What Is Parkinson’s Disease?
Parkinson’s disease is a neurological disorder that affects movement, muscle control, and balance. Parkinson’s disease most commonly affects people 55 - 75 years old, but it can also develop in younger people. The disease is usually progressive, with symptoms becoming more severe over time.
Symptoms of Parkinson’s Disease
Parkinson’s disease may be difficult to diagnose in its early stages. The disease is diagnosed mostly through symptoms, which may include:
There is no cure for Parkinson’s disease. Treatments focus on controlling symptoms and improving quality of life.
New Drug Approval
In 2012, the Food and Drug Administration (FDA) approved rotigotine (Neupro) for treatment of early and advanced stage Parkinson’s disease. The dopamine agonist drug is delivered through a transdermal (skin) patch that is applied once a day.
Deep Brain Stimulation: Expert Consensus
In 2011, a panel of 50 international experts published a consensus statement on the use of deep brain stimulation (DBS). The panel advised that:
Tai Chi May Improve Balance
Tai chi, a Chinese martial art that emphasizes slow flowing motions and gentle movements, may help patients with Parkinson’s improve strength and balance and reduce the risk of falls, according to a small study published in the New England Journal of Medicine. Other small studies have suggested that dance styles such as the Argentinean tango may help with balance and mobility.
Parkinson's disease (PD) is a slowly progressive neurological disorder that affects movement, muscle control, and balance. Parkinson’s disease is part of a group of conditions called motor system disorders, which are associated with the loss of dopamine-producing brain cells. These dopamine-associated motor disorders are referred to as parkinsonisms.
Parkinson's disease occurs from the following process in the brain:
Parkinson's disease is a slowly progressive disorder that affects movement, muscle control, and balance. Part of the disease process develops as cells are destroyed in certain parts of the brain stem, particularly the crescent-shaped cell mass known as the substantia nigra. Nerve cells in the substantia nigra send out fibers to tissue located in both sides of the brain. There the cells release essential neurotransmitters that help control movement and coordination.
Dopamine deficiency is the hallmark feature in PD. Dopamine is one of three major neurotransmitters known as catecholamines, which help the body respond to stress and prepare it for the fight-or-flight response. Loss of dopamine negatively affects the nerves and muscles controlling movement and coordination, resulting in the major symptoms characteristic of Parkinson's disease. Dopamine also appears to be important for efficient information processing, and deficiencies may also be responsible for the problems in memory and concentration that occur in many patients.
Although doctors don’t know exactly what causes Parkinson's disease, they think it’s probably due to a combination of genetic and environmental factors.
Specific genetic factors appear to play a strong role in early-onset Parkinson's disease, an uncommon form of the disease. Multiple genetic factors may also be involved in some cases of late-onset Parkinson's disease.
Environmental factors are probably not a sole cause of Parkinson's disease, but they may trigger the condition in people who are genetically susceptible.
Some evidence implicates pesticides and herbicides as possible factors in some cases of Parkinson's disease. A higher incidence of parkinsonism has long been observed in people who live in rural areas, particularly those who drink private well water or are agricultural workers.
The average age of onset of Parkinson's disease is 55. About 10% of Parkinson's cases are in people younger than 40 years old. Older adults are at higher risk for both parkinsonism and Parkinson's disease.
Parkinson’s disease is more common in men than in women.
People with siblings or parents who developed Parkinson's at a younger age face an increased risk for the condition. However, relatives of patients who developed Parkinson’s at an older age appear to have an average risk.
African-Americans and Asian Americans appear to have a lower risk than caucasians.
Both smoking and coffee drinking are associated with a lower risk for PD.
Smoking and Nicotine. Cigarette smokers appear to have a lower risk for Parkinson's disease, indicating possible protection by nicotine. This finding is, of course, no excuse to smoke. The few studies on nicotine replacement as a treatment for Parkinson’s have not provided any strong evidence that nicotine therapy provides benefits.
Coffee Consumption. Some studies suggest that the risk for PD in coffee drinkers is lower than for non-coffee drinkers. In a 30-year study of Japanese-American men, coffee consumption was associated with a lower risk for Parkinson's disease, and the more coffee they drank, the lower their risk became.
Parkinson's disease (PD) is not fatal, but it can reduce longevity. The disease progresses more quickly in older patients, and may lead to severe incapacity within 10 - 20 years. Older patients also tend to have muscle freezing and greater declines in mental function and daily functioning than younger people. If PD starts without signs of tremor, it is likely to be more severe than if tremor had been present.
Parkinson's disease can seriously impair the quality of life in any age group. In addition to motor symptoms (motion difficulties, tremors) Parkinson’s can cause various non-motor problems that have physical and emotional impacts on patients and their families.
Swallowing problems (dysphagia) are sometimes associated with shorter survival time. Loss of muscle control in the throat not only impairs chewing and swallowing, which can lead to malnourishment, but also poses a risk for aspiration pneumonia.
Depression is very common in patients with Parkinson's. The disease process itself causes changes in chemicals in the brain that affect mood and well-being. Anxiety is also very common and may present along with depression.
Some drug treatments (levodopa combined with a dopamine agonist) can cause compulsive behavior, such as gambling, shopping, and increased sexuality. Patients who have pre-existing tendencies for novelty-seeking behavior, or a family or personal history of alcohol abuse, may be more likely to develop compulsive gambling. Deep brain stimulus (DBS) surgery may also increase the risk for compulsive gambling in patients who have a history of gambling.
Impaired Thinking (Cognitive Impairment). Defects in thinking, language, and problem solving skills may occur early on or later in the course of the disease. These problems can occur from the disease process or from side effects of medications used to treat Parkinson’s. Patients with PD are slower in detecting associations, although (unlike in Alzheimer's disease) once they discover them they are able to apply this knowledge to other concepts.
Dementia. Dementia occurs in about two-thirds of patients with Parkinson’s, especially in those who developed Parkinson’s after age 60. Dementia is significant loss of cognitive functions such as memory, judgment, attention, and abstract thinking. It is most likely to occur in older patients who have had major depression. PD marked by muscle rigidity (akinesia), rather than tremor, and early hallucinations also increase the risk for dementia. (Visual hallucinations can also occur as a side effect of dopamine medication.) Unlike Alzheimer's, language is not usually affected in Parkinson's-related dementia.
Excessive daytime sleepiness, insomnia, and other sleep disorders are common in PD, both from the disease itself and the drugs that treat it. Bladder problems can also contribute to sleep disturbances. Many patients also suffer from nighttime leg cramps and restless legs syndrome. Some of the medications used for Parkinson's may cause vivid dreams as well as waking hallucinations.
Although Parkinson's disease and its treatments can cause compulsive sexual behavior, the disease can also cause a loss of sexual desire in both men and women. For men, erectile dysfunction can be a complication of Parkinson’s.
Constipation is a common complication of Parkinson’s disease. It is often caused by muscle weakness that can slow down the action of the digestive system. Weakness in pelvic floor muscles can also make it difficult to defecate.
Patients with Parkinson’s disease frequently experience urinary incontinence, including increased urge and frequency. Parkinson’s can also cause urinary retention (incomplete emptying of the bladder).
Decreased Sense of Smell. Many patients experience an impaired sense of smell.
Vision Problems. Vision may be affected, including impaired color perception and contrast sensitivity.
Pain. Painful symptoms associated with Parkinson’s disease include muscle numbness, tingling, and aching. Pain in Parkinson’s is often a result of dystonia, involuntary muscle contractions and spasms that can cause twisting and jerking.
Parkinson's disease (PD) symptoms often start with tremor, which may occur in the following ways:
About a quarter of patients with Parkinson’s do not develop tremor.
Many PD symptoms involve motor impairment caused by problems in the brain nerves that regulate movement:
Parkinson’s disease also causes non-motor symptoms, including sleep problems, gastrointestinal and urinary disorders, sexual dysfunction, decreased sense of smell, and depression and anxiety. [See Complications section of this report.]
Sialorrhea (drooling) is a common and bothersome symptom for those with Parkinson's disease. It can cause chapped skin and lips around the mouth, dehydration, an unpleasant odor, and social embarrassment.
Parkinson’s disease can be difficult to diagnose in its early stages. Doctors base their diagnosis on the patient’s medical history and symptoms evaluated during a neurological exam. No laboratory or imaging tests can diagnose Parkinson’s, although brain scans such as computed tomography (CT), magnetic resonance imaging (MRI), or positron-emission tomographic (PET) may be used to rule out other neurological disorders.
A medical and personal history should include any relevant symptoms as well as any medications taken, and information on other conditions the patient may have.
In a neurological exam, the doctor will ask the patient to sit, stand, walk, and extend their arms. The doctor will observe the patient’s balance and coordination. Parkinson's may be suspected in patients who have at least two of the following four symptoms, especially if they are more obvious on one side of the body:
A levodopa challenge test may confirm a diagnosis of Parkinson's disease. If patients' symptoms improve when they take levodopa, they likely have Parkinson's, ruling out other neurological diseases.
The American Academy of Neurology (AAN) recommends the Beck Depression Inventory or the Hamilton Depression Rating Scale to screen for depression in patients with Parkinson's disease. The AAN recommends the Mini Mental State Examination (MMSE) and Cambridge Cognitive Examination (CAMCOG) tests to screen for dementia. During these tests, the patient answers a series of questions.
Parkinsonism Plus Syndromes. Parkinson’s disease is the most common type of parkinsonism. Parkinsonism refers to a group of movement disorders that share similar symptoms with Parkinson’s disease, but also have unique symptoms of their own. About 15% of parkinsonism cases are due to conditions called Parkinson’s plus syndromes (PPS) or atypical parkinsonism. These syndromes include:
Patients with PPS often have earlier and more severe dementia than those with Parkinson’s disease. In addition, they do not usually respond to medications that are used to treat Parkinson’s disease.
Other Neurologic Conditions. Many medical conditions may cause some symptoms of Parkinson's disease and parkinsonism. Hardening of the arteries (arteriosclerosis) in the brain can cause multiple small strokes, which can produce loss of motor control. Alzheimer’s disease can share similar symptoms with Parkinson’s and the conditions can exist together.
Medications. Several drugs, including antipsychotic and antiseizure medications, can cause Parkinson’s symptoms.
There is no cure for Parkinson’s disease, but drugs, physical therapy, and surgical interventions can help control symptoms and improve quality of life. The goals of treatment for Parkinson's disease are to:
Treatment is very individualized for this complicated condition. Patients must work closely with doctors and therapists throughout the course of the disease to customize a program suitable for their particular and changing needs. Patients should never change their medications without consulting their doctor, and they should never stop taking their medications abruptly.
No treatment method has been proven to change the course of the disease. For early disease with little or no impairment, drug therapy may not be necessary.
A number of issues must be considered in choosing medication treatment. These include how effective a specific drug group is in treating symptoms, side effect profile, loss of effectiveness over time, and other considerations.
The American Academy of Neurology recommends the following therapies for the initial treatment of Parkinson’s disease:
Levodopa (L-dopa). Levodopa, or L-dopa, has been used for years and is the gold standard for treating Parkinson's disease. L-dopa increases brain levels of dopamine. It is probably the most effective drug for controlling symptoms and is used in nearly all phases of the disease. The standard preparations (Sinemet, Atamet) combine levodopa with carbidopa, a drug that slows the breakdown of levodopa. Levodopa is better at improving motor problems than dopamine agonists but increases the risk of involuntary movements (dyskinesia). Effectiveness tends to decrease after 4 - 5 years of usage.
Dopamine Agonists. Dopamine agonist drugs mimic dopamine to stimulate the dopamine system in the brain. These drugs include pramipexole (Mirapex, generic), ropinirole (Requip, generic), bromocriptine (Parlodel, generic), and rotigotine (Neupro).
Selegiline (Eldepryl) and Rasagiline (Azilect). Selegiline (Eldepryl, generic) is a monoamine oxidase B (MAO-B) inhibitor that may have some mild benefit as an initial therapy. Rasagiline (Azilect) is another MAO-B inhibitor used for treatment of Parkinson’s.
Drug treatments for Parkinson disease do not consistently control symptoms. At certain points during the day, the beneficial effects of drugs wear off, and symptoms can return, including uncontrolled muscular motor function, difficulty walking, and loss of energy. The American Academy of Neurology (AAN) recommends the following drugs as best for controlling off time symptoms:
Other dopamine agonists, such as ropinirole (Requip, generic) and pramipexole (Mirapex, generic), and the COMT inhibitor tolcapone (Tasmar) may also be helpful for treating off-time symptoms. Deep brain stimulation is a surgical treatment that may help improve motor fluctuations in some patients.
Conditions associated with non-motor impairment symptoms of Parkinson's disease may need a variety of treatments.
Depression. Antidepressants used for PD include tricyclics, particularly amitriptyline (Elavil). Some studies have found that selective serotonin-reuptake inhibitors (SSRIs) -- which include fluoxetine (Prozac, generic), sertraline (Zoloft, generic), and paroxetine (Paxil, generic) -- may worsen symptoms of Parkinson's. Doctors should monitor patients taking SSRIs.
Psychotic Side Effects. Studies indicate that clozapine (Clozaril, generic) and quetiapine (Seroquel), antipsychotic drugs used to treat schizophrenia, may be the best drugs for treating psychosis in patients with Parkinson's disease. A similar drug, olanzapine (Zyprexa), should not be used for patients with PD because it can worsen psychotic symptoms.
Dementia. The cholinesterase inhibitor drugs donepezil (Aricept) and rivastigmine (Exelon) are used to treat Alzheimer’s disease and are sometimes used for Parkinson’s. The benefit from these drugs is often small, and patients and their families may not notice much change.
Daytime Sleepiness and Fatigue. Modafinil (Provigil), a drug used to treat narcolepsy may be helpful for patients with sleepiness related to their disease. Methylphenidate (Ritalin, generic) may be considered for patients who experience fatigue.
Erectile Dysfunction. PDE5 inhibitor drugs such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) can be helpful for men with Parkinson's disease who suffer from erectile dysfunction. However, these drugs may worsen orthostatic hypotension (lightheadedness or dizziness that occurs when suddenly standing up), a side effect of some PD medications.
Constipation. Laxatives that contain macrogol (polyethylene glycol) may be helpful for improving constipation. Brand names include Softlax, Miralax, and Glycoprep.
Drooling. Glycopyrrolate, scopolamine, and injections of botulinum toxin may be used to relieve drooling symptoms.
Advanced Parkinson’s disease poses challenges for both patients and caregivers. Eventually, symptoms such as stooped posture, freezing, and speech difficulties may no longer respond to drug treatment. Surgery (deep brain stimulation) may be considered for some patients. Patients become increasingly dependent on others for care and require assistance with daily tasks. Modifications (wheelchair ramps, grab bars and handrails) may need to be made in the home. Some patients may need to move to an assisted living facility or nursing home. The goal of treatment for advanced Parkinson’s disease should be on providing patients with safety, comfort, and quality of life.
Levodopa, also called L-dopa, which is converted to dopamine in the brain, remains the gold standard for treating Parkinson's disease. The standard preparations (Sinemet, Atamet) combine levodopa with carbidopa, which improves the action of levodopa and reduces some of its side effects, particularly nausea. Dosages vary, although the preparation is usually taken in three or four divided doses per day.
In general L-dopa has the following effects on Parkinson's disease:
In many patients, levodopa significantly improves the quality of life for many years.
The toxic effects of levodopa with or without carbidopa are considerable.
Physical Side Effects. The physical side effects include:
Psychiatric and Mental Side Effects. The major adverse effects of the drug are psychiatric. Patients taking levodopa, especially in combination with other drugs, can experience:
Levodopa causes fewer psychiatric side effects than other drugs used for Parkinson's disease, including anticholinergics, selegiline, amantadine, and dopamine agonists. Psychiatric side effects often occur at night. If these side effects are severe, some doctors recommend reducing or stopping the evening dose.
Within 4 - 6 years of treatment with levodopa, the effects of the drug in many patients begin to last for shorter periods of time after a dose (called the wearing-off effect), and the following pattern may occur:
Preventing the Wearing-Off Effect. To reduce the effects of fluctuation and the wearing-off effect, it is important to maintain as consistent a level of dopamine as possible. Unfortunately, levodopa is poorly absorbed and may remain in the stomach a long time. A number of strategies are used to take care of these problems:
Selegiline (Eldepryl, Zelapar, generic), also known as deprenyl, is an antioxidant drug that blocks monoamine oxidase B (MAO-B), an enzyme that degrades dopamine. Until recently, selegiline was commonly used in early-onset disease and in combination with levodopa for maintenance. Concerns over significant side effects have been raised, however.
A newer MAO-B inhibitor, rasagiline (Azilect), is used alone during early-stage PD and in combination with L-dopa for moderate-to-advanced PD. Unlike selegiline, which is taken twice a day, rasagiline is taken once a day.
Side Effects. MAO-B inhibitors may have severe side effects:
Dopamine agonists stimulate dopamine receptors in the substantia nigra, the part of the brain in which Parkinson's is thought to originate. Dopamine agonists are effective in delaying motor complications during the first 1 or 2 years of treatment.
Newer Dopamine Agonists. The most commonly prescribed dopamine agonists are pramipexole (Mirapex, generic) and ropinirole (Requip, generic). They are used either alone or in combination with L-dopa. Pramipexole appears to work better and have fewer side effects than ropinirole.
Research indicates that L-dopa is better at improving motor disability, and dopamine agonists are better at reducing motor complications. L-dopa has a higher risk for dyskinesia side effects than dopamine agonists, but dyskinesia (difficulty controlling muscle movements) can also occur with dopamine agonists. There is debate about the value of dopamine agonists as initial therapy for Parkinson’s disease. Recent research suggests that early treatment with dopamine agonists may not provide any long-term advantages compared with starting treatment with L-dopa.
Side Effects. Side effects of pramipexole and ropinirole vary but can be severe and include:
Other Dopamine Agonists.
Catechol-O-methyl transferase (COMT) inhibitors increase concentrations of existing dopamine in the brain. Entacapone (Comtan, Stalevo) is the current standard COMT inhibitor. (Stalevo combines entacapone and levodopa in a single pill.) It improves motor fluctuations related to the wearing-off effect and has shown good results in improving on time and reducing the requirements for L-dopa. If the patient does not respond to the drug within 3 weeks, it should be withdrawn. No one should withdraw abruptly from these drugs.
Side Effects. Side effects may include:
Of major concern are reports of a few deaths from liver damage in patients taking the COMT inhibitor tolcapone (Tasmar). The drug has been taken off the market in many countries and is recommended in the U.S. only for patients who cannot tolerate other drugs. Entacapone does not appear to have the same effects on the liver and does not require monitoring. Still, patients should watch out for symptoms of liver damage, including jaundice (yellowish skin), fatigue, and loss of appetite.
Jaundice is a condition produced when excess amounts of bilirubin circulating in the bloodstream dissolve in the subcutaneous fat (the layer of fat just beneath the skin), causing a yellowish appearance of the skin and the whites of the eyes. With the exception of normal newborn jaundice in the first week of life, all other jaundice indicate pigment overload (from excessive breakdown of red blood cells), damage to the liver, or inability to move bilirubin from the liver through the biliary tract to the gut.
Some data indicate that Stalevo may increase the risk for heart events (heart attack, stroke, and death). The FDA is reviewing this evidence and advises doctors to monitor the heart health of patients taking Stalevo, especially if they have a history of heart disease. The FDA is also investigating whether Stalevo may increase the risk of prostate cancer.
Anticholinergics were the first drugs used for PD, but they have largely been replaced by dopamine drugs. They are generally used only to control tremor in the early stages. They are not as effective against bradykinesia and posture problems and may increase the risk for dementia in late stages. Among the many anticholinergics are trihexyphenidyl (Artane, Trihexane, generic), benztropine (Cogentin, generic), and biperiden (Akineton, generic), Orphenadrine (Norflex, generic) is a drug with anticholinergic properties, but it is also a muscle relaxant and does not cause urinary retention.
Side Effects. Anticholinergics commonly cause dryness of the mouth (which can actually be an advantage in some people who experience drooling). Other side effects are nausea, urinary retention, blurred vision, and constipation. These drugs can increase heart rate and worsen constipation. Anticholinergics can sometimes cause significant mental problems, including memory loss, confusion, and even hallucinations. People with glaucoma should use these drugs with caution.
Amantadine (Symadine, Symmetrel) stimulates the release of dopamine and may be used for patients with early mild symptoms. It has some benefit against muscle rigidity and slowness and may help some patients in advanced stages who are unresponsive to other drugs. It is less powerful than levodopa and may lose its effectiveness after 6 months. It may also reduce motor fluctuations brought on by levodopa, however, and these benefits appear to persist for at least a year. Large, well-conducted studies are still needed to determine its true benefits and safety.
Side Effects. Side effects are similar to those of anticholinergic drugs and may include swollen ankles and mottled skin. Amantadine can also cause visual hallucinations. Overdose can cause serious and even life-threatening toxicity. Patients with Parkinson's should not withdraw from this drug abruptly. In rare instances, it can cause acute delirium or a life-threatening condition called neuroleptic malignant syndrome.
Surgical procedures are recommended for specific patients with advanced Parkinson’s disease whose symptoms are not controlled by drug treatments. Surgical treatment cannot cure Parkinson's disease, but it may help control symptoms such as motor fluctuations and dyskinesia. Pallidotomy and thalamotomy are older procedures that destroy tissue in certain parts of the brain. Deep brain stimulation, the current standard surgical practice for Parkinson’s disease, has largely replaced the older operations.
In deep brain stimulation (DBS), also called neurostimulation, an electric pulse generator controls symptoms such as severe tremors, wearing-off fluctuations, and dyskinesia. The generator is similar to a heart pacemaker. It sends electrical pulses to specific regions of the brain. Candidates most likely to benefit from DBS are those who have advanced Parkinson’s, have responded well to levodopa drug treatment, are younger age, and do not have significant cognitive or psychiatric problems.
For treatment of motor symptoms, DBS usually targets one of two areas of the brain: the subthalamic nucleus (STN) or the globus pallidus pars interna (GPi). Research indicates that both areas equally likely to respond well to DBS. DBS targeting the STN may allow patients to use less medication, but treatment of this brain area may worsen depression, apathy, impulsivity, ease of using words, and falls.
For treatment of disabling tremors, DBS may be used to target the STN, GPi, or the ventral intermediate nucleus of the thalamus.
DBS should be performed by an experienced neurosurgeon who is trained in stereotactic neurosurgery (surgery that uses three-dimensional imaging to help target specific areas of the brain).
The procedure is performed as follows:
The benefits of DBS appear to be long lasting, but it may take 3 - 6 months to achieve results. During this time, doctors may need to adjust the implanted device. Researchers are still trying to determine the best surgical techniques for implanting the DBS device, and how to best select the patients who are most likely to benefit.
Pallidotomy and thalamotomy are surgical procedures that destroy brain tissue in regions of the brain associated with Parkinson’s symptoms, such as dyskinesia, rigidity, and tremor. In these procedures, a surgeon drills a small hole in the patient’s skull and inserts an electrode to destroy brain tissue. Pallidotomy targets the global pallidus area. Thalamotomy targets the thalamus. Because these procedures permanently eliminate brain tissue, most doctors now recommend deep brain stimulation instead of pallidotomy or thalamotomy.
Surgical complications may include behavioral or personality changes, trouble speaking and swallowing, facial paralysis, and vision problems. Weight gain after surgery is also common.
Scientists are investigating whether stem cells may eventually help treat Parkinson disease. Experimental surgery has shown promise using fetal brain cells rich in dopamine implanted in the substantia nigra area of the brain. Because the use of embryonic stem cells is controversial, researchers are studying alternative types of cells, including stem cells from adult brains and cells from human placentas or umbilical cords. All of this research is still preliminary.
No special diets or natural foods have been shown to slow the progression of Parkinson's disease, but there are some dietary recommendations.
Protein. High levels of proteins may affect how much levodopa can reach the brain and may, therefore, reduce the drug's effectiveness. Avoiding protein altogether is not the solution, since malnutrition can result. Most doctors recommend reducing protein or eating most of your protein at the evening meal. Patients should discuss a low-protein diet and other nutritional strategies with their health team.
Good control of protein intake may help minimize fluctuations and wearing-off and may allow some patients to reduce their daily levodopa dosage.
Fruits and Vegetables and Increasing Fiber. Eating whole grains, fresh fruits, and vegetables is the best approach for any healthy life. A diet rich in fruits and vegetables may help protect nerve cell function. Many of these foods are also often rich in fiber, which is particularly important for helping to prevent constipation.
Dietary fiber is the part of food that is not affected by the digestive process in the body. Only a small amount of fiber is metabolized in the stomach and intestine, the rest is passed through the gastrointestinal tract and makes up a part of the stool. There are two types of dietary fiber, soluble and insoluble. Soluble fiber retains water and turns to gel during digestion. It also slows digestion and nutrient absorption from the stomach and intestine. Soluble fiber is found in foods such as oat bran, barley, nuts, seeds, beans, lentils, peas, and some fruits and vegetables. Insoluble fiber appears to speed the passage of foods through the stomach and intestines and adds bulk to the stool. It is found in foods such as wheat bran, vegetables, and whole grains. Fiber is very important to a healthy diet and can be a helpful aid in weight management. One of the best sources of fiber comes from legumes, the group of food containing dried peas and beans.
People whose diets have been low in fiber should increase it gradually. It is best to obtain dietary fiber, soluble or insoluble, in the natural form of whole grains, nuts, legumes, fruits, and vegetables. If it proves difficult to do so, psyllium, (found in products such as Metamucil), is an excellent soluble fiber supplement. Drinking lots of fluids is particularly important in preventing constipation.
Generally, manufacturers of herbal remedies and dietary supplements do not need FDA approval to sell their products. Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. There have been a number of reported cases of serious and even lethal side effects from herbal products. Always check with your doctor before using any herbal remedies or dietary supplements.
The following dietary supplements are being studied for treatment of Parkinson's disease:
Exercise is an important component of rehabilitation. Physical therapy can help with physical function and quality of life. It usually includes active and passive exercise, gait training, and practice in normal activities. To date, no specific exercise approach has been proven to be better than others.
Exercise Programs. Exercise programs are defined as passive or active.
Gait Training. Practicing new methods for standing, walking, and turning may help retain balance and reduce the risk of falls. The following tips may be helpful:
Tai chi, a Chinese martial art that emphasizes slow flowing motions and gentle movements, may help patients with mild-to-moderate Parkinson’s improve strength and balance and reduce the risk of falls. Some research suggests that tango dance may also help with balance and mobility.
Reducing Muscle Freezing. The patient should practice regular daily activities that simplify actions and reduce the incidence of muscle freezing. Most often, freezing occurs when a patient begins to move or is presented with an obstacle. The following tips may be helpful:
Mental Tasks. Mental training is also helpful. Approaches include:
Speech Therapy. Speech therapy may help those who develop a monotone voice and lose volume. Therapy is prescribed to help with speech and to evaluate and monitor swallowing.
A number of devices can be helpful for maintaining stability and preventing falls. Examples include:
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Review Date: 9/10/2012
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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