Jennifer Derasmo

Parkinson’s disease

July 26, 2016

People often hear the words Parkinson’ disease, but more often

they are not sure exactly what that means. They might immediately think of

Michael J. Fox or Mahammad Ali. Parkinson’s disease was first described

in 1817 in James Parkinson’s publication, “Essay on the Shaking Palsy”. (1)

He first described the “classic triad” of signs –tremor at rest, rigidity, and

bradykinesia. Parkinsonism is a term used to describe a cluster of symptoms

including bradykinesia with rigidity and/or tremor. (1) Parkinson's disease

is the most common form of these conditions. Although the exact cause of

Parkinson's disease is unclear, this narrow degenerative disease results in

the loss of dopamine producing cells in the substantia nigra portion of the

brain. A person's brain slowly stops producing the neurotransmitter

dopamine. With less and less dopamine, a person has less and less ability to

regulate their movements, body and emotions. It is clear to see that this

disease might promote a sense of failure or a sense of low worth due to the

inability to be able to carry out normal daily activities of living. It is

important for the patient and family members to be on the same page when

it comes to self-care.

Parkinson’s disease is not fatal unlike many diseases out there.

However, there is not a cure. The goal is to treat the symptoms as early as

possible. Unfortunately, the symptoms in Parkinson’s disease may begin

insidiously, spread over several years, and the patient may not know it’s

even there or it’s in the process of becoming worse. The diagnosis can be

difficult, so there is no definitive diagnostic test; instead, evaluation of

symptoms and response to treatment allows a diagnosis to be made. (1)

There are scales used to access the severity of this disease such as the

United Parkinson’s Disease Rating Scale (UPDRS) - this will assess detail

for cognition, behavior, mood, ADL, and motor skills. “Parkinson's disease

itself is not fatal. However, complications from the disease are serious; the

Centers for Disease Control and Prevention (CDC) rated complications

from PD as the 14th top cause of death in the United States. “(2)

Approximately 60,000 individuals in United States are diagnosed with

Parkinson's each year. “The incidence of Parkinson's disease increases with

age, it is really diagnose before the age of 40, and is more commonly

diagnosed and men.” (1)

With Parkinson’s disease, a person's brain slowly stops producing

a neurotransmitter called dopamine. With less and less dopamine, a person

has less and less ability to regulate their movements, body and emotions.

Dopamine, the subgroup is catecholamine, is used extensively by CNS;

helps to coordinate movement; involved in emotion and motivation.

Dopamine is a chemical that relays messages between the substantia nigra

and other parts of the brain to control movements of the human body.

Dopamine helps humans to have smooth, coordinated muscle movements.

Without the production of dopamine, clearly you can see why a person with

this disease will have difficulty in most type of movements. Common signs

and symptoms can include Tremor at rest, muscle rigidity, stooped posture,

expressionless face, slow movement (bradykinesia), and ataxia – lack of

balance during walking, poor balance and coordination, difficulty

swallowing which will pose issues with diet and food intake. Freezing can

also occur which is when a person starts to say something, is getting out of

bed, begins to put the laundry away, or stands up from a chair. It's one of

the most distressing Parkinson's symptoms because the patient must begin

to consciously consider every aspect of his movements and actions. Lock in

position which is the last stage when the patient can only move their eyes.

Treatment for Parkinson’s can include “El-dopa” (Duopa™) (1)

which is converted to dopamine, is given to patients with this disease

because it can pass through the Blood Brain Barrier. This particular drug is

considered the gold standard drug for this disease. Parkinson’s drugs are

aimed at either temporarily replenishing dopamine or mimicking the action

of dopamine. These types of drugs are called dopaminergic medications.

They generally help reduce muscle rigidity, improve speed and coordination

of movement and lessen tremor. Surgery is performed to insert a tube in the

small intestine, which delivers a gel formulation of carbidopa/levodopa

(Duopa™). Sometimes Deep Brain Stimulation can occur. Like all brain

surgeries, DBS carries a small risk of infection, stroke, bleeding or seizures.

“DBS surgery was first approved in 1997 to treat Parkinson’s disease

tremor, then in 2002 for the treatment of advanced Parkinson's disease

symptoms. More recently, in 2016, DBS surgery was approved for the

earlier stages of Parkinson's, for those with at least four years disease

duration and with motor complications that are not adequately controlled

with medication. In deep brain stimulation, surgery is performed to insert

electrodes into a targeted area of the brain, using MRI and recordings of

brain cell activity during the procedure. A second procedure is performed to

implant an impulse generator or IPG (similar to a pacemaker) under the

collarbone or in the abdomen. The IPG provides an electrical impulse to a

part of the brain involved in motor function. Those who undergo DBS

surgery are given a controller to turn the device on or off.” (3)

There are a lot of ramifications can that occur with this disease

specifically in the world of nutrition which is directly linked to heath. Some

of the effects of this disease can include esophageal motor abnormalities,

constipation and unintended weight loss which can result in morbidity and

mortality. Weight loss occurs from increased energy expenditure due to

tremor, dyskinesia’s and rigidity. Rigidity interferes with the ability to

control the position of the head and neck which is necessary for eating.

Some other effects include reduced energy because there can be dysfunction

in the olfactory areas, depression, dysphagia so they can’t really chew their

food and swallow, so they become afraid to eat, anorexia, insomnia and

disability. When it comes to protein, this is a huge factor in this patient’s

diet. High intake of protein diminishes the effectiveness of levodopa. The

amount of protein intake will be lower than of a normal healthy individual

due to the medication. The amount of intake would be 0.5 g/kg of body

weight. (3) Timing of the medication is crucial as well, so avoid conflicting

responses to protein with meals. Texture and the way meals are prepared

are major factor as well. Foods should be cut, softened, or minced.

Parkinson’s patients need to keep their meals small and frequent. “Nutrition

interventions should address the possible need for increased energy intake

and close monitoring of weight status. Individuals experiencing eating

difficulties may benefit from protein modification to decrease tremors.

Assistance with eating and extended mealtimes could increase intake

especially since there is rigidity of the extremities that could interfere with

the patient’s ability to care for self”. (1) Nutritional status may be affected

by numerous gastrointestinal symptoms that occur with Parkinson’s disease.

Muscular rigidity, tremor, and bradykinesia can affect the stages of

swallowing and increase the risk for aspiration. The muscular dysfunction

and nervous system abnormalities could lead to gastroparesis which is

delayed emptying of the stomach. (1)

Again, it is very important for providing education for the patients

and the family when it comes to anything pertaining to diet for this type of

patient as mentioned above of the negative outcomes if they are not made

aware of. Providing tips on antioxidant foods such as cherries, blueberries,

green tea, and coffee are an important component for this patient. (2)

Maintain bone density is important too as hip fractures can be common due

to falls. So, maintaining proper vitamins and minerals to keep bones would

be an advantage. Foods such as fermented meats, sausages, and salamis

should be avoided to follow a tyramine-restricted diet. Also, the patient and

family need to be concerned with their daily activities of living and where

furniture and items are placed in their direct contact. All of these factors

play a huge role in the success and outcome for this patient. Regular

exercise is also very important. It’s important for this type of patient to keep

active as much as possible. This may also help with their overall well-

being.

In conclusion, this disease is certainly a serious one to take into

consideration. There are too many symptoms and signs that prevent this

patient from living a normal life. Even though they are able to still function,

it is important to keep them in a positive environment with lots of care and

assistance when needed.

References

1. Nahikian-Nelms, M. (2011). Nutrition therapy and

pathophysiology. Belmont, CA: Wadsworth, Cengage Learning.

2. National Parkinson Foundation: Believe in Better. (n.d.).

http://www.parkinson.org/understanding-parkinsons/what-is-parkinsons

3. Escott-Stump, S. (n.d.). Nutritio Surgical Treatments. (n.d.).

Retrieved July 19, 2016, from http://www.pdf.org/en/surgical_treatments n

and diagnosis-related care, 8th edition.

4. Amerman, E. C. (2010). Anatomy & Physiology (1st ed., Vol. 1).

Englewood, CO: Morton Pub.