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Neurology: Parkinson’s Disease = Shaking Palsy

Parkinson’s disease is a chronic, progressive neurodegenerative disease when the neurons in the brain starts to degenerate and die. The neuron is called dopamine which acts as a chemical in the brain to control the movement in the body. Patients will normally present with resting tremor, bradykinesia and muscular rigidity. The term “parkinsonisms” is often used to describe the clinical symptoms of PD. Although PD is a motor neuron disease but it also presents with non- motor symptoms such as sleeping disorders, depression, constipation and cognitive changes. (NICE clinical guidelines, 2006)


People with PD also lose the nerve endings that produce norepinephrine which is the main chemical messenger of the sympathetic nervous system. It controls many automatic functions of the body such as heart rate and blood pressure. The loss of norepinephrine might explain some of the non-movement related features of Parkinson's, such as fatigue, irregular blood pressure, decreased movement of food through the digestive tract and sudden drop in blood pressure when a person stands up from a sitting or lying-down position.


Early symptoms of Parkinson's disease are subtle and occur gradually. For example, affected people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly or that their handwriting is slow and looks cramped or small. Friends or family members may be the first to notice changes in someone with early Parkinson's. They may see that the person's face lacks expression and animation or the person does not move an arm or leg normally. (Schrag A, 2015)


People with Parkinson's often develop a parkinsonian gait that includes a tendency to lean forward, small quick steps as if hurrying forward and reduced swinging of the arms. They may also have trouble initiating or continuing movement. Hence, they will have a higher tendency of fall that will lead to mortality.


Parkinson’s disease is a lifelong and progressive condition. Although there is no medication to cure PD, physiotherapy management could provide symptomatic treatment and maximize the independency of the patient with rehabilitation. We will discuss the staging and management of Parkinson’s Disease in the next article. Stay tune!



Reference:


National Institute for Health and Care Excellence (NICE) Parkinson’s disease: diagnosis and management in primary and secondary care. NICE clinical guidelines 35. Jun, 2006.

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