Understanding Parkinson Disease

Parkinson disease (PD) is a condition of degeneration of cells in the brain, particularly in the substantia nigra, which is in the lower part of the brain, called the brain stem. The deterioration leads to several classic symptoms, most notably the resting tremor or rhythmic shaking of body parts. Classically, the PD tremor is a “pill-rolling tremor,” a rubbing of the thumb over the index finger. Other symptoms include rigidity, stiffness of the joints and a loss of facial expression, often called “mask-like facies.” A person with PD will often produce progressively smaller handwritten letters, known as micrographia.

Patients with PD can have trouble swallowing since the brain controls the muscles of the esophagus. This can lead to aspiration and pneumonia.

They also can develop orthostatic hypotension, a condition of the sudden dropping of the blood pressure upon standing. You may have experienced lightheadedness when you have stood up too quickly. Multiply that by 10 and you can appreciate what some PD patients experience. Orthostatic hypotension can be dangerous because it can lead to fainting and falls.

Patients with PD have a characteristic shuffling gait. They also tend to not swing their arms with their steps. Falls become frequent, as the disease progresses. Patients will also have a slowing of movement, called bradykinesia. It will almost seem as if they are in slow motion.

PD can cause changes in smell, sleep disturbances and depression. Dementia can also be a part of the picture.

According to the Parkinson’s Foundation, about one million people in the US have PD with 60,000 new diagnoses per year. More men than women get PD. Most of them are senior citizens; however, about 4% will develop the illness before age 60.

Treatment for PD has expanded in recent years. There are four categories: physical therapy, medications, surgery, and regenerative treatments.

Physical therapy can improve balance and stiffness to some extent early in the disease. It can improve safety, too.

Medications can help dramatically, especially early in the disease, but they do not cure the disease. Carbidopa-levodopa is a mainstay of PD treatment. The levodopa part is converted in the body to dopamine, raising the low levels in the substantia nigra. Mostly, it is taken orally. New therapies for advanced disease include inhaled forms and forms continually infused via intestinal tubes.

Patients with PD and their caregivers are often quite burdened by debilitating symptoms of PD, with or without dementia. As the largest nonprofit hospice provider in San Diego County and Southwest Riverside County, The Elizabeth Hospice offers personalized, compassionate support to patients and their families, a comprehensive program that goes beyond managing symptoms and relieving pain. Our focus is not on curing the incurable but on bringing meaning and joy to a person’s life.

We provide all the necessary durable medical equipment, like walkers, hospital beds and bedside commodes, as well as the hospice-related medicines. Each patient is placed under the care of an interdisciplinary team comprised of a hospice doctor or nurse practitioner, registered nurse case manager, social work, home health aide and spiritual counselor.

Family caregivers greatly appreciate the support they receive from The Elizabeth Hospice.  With our help, they are free to be loving family members without worrying about  their loved one’s medical and nursing details of care. Hospice even has respite care, a three-to-five-day stay in a nursing home, supervised by the hospice team, that allows family caregivers the opportunity to take a vacation or other needed break.

The important thing is that you and your loved one will receive the attention and treatment you need and deserve. We call this individualized, compassionate care, The E Way. To find out how your loved one who has been diagnosed with Parkinson disease can benefit from hospice care, contact The Elizabeth Hospice at 800.797.2050.

By George Delgado, MD
Chief Medical Officer, The Elizabeth Hospice