The Progression of Parkinson's Disease
What happens when you are diagnosed with Parkinson's disease?
When a person has Parkinson's disease, for unknown reasons, certain cells are destroyed in parts of the brain stem, predominantly the crescent-shaped cell mass known as substantia nigra which produces the neurotransmitter dopamine. When about 80% of dopamine is lost, you develop symptoms such as tremor, balance problems, and stiffness. What happens when dopamine-producing neurons die? What this means is that the basic building blocks of your nervous system have low levels of dopamine, and it manifests in some very disruptive ways. The nerve cells try to fire, but messages cannot go through. As the body tries to compensate for the lack of dopamine, the level of glutamate (neurotransmitter) is elevated. And, too much of glutamate can be damaging to the entire brain and nerve cells. At normal concentrations, glutamate neurotransmitter is helpful in learning and memory.
Will you get better?
Parkinson's is a neurological disorder affecting movement, balance, and muscle control associated with dopamine-producing cells. Dopamine plays a vital role in many brain functions such as moods, motor control, working memory, learning, sleep, and the ability to focus. A low dopamine level leaves you feeling apathetic, joyless and sucks the zest out of you. The progress of the disease is faster in older patients, leading to a lack of movement between 10 to 20 years. The progression of the disease varies amongst diverse people. Although it has no cure yet, there are various treatments and therapies and support methods accessible to manage the condition.
Can you continue driving or working?
You don't have to stop driving. However, it is good to stay safe on the road by having a medical and driving assessment. Inform the authorities about your current condition. This does not mean you have to stop working. With treatment and support, you may continue working for many years. You may have to quit your current job eventually and in time. You can also look to get a disability in your country and place of work. You can also consider a better residence that supports your condition. Look for a home that avoids stairs and tiny bathrooms as these can give you problems when the disease progresses. Pay attention to your body. You need to have a chart of symptoms so that a doctor may be able to review your condition with facts.
You need your family. Talk to them if you think you need help from them. It might take you a few minutes to button your shirt for example. Therefore, begin the activity early enough so that you have the time to do so. As the disease progresses, you go through huge physical and emotional changes, so try to appreciate your family. They are stressed and scared the same way you probably are. There might also be changes in your sexual behavior, as treatments might bring about sexual changes. Treatments can cause compulsive sexual behavior. In other cases, it brings loss of sexual desire in both men and women.
Understanding Parkinson's disease rating scales
The rating scale is a tool doctors use to measure the progression of Parkinson's disease. The tool focuses on motor symptoms. Then again, newer scales include information about non-motor symptoms such as issues with the sense of smell.
Hoehn and Yahr (H-Y) PD scoring system
Hoehn and Yahr's method puts symptoms on a 1-5 rating scale depending on a person's difficulties. The scale of 1-2 represents the early stages of the disease, while 3-4 on the scale represents the mid-stage. Finally, the 4-5 scale represents the advanced stages of PD.
United Parkinson’s disease (UPDRS) scoring system
The UPDRS is used by clinicians and researchers as a basis of the treatment in clinics. The rating scale known as United Parkinson’s disease (UPDRS) is considered more comprehensive than the Hoehn and Yahr in gauging the course of Parkinson's disease. UPDRS is a 50 question scaling system that evaluates both non-motor and motor symptoms. The sections to be completed by a clinician are in 4 parts which include:
- The non-motor experiences of your daily living
- The motor experiences of your daily living
- Motor exams
- The motor complications
UPDRS strengths
- Widely used
- Near comprehensive coverage of symptoms
- Its clinimetric properties
- Its validity and reliability
UPDRS Weaknesses
- Have some metric flaws
- Missing some of the screening vital non-motor aspects of PD
- Ambiguities in the written text
- Insufficient instructions for raters
How severe is your Parkinson's?
The severity of the PD can be described as mild, moderate, or advanced. Many patients may not reach an advanced stage.
Stage 1
The initial stage begins with the feeling of mild symptoms that do not interfere with daily activities, although it becomes slightly inconvenient to move. Tremors may begin at this stage, for example, a person may find it hard to get out of a chair. Tremors happen in the hand, especially when the hand is at rest or when the person is under stress. Their handwriting may appear cramped. A tremor disappears with sleep or gets better with a deliberate movement. Your family may notice changes in your posture, facial expression, and walking style. A person with Parkinson's is unusually unsteady and slow with a “masked face”. Only one side of the body is usually affected by tremors and other movement symptoms. The medications can easily suppress the mild symptoms. In general, exercises like gym training, dancing, and hydrotherapy may reduce constipation and depression. Likewise, exercises provide a sense of achievement and improve mobility, balance, and flexibility.
Stage 2
Parkinson's symptoms begin to worsen. The tremor and movement symptoms now affect both sides of the body. The tremor may make it difficult even to hold a newspaper or utensils. A person can still live alone even though their walking and posture problems will become more pronounced. It takes time for a person to complete day-to-day tasks.
Stage 3
The hallmarks of this stage include slow movements, poor coordination, and loss of balance. A person can still be independent but with impairments while engaging in activities such as eating and dressing. Falling is a common phenomenon at this point.
Stage 4
The symptoms of Parkinson's become severe and limiting. Movements require a walker, though people can stand without assistance. Help is needed for the person suffering from Parkinson's. Freezing episodes occur, where your feet feel stuck to the ground. At this point, a person with Parkinson's should not live alone. Continue with regular exercises. Also, incorporate physical therapy to improve mobility and balance. PD medications may wear off between your dosages. Medications may have side effects such as dyskinesia. Your occupational therapists can give strategies that promote independence.
Stage 5
At stage 5, the motor symptoms are more prevalent and you are not able to live alone. You are either in bed the better part of the day or in a wheelchair. The patient requires around-the-clock nursing care. The disease is dilapidating because the legs are still making it difficult to walk or stand. Other symptoms include hallucinations and delusions. At this point, it is challenging to balance the effect of the medication and side effects.
Closing thoughts
Researchers use the scoring systems to measure the benefits of a particular therapy in a more cohesive and accepted scaling system. Also, neurologist uses the scoring system to follow the progressiveness of their patients with PD in an impartial way.
