Parkinson's Disease

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People with Parkinson's can make a number of lifestyle changes to enhance the quality of their lives and help minimize symptoms. These include eating a well-rounded diet, getting regular exercise—yoga and tai chi are especially effective at improving flexibility and balance—and seeking physical or occupational therapy to maintain or regain muscle tone.

As with any chronic disease, Parkinson's places significant stress on all parties involved. Support groups can be valuable; they not only educate families about the disease but also help patients and caregivers to develop coping skills. In some cases, professional counseling may be necessary to relieve anxiety, depression, or other psychosocial symptoms of the disease.

This section contains more information on:

  • Eating
  • Exercise
  • Physical, speech, and occupational therapy
  • Sexual difficulty
  • Sleep disturbances
  • Coping with depression
  • Eating

    People with Parkinson's are advised to eat a well-balanced diet that is high in antioxidants. The body functions better when it is well-nourished, and many health experts believe that antioxidants may play a role in slowing the progression of age-related diseases. Foods rich in antioxidants include prunes, blueberries, blackberries, strawberries, raspberries, raisins, and spinach. Because many people are troubled by constipation, fiber is also a key component of the diet. Good sources include bran, fruits, vegetables, beans, and whole-grain cereals and breads. It's also important to drink six to eight glasses of water daily.

    Malnutrition is sometimes a consequence of Parkinson's, perhaps because the patient becomes depressed or experiences nausea as a side effect of medication, or begins to have difficulty swallowing. If he or she loses interest in food, or struggles to chew or coughs and chokes while eating, it may be helpful to consult a physician for advice or for a swallow study, during which an X-ray will reveal whether an administered liquid is passing into the trachea rather than the esophagus. If swallowing is the issue, it may be possible to address the problem by cutting food into tiny pieces and by sitting up straight during meals. Or the patient may be helped by speech or occupational therapy. Patients who experience swallowing difficulties should also consider taking nutritional supplements.

    Protein and other foods interfere with the absorption of levodopa (the key ingredient in Sinemet or Stalevo). It's advisable to take Sinemet or Stalevo at least 30 minutes, and preferably an hour, before or after meals to ensure effective absorption. If the drugs produce nausea, they can be taken with crackers.

    Exercise

    Exercise is very helpful in maintaining or increasing the capacity to be active and mobile, decreasing rigidity and stiffness, improving balance and coordination, and helping with gait. Patients are advised to begin exercising regularly as soon as they get a diagnosis, since exercise can help delay the onset of new symptoms.

    In the early stages of the disease, it is typically possible to choose any exercise program that would interest you with or without Parkinson's, as long as it builds in stretching and targets all parts of the body. If freedom of movement and balance are impaired, a physical therapist can help develop an appropriate exercise regimen. Or your doctor may be able to refer you to an exercise class specifically for Parkinson's patients. As is true for anyone, it's important to get a green light from your doctor before beginning a vigorous regime, particularly if you have any heart conditions.

    Some activities that are highly recommended: yoga and tai chi for balance and flexibility, and walking and swimming for aerobic conditioning. A weight training program may be recommended as a way to improve strength and balance.

    People who experience lightheadedness upon standing, a fairly common occurrence in Parkinson's patients that is related to a drop in blood pressure, should stop exercising if they feel this way while working out.

    Physical, speech, and occupational therapy

    Patients with Parkinson's often suffer from slow movements, stiffness, walking difficulties, and balance problems. Physical therapists can help devise a regular exercise program that will minimize some symptoms of the disease, improving strength, balance, and gait. These exercises can help patients move more easily and independently. Besides exercises, therapists can teach patients techniques that will help them move better.

    For example, physical therapy can help patients cope with "freezing," a common phenomenon in which they suddenly can't move their feet. Therapists coach patients on how to get started again by consciously trying to make a different motion—stepping over a line or someone's foot, for example. Some people use a cane with a laser pointer so that they try to step on a target. Basically, the idea is to stop the brain from trying to execute a continuous action that isn't working (walking through the door) and start over with a new action (stepping over something).

    Patients with Parkinson's often experience speech difficulties, including low volume (hypophonia) and a slowed rate of speaking. Speech therapists work with the mechanics of speaking and aspects of breathing that help speech. Your neurologist is a good referral source for speech therapists. There is also a voice-training program called the Lee Silverman Voice Treatment that has been shown to be particularly effective in Parkinson's patients. You can find therapists trained in this program at LSVTglobal.org.

    Occupational therapists help with ways to manage the activities of daily living, with an eye toward increasing a patient's safety and independence and motor coordination of the upper extremities. They often make recommendations for use of orthotics and assistive devices, as well as home and workplace modification and safety.

    Modifications that make dressing easier, for example, include a long-handled shoehorn, zippers or Velcro closures instead of buttons, and elastic shoelaces. Ideas for bathroom safety include grab bars or tub rails, a shower chair and a flexible shower hose, a raised toilet seat, an electric razor (especially if you have a hand tremor), a shower caddy to eliminate the need for bending over, a night light, and nonslippery surfaces applied to the tub or shower floor to help prevent falls. The hot-water heater should be turned down to prevent accidental burns.

    Sexual difficulty

    Many patients with Parkinson's are troubled by sexual problems, including impotence. If you experience this, sharing the problem with your physician is a good idea. A referral to a urologist or gynecologist may be helpful.

    Sleep disturbances

    Sleep disorders are very common in patients with Parkinson's disease, including restless legs, vivid dreams or hallucinations, or violent movements during sleep. Many patients also experience daytime sleepiness, often a side effect of the dopamine agonist medications. A neurologist may order a sleep study or try changing medications, changing the timing of medications, or adding a new medication—for restless leg syndrome, for example—or to minimize hallucinations at night.

    If you experience Parkinson's symptoms during the night because your medicine is wearing off, the doctor may prescribe a long-acting form of Sinemet to be taken just at bedtime.

    Coping with depression

    Depression commonly complicates the course of Parkinson's. It has been estimated that clinically significant depression is twice as common in patients with the disease as it is in patients with other medical illnesses. Signs of depression include trouble sleeping or sleeping too much; problems with concentration, weight loss or gain, anxiety, or irritability; panic attacks; lack of pleasure in usual activities; and crying or moodiness.

    It's important to let your physician know if you feel depressed. You may be referred to a counselor for assistance adjusting to the changes chronic disease brings to your life and the life of your family. An antidepressant may help to relieve the symptoms of depression. Besides improving the spirits, treating depression may slow cognitive decline and keep a person active longer.

    Last reviewed on 04/11/2006

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