe Parkinson’s disease-like symptoms.

The Treatment of Parkinson’s Disease

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There is no cure for Parkinson’s disease, and various treatments are employed to alleviate and soften the effects of the symptoms. Therapies usually involve taking a three-pronged approach:

  • A thorough investigation and evaluation of the extent of the effects of the disease.
  • The managing of emotional complications and components of the disease to increase the patients’ quality of life.
  • Providing social and familial education and support to enhance awareness of the disease.

As mentioned this disease produces the atrophy and degeneration of the dopamine-producing neurons in the substantia nigra located in the brain. Therefore, medications that are specifically geared to revitalize and enhance the production of dopamine within the nerve cells may be administered to revive and increase the amount of dopamine.

Lewy bodies are protein deposits, develop in the nerve cells in regions of the brain involved in cognition, memory and motor control and significant indicators of Parkinsons Disease. Microscopic analysis of these nerve cells in the substantia nigra displays not only a reduction in neuromelanin pigmentation exhibiting neuronal loss but also the presence of Lewy bodies in the surviving nerve cells.  Therefore, medications are prescribed for Parkinson diseases are designed to activate and enhance the production of dopamine or replenish the amount of dopamine in the substantia nigra. One medication, Levodopa is an exceptionally common drug prescribed because it usually converts into dopamine and increases the amounts in the substantia nigra. However, continuous use of levodopa lessens in effectiveness as the disease progresses.

Psychological Components of the Disease   

Depression is common in approximately thirty to forty percent of those diagnosed, but, only twenty percent receive any referrals for psychological counseling. As a result, many patients suffer from lack of care and undergo a reduced healthcare related quality of life. T Brod and colleagues (1998) state that only eleven percent of depressed patients scored their psychological symptoms as being a  health problem, despite being clinically depressed. Therefore, even when Parkinson’s patients are clinically depressed, they are more likely to talk about the hardships of other symptoms. Recognition and treatment of patients with depression may reduce further cognitive and functional decline. Thus, treating depression in PD may help to prevent or delay the progression of cognitive and functional decline in this neuro-psychiatric population. Physicians treating patients with Parkinson’s Disease should regularly screen for depression.

There have been a few explanations for the occurrence of depression suggesting that depression is a reaction to the anxiety of managing this chronic and progressively disabling disease. It should be noted that research findings relating depression to the physical disabilities are inconsistent, and conflicting reports do not provide a direct relationship between depression and the disabling features of the disease.

Another aspect pertaining to the treatment of Parkinson’s disease involves the emotional component associated with the illness. Symptoms, such as confusion, hallucinations, delirium, are some of the side effects associated with the disease and the mere thought of having this illness frequently produces bouts of cyclical depression that may further aggravate the condition. Psychological treatments that involve ongoing sessions can help both the patient and family members cope with the emotional stress and symptoms of the disease.

Tips for Talking to your children

  1. Describe the diagnosis in words that they can understand including the symptoms of the illness and associated behaviors. (Hand tremors)
  2. Explain that there may be adjustments in their daily routine and how working as a team will be helpful to all family members.
  3. Some with this diagnosis who have more than one child, decide to talk to them one at a time, others choose differently. Discuss the idea of having a family meeting with your partner.
  4. Be ready to answer difficult questions, such as is the diagnosis life threatening, contagious or harmful to them. Encourage questions, and be emotionally available and ready because some of the questions will be sensitive in quality. Talk about how they can discuss the disease with their friends. Explain that some people may at times stare because of the symptoms and that people do this because they are curious.
  5. Make an appointment with your neurologist to talk about the illness with your children so they will be aware of what to expect.
  6. If the child has a difficult time coping with the diagnosis, ask your doctor to recommend a therapist.

Tips for those who are taking care of someone with Parkinson’s Disease  suggestions

  • Recognize Emotional Triggers: The first step in decreasing stress is to pinpoint and acknowledge the source of stress.  By identifying these triggers, you will then be able to find solutions to reduce tension.
  • Be Flexible: Become a creative problem solver by stepping back, identifying the issue which will ease tension, thereby, enabling you to think of alternative problem-solving solutions.
  • Focus on the Positive: Most people hold some degree of optimism, try to become an expert in nurturing the positive.
  • Build Support Networks:  Families, friends, and caregiver support groups provide a network of people who can help. In addition, consider talking with a counselor or therapist. Beyond being a place where people can express their emotions, support groups are a forum for exchanging resources.
  • Express yourself: Write in a journal, take a photography class or find ways to express, release and let go of your emotions.
  • Treat Yourself with kindness
  • Follow an exercise program:  Practice some form of yoga and meditation, and make time to be with active people.

Social Aspects of Parkinson’s Disease

The society as a whole can play a vital role in raising awareness and understanding for those who are suffering from Parkinson’s disease. Various support groups around the world have been organized to help patients cope with the symptoms and effects of the illness. Advocacy groups such as those of the National Parkinson Foundation, Parkinson’s Disease Foundation, American Parkinson Disease Association, and European Parkinson’s Disease Association have played important roles in funding research on the disease. Likewise, friends and relatives can readily help and play a very critical role in assuaging the diseases impact.

A diagnosis of Parkinson’s disease is a life-changing experience for everyone, the spouse, child, extended family and friends who volunteer to care for the patient. These caretakers take on various obligations, such as, accompanying them on visits to doctors, doing the grocery shopping, provide physical care and the care-taking role may last for many years. It is imperative if you are the caretaker to remember that you must take care of yourself because by staying physically and emotionally healthy you will be able to better support the one you love.

Live Well,

© Dr. Cheryl MacDonald

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Cheryl Ann MacDonald Psy’D

Health Psychology of San Diego

References

Cover Image: canstockphoto|Lighthunter

  1. Parkinson J. An essay on the shaking palsy. J Neuropsychiatry Clin Neurosci 2002;14:223–36
  2. Jankovic J, Tolosa E. Parkinson’s disease and movement disorders. Philadelphia: Lippincott Williams and Wilkins, 2007
  3. Bhatt M. H., Elias M. A., Mankodi A. K. (1999). Acute and reversible parkinsonism due to organophosphate pesticide intoxication: five cases. Neurology 52, 1467–1471. Miguel Chin-Chan,Juliana Navarro-Yepes,and Betzabet Quintanilla-Vega http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4392704/
  4. Roseanne D. Dobkin, Jade Tiu Rubino, Jill Friedman, Lesley A. Allen, Michael A. Gara, Matthew Menza Barriers to Mental Health Care Utilization in Parkinson’s Disease Journal of Geriatric Psychiatry and Neurology 06/01/2013