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Parkinson’s & Driving Safety

February 1, 2020 Change, Life

The topic of driving can be a sensitive subject for folks with Parkinson’s disease (PD) and their care partners. Fortunately, just because one has a PD diagnosis does NOT necessarily mean that the freedom to drive needs to be taken away. There are many people with PD who continue to drive safely, years after they have been diagnosed.

However, we know that PD progresses over time. Symptoms change. Medications may be added and others stopped. Side effects from medications can change. New health problems may arise that make controlling PD more difficult. Because of these things, driving safety is an issue that requires re-evaluation from time to time. Independence and safety are priorities that should both be honored, while recognizing that sometimes modifications may need to be considered.

Things to consider when deciding whether to drive
Driving plays an important role in an individual’s sense of independence, personal control, and self-reliance, so giving up driving can be very difficult. People living with PD should consider the following questions when deciding whether or not to drive:

How is my vision? Can I see well at night? Can I distinguish colors, such as in traffic lights?
Would I be putting my passenger (friend or loved one) at risk?
How fast is my reaction time? Could I safely avoid a surprise obstacle in the road?
Has anyone (friend or family member) commented negatively on my ability to drive?
Can I handle multiple activities at the same time (whether driving or not)?
Can I effectively and quickly turn the wheel or step on the brake with enough strength?
Do my medications for PD (or other conditions) cause side effects like sleepiness, dizziness, blurred vision, or confusion?

These are understandable and important questions to be considered, but often people struggle with how to discuss the issue with loved ones or care partners. Sharing concerns or observations with a trusted friend or family member might be a good place to start.

In some cases, speaking with a doctor or professional, such as an occupational therapist, might be helpful. The American Occupational Therapy Association maintains a searchable database to help locate a Driving Rehabilitation Specialist so you or a family member may receive an assessment (https://www.aota.org/Practice/ Productive-Aging/Driving/driving-specialistsdirectory-search.aspx).

Driver Rehabilitation Specialists work with people of all ages and abilities, evaluating, training, and exploring alternative transportation solutions. Another tool for rating driving ability is offered by AAA at https://seniordriving.aaa.com/evaluate-yourdriving-ability/self-rating-tool/. Local rehabilitation hospitals also sometimes offer assistance in driver evaluation and training.

When the time comes that a person with PD needs to give up driving, it is important to remember that there are options. Public transportation can be an option. Friends and family members are often happy to help, and it is important not to be afraid to ask. Also, look into special shuttle services through local organizations and community centers.

Socialization and staying active help manage Parkinson’s symptoms. You don’t have to stay home once you are no longer driving.

Article from February 2020 issue of Dallas Area Parkinsonism Society newsletter.

Doctors Prescribing Music Therapy

January 1, 2020 Caregivers, Life, Research

Music has proven time and again to be an important component of human culture. From its ceremonial origin to modern medical usage for personal motivation, concentration, and shifting mood, music is a powerful balm for the human soul. Though traditional “music therapy” encompasses a specific set of practices, the broader use of music as a therapeutic tool can be seen nowadays as doctors are found recommending music for a wide variety of conditions.

1. Music Helps Control Blood Pressure and Heart-Related Disorders

According to The Cardiovascular Society of Great Britain, listening to certain music with a repetitive rhythm for least ten seconds can lead to a decrease in blood pressure and a reduced heart rate. Certain classical compositions, if matched with human body’s rhythm, can be therapeutically used to keep the heart under control. The Oxford University study states, “listening to music with a repeated 10-second rhythm coincided with a fall in blood pressure, reducing the heart rate” and thus can be used for overcoming hypertension.

2. Listening and Playing Music Helps Treat Stress and Depression

When it comes to the human brain, music is one of the best medicines. A study at McGill University in Canada revealed that listening to agreeable music encourages the production of beneficial brain chemicals, specifically the “feel good” hormone known as dopamine. Dopamine happens to be an integral part of brain’s pleasure-enhancing system. As a result, music leads to great feeling of joy and bliss.

It’s not only listening to music that has a positive effect on stress and depression. The Namm Foundation has compiled a comprehensive list of benefits of playing music, which includes reducing stress on both the emotional level and the molecular level. Additionally, studies have shown that adults who play music produce higher levels of Human Growth Hormone (HgH), which according to Web MD, is a necessary hormone for regulating body composition, body fluids, muscle and bone growth, sugar and fat metabolism, and possibly heart function.

For more on how music can be composed to benefit the brain, read about States of Consciousness and Brainwave Entrainment.

3. Music Therapy Helps Treat Alzheimer’s Disease

Music therapy has worked wonders on patients suffering from Alzheimer’s disease. With Alzheimer’s, people lose their capacity to have interactions and carry on with interactive communications. According to studies done in partnership with the Alzheimer’s Foundation of America, “When used appropriately, music can shift mood, manage stress-induced agitation, stimulate positive interactions, facilitate cognitive function, and coordinate motor movements.”

4. Studying Music Boosts Academic Achievement in High Schoolers

Early exposure to music increases the plasticity of brain helping to motivate the human brain’s capacity in such a way that it responds readily to learning, changing and growing. “UCLA professor James S. Catterall analyzed the academic achievement of 6,500 low-income students. He found that, by the time these students were in the 10th grade, 41.4% of those who had taken arts courses scored in the top half on standardized tests, contrasted with only 25% of those who had minimal arts experience. The arts students also were better readers and watched less television.” This goes to show that in the formative stages of life, kids who study music do much better in school.

5. Playing Guitar (and Other Instruments) Aids in Treating PTSD

The U.S. Department of Veterans Affairs shared a study in which veterans experiencing Post Traumatic Stress Disorder (PTSD) experienced relief by learning to play guitar. The organization responsible for providing guitars, Guitars For Vets “enhances the lives of ailing and injured military Veterans by providing them free guitars and music instruction.” Playing music for recovery from PTSD resembles traditional music therapy, in which patients are encouraged to make music as part of their healing process. Guitar is not the only instrument that can help PTSD. In fact, Operation We Are Here has an extensive list of Therapeutic Music Opportunities For Military Veterans.

6. Studying Music Boosts Brain Development in Young Children

A research-based study undertaken at the University of Liverpool in the field of neuroscience has light to shed on the beneficial effects of early exposure to music. According to the findings, even half an hour of musical training is sufficient to increase the flow of blood in the brain’s left hemisphere, resulting in higher levels of early childhood development.

The Portland Chamber Orchestra shares, “Playing a musical instrument involves multiple components of the central (brain and spinal cord) and peripheral (nerves outside the brain and spinal cord) nervous systems. As a musician plays an instrument, motor systems in the brain control both gross and fine movements needed to produce sound. The sound is processed by auditory circuitry, which in turn can adjust signaling by the motor control centers. In addition, sensory information from the fingers, hands and arms is sent to the brain for processing. If the musician is reading music, visual information is sent to the brain for processing and interpreting commands for the motor centers. And of course, the brain processes emotional responses to the music as well!”

7. Music Education Helps Children Improve Reading Skills

Journal Psychology of Music reports that “Children exposed to a multi-year program of music tuition involving training in increasingly complex rhythmic, tonal, and practical skills display superior cognitive performance in reading skills compared with their non-musically trained peers.” In the initial stages of learning and development, music arouses auditory, emotional, cognitive and visual responses in a child. Music also aids a child’s kinesthetic development. According to the research-supported evidence, a song facilitates language learning far more effectively than speech.

8. Listening To Music Helps Improve Sleep

According to The Center for Cardiovascular Disease in China, listening to music before and during sleep greatly aids people who suffer from chronic sleep disorders. This “music-assisted relaxation” can be used to treat both acute and chronic sleep disorders which include everything from stress and anxiety to insomnia.

9. Playing Didgeridoo Helps Treat Sleep Apnea

A study published in the British Medical Journal shows that people suffering from sleep apnea can find relief by practicing the Australian wind-instrument known as the didgeridoo. Patients who played the didgeridoo for an average of 30-minutes per day, 6 days per week, saw significant increases in their quality of sleep and decreases in daytime tiredness after a minimum period of 3-months of practice. Dr. Jordan Stern of BlueSleep says, “The treatment of sleep apnea is quite challenging because there is not a single treatment that works well for every patient. The didgeridoo has been used to treat sleep apnea and it has been shown to be effective in part because of strengthening of the pharyngeal muscles, which means the muscles of the throat, as well as the muscles of the tongue.”

Article from DidgeProject.com.

Teen Scientist Working on Parkinson’s Treatment

January 1, 2020 Awareness, Change, Research

In North Texas, bright young minds are hard at work and one in particular may be on the verge of shaping the future for patients with Parkinson’s disease.

At 14 years old, it seems there’s nothing Anushka Sridhar hasn’t done.

“Outside of school, I play volleyball, basketball, I’m a third-degree black belt in taekwondo. I do an Indian cultural dance and I’m also part of Destination Imagination,” the Plano ISD 8th grader said.

Sridhar is also a budding scientist, who won the grand prize in her school’s science fair.

She created a device designed to lessen the tremors experienced by Parkinson’s patients.

“My great aunt passed away. With her tremors though, she had a lot of difficulties just with daily activity,” Sridhar said. “So that sparked an idea for me to try and create like a wrist band that could mitigate the tremors.”

For two months, she dove head first into researching Parkinson’s disease, a neurological disorder that causes hand tremors and imbalance.

She learned about how vibration therapy can help the motor skills of Parkinson’s patients.

The idea is the vibrations fool the brain and distract it from the physical sensation of tremors so that patients have an easier time writing.

It’s a well-known theory that even the goliaths of the industry, like Microsoft, are looking into.

Sridhar used common materials, like velcro and simple curcuits to create a prototype wristband. She reached out to the Dallas Area Parkinsonism Society, or DAPS, for test subjects willing to strap on her homemade wristband.

“They were excited that a young person would take that kind iof interest. You can’t help but be impressed when you hear her,” DAPS Executive Director Mike Miles said.

The partnership blossomed, and Sridhar connected with people five times her age. Each one seem impressed with the device, that not only worked, but gave them hope!

“I’m sure she will study that and improve on it and one day, we will have a device that we could put on and write normally,” said 81-year-old Ryan Wagner of Plano.

Sridhar said she planned to expand her research and build more prototypes of her wristband.

She hopes to one day affect the lives of every Parkinson’s patient.

She now advances to the Plano ISD district fair and the Dallas regional science fair.

Article from NBCDFW.

Your Parkinson’s tremor printed in 3D

January 1, 2020 Community Outreach, Education, Life

Parkinson’s Life talk to two of the creatives behind ‘Printed by Parkinson’s’, a Berlin-based art collection that saw 3D printers ‘affected’ with the data of six people with Parkinson’s in order to replicate their individual tremors – and visualise the everyday difficulties facing people with the condition

A team of creatives from Berlin, Germany, are combining art, technology and Parkinson’s in an innovative new fundraising project.

As part of the project, organisers asked six people living with Parkinson’s to choose an object that they found difficult to use due to their symptoms. The team then used kinetic and neurological data to create a 3D printer which mirrored their personal Parkinson’s symptoms, and printed each object in bronze – creating art that reflects their struggles with the condition.

We spoke to Reiner Gorissen and Marlon von Franquemont, the two creatives behind the fundraiser.

Hello, thanks for talking to Parkinson’s Life. What’s your story and your connection to Parkinson’s?

Hi, I’m Reinier Gorissen and this is Marlon von Franquemont. We’re creatives who work at INNOCEAN Berlin. We produce advertising campaigns for global brands, but also try to find projects that could help important causes.

We started the ‘Printed by Parkinson’s’ project after a colleague had two family members diagnosed with Parkinson’s. We realised that, like most people, we didn’t know anything about the condition – and we wanted to change that.

How did you come up for the concept of ‘Printed by Parkinson’s’?

R.G: While planning, we learned about the Parkinson’s research projects conducted by Charité, one of Europe’s biggest university hospitals, and decided to put our minds together to support them.

We wanted to create a concept that would educate people about Parkinson’s and support the research at the same time. When we brought the ‘Printed by Parkinson’s’ idea to Charité, they instantly embraced it.

Who worked on this project with you?

M.V.F: The project brings the medical, tech and art world together. It was overwhelming to see how all involved parties embraced our initiative and worked long hours to make it happen.

Charité involved their patients by recording their data, production company MediaMonks was responsible for the 3D printing and the project’s website and creative content agency Cosmopola produced the photography and film material. As the initiator of the project, INNOCEAN Berlin created all marketing-related assets and organised the exhibition.

How was the data used to create the 3D models?

R.G: First, we recorded the kinetic and neurological data of the participants using electroencephalography (EEG) systems – which monitor electrical activity in the brain – and accelerometers at Charité.

The production company MediaMonks then turned the data into algorithms, devising one for each participant.

After a long period of testing, we managed to 3D print the objects selected by each patient while the printer was affected by their personal Parkinson’s data.

Why did you settle on 3D printing over more traditional art forms?

R.G: Parkinson’s is a very complex condition and most people don’t know how significant the impact of it is on people’s lives. By using technology and art, we were able to break through the clutter and also engage younger audiences. The art objects instantly give people an idea how Parkinson’s affects lives – and invite people to learn the stories behind the objects.

Why did you think using seemingly simple, everyday objects would make an impact on those outside of the Parkinson’s community?

M.V.F: We believed that the collection would be most impactful if each object portrayed a personal story. That’s why we asked participants to name an object that represented a job, hobby or activity that was affected by the onset of their Parkinson’s.

Most people outside the Parkinson’s community don’t know much about the condition. They often think it only affects older people and don’t know that Parkinson’s has more than 40 symptoms. The ‘Printed by Parkinson’s’ collection visualises the daily struggles that people have with simple tasks like using a pen or a camera.

How was the collection received by the general public, the participants involved – and by people with Parkinson’s?

M.V.F: The response has been great from all directions. The collection was shared on medical, tech and art platforms all around the world and was broadcasted on multiple TV channels in several different languages.

We also received great feedback from those who took part. On top of that, others showed interest in sharing their story – and we hope it inspires more people to be open about their condition as people must keep sharing their story to make the public aware of the condition.

How much money has been raised so far from sales?

R.G: We have received multiple bids, but unfortunately can’t reveal the digits. Let’s just say we’re very proud of the offers – all of which will go towards research at Charité.

Do you have any plans for further Parkinson’s-related art projects or campaigns?

M.V.F: Definitely. In fact, there are some projects on the way already. Hopefully we’ll be able to share them with you soon.

Printed by Parkinsons's

Reiner Gorissen (left) and Marlon von Franquemont (right), the creatives behind ‘Printed by Parkinson’s’.

This collection was exhibited at gallery Alte Münze, in Berlin for one week in July 2019. For more information on the project, please visit the ‘Printed by Parkinson’s’ website.

A Wearable Device Is Changing the Way Clinicians Manage PD

November 1, 2019 Education, Life, Research

A recently published study in Functional Neurology suggests that using data from an FDA-cleared watch-like device called the Personal KinetiGraph (PKG) provides an objective and more effective approach to assessing motor fluctuations in patients with Parkinson’s disease (PD) compared with patient-reported motor diaries.

“Motor fluctuations, including ‘wearing-off’ and dyskinesia, are associated with increased disease severity and disability, and PD patients experience decreased quality of life as their response to medical therapy becomes less predictable,” said Echo Tan, MD, a neurologist at Cedars-Sinai Medical Center and lead author on the publication. “Effectively managing motor fluctuations is complicated by the lack of objective assessment tools, leading patients and physicians to rely on direct observation in the clinic or patient reports, which may be unrevealing, incomplete and unreliable. The results of our study demonstrate that the fluctuation score calculated by the PKG system provides objective quantification of motor fluctuations.”

This may help improve the routine management of Parkinson’s patients and enable more objective assessments in clinical trials of Parkinson’s therapies, she said.

Tan told MD+DI the study revealed that the PKG system (developed by Global Kinetics) and the algorithms for calculating a fluctuator score can differentiate between non-dyskinetic and dyskinetic patients. The fluctuator score does not, however, have the sensitivity to detect mild wearing off because no prior study divided patients into more than a binary system. On the plus side, Tan said the PKG also can distinguish between exercise and dyskinesia on the graphical data obtained.

The fact that the fluctuator score was not sensitive enough to detect mild wearing off did come as a surprise to the investigators, but the fluctuator score did show progressively increasing average score range between the four groups, Tan said.

During a BIOMEDevice Boston 2019 panel discussion, Teresa Prego, vice president of marketing and marketing development at the Melbourne, Australia-based company, said the integration of consumer wearables with wearables for chronic disease management has changed the delivery of care and where that care is delivered.

“If I look at the PKG-Watch, for example, in Australia where there are great geographic distances between people with Parkinson’s and a care provider. They are using this remotely,” Prego said. “So you’ll go and see your clinician, have an assessment, but then for the next year, there’s really no need to go into the clinic. You can make care decisions remotely. They’re wearing the vehicles to get that information to the clinician.”

“This implies that it is better at detecting moderate to severe fluctuations,” she said.

Most importantly, the device has changed the way Tan and her colleagues assess and monitor patients with Parkinson’s disease.

“The PKG system can provide additional information about fluctuations that a clinic visit and history can not reveal,” she said. “This is particularly useful for those patients who are not able to provide a good history – such as those with a language barrier or cognitive impairment. It can show true objective levodopa responsiveness, motor fluctuations, daytime somnolence, and medication compliance. “It can be an important triage mechanism for a referral to a movement disorder specialist, or for an advanced surgical therapy referral. It has provided another objective source of information for our clinicians in deciding how to change medical management. Patients also report that the medication reminder function on the device helps them with medication compliance, thereby also enhancing their motor function as well.”

Parkinson’s disease patients typically respond well to medical therapy in the first few years of their disease, but about 40% of the patient population develops fluctuations of response to levodopa and dyskinesia after four to six years of treatment. That percentage jumps to 70% after long-term treatment of nine years or more, according to Global Kinetics. The company said it developed the PKG system to address the lack of objective measurement tools for movement disorders and quantifies the kinematics of Parkinson’s symptoms, including tremor, bradykinesia, and dyskinesia. An algorithm translates the raw data from these assessments into a fluctuation score that can distinguish between patients with motor fluctuations and those without.

The study investigators correlated PKG fluctuator scores (FS) with clinical motor fluctuator profiles in a case-controlled cohort of the study that included 60 patients attending the Movement Disorders Clinic at Cedars-Sinai Medical Center in Los Angeles, CA. Of the 60 patients in the study, six had incomplete data and were excluded from analyses, the company noted.

Here are some key findings from the 54 subjects who completed a six-day PKG trial and completed a standardized motor diary:

Based on Wearing Off Questionnaire (WOQ9) and Movement Disorders Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part IV scores patients were categorized based on the presence and extent of fluctuations, as follows:
- Non-fluctuators (NF), N = 14
- Early fluctuators (EF), N = 15
- Moderate fluctuators (MF), N = 15
- Troublesome fluctuators (TF), N = 10
The groups varied significantly in terms of disease duration, which was progressively longer with increasing severity of clinical fluctuation and PD dopamine medication measured as levodopa equivalent dose (LED).
LED was more than double in patients with troublesome fluctuations compared to those without fluctuations, while patients in the groups including early and moderate fluctuators reported equivalent daily dosages.
MDS-UPDRS score increased significantly with the severity of fluctuations, with the highest scores recorded in those with troublesome fluctuations.
Patients had a higher tendency to return the PKG than the motor diary (88% vs. 65%).
50% of the patients in the troublesome fluctuator group were excluded due to incorrect diary completion.
Compliance with the motor diary improved with decreasing severity of fluctuations.
PKG fluctuation score significantly differentiated EF and TF (p = 0.01), as well as dyskinetic and non-dyskinetic subjects (p < 0.005). In contrast, motor diaries could not distinguish the four study groups on the basis of average OFF time, while average time with dyskinesia distinguished NF and MF but did not distinguish among all four groups.
PKG identified high levels of dyskinesia in patients who denied having dyskinesia.

The study authors conclude that the data support the use of the PKG fluctuation score as an objective tool for capturing and quantifying motor fluctuations as a mechanism for triaging PD patients. They also note that the PKG transcends language and cognitive barriers and time constraints in the clinic, which are challenges to obtaining accurate patient symptoms to effectively adjust PD treatment.

The main barrier to adoption for products like these is reimbursement, Prego noted.

“Capturing this data and utilizing the advent of these consumer technologies to help manage chronic disease, it’s pretty interesting,” she said. “I think that our traditional ways of reimbursing for medical care have not quite caught up to where the development of consumer wearables has taken us.”

Article from MD+DI.

Heel, Toe: Walking with Mindfulness

July 1, 2019 Exercise, Life

“Mindfulness isn’t difficult, we just need to remember to do it.” — Sharon Salzberg

The ability to walk is something many of us, myself included, have always taken for granted. Now that I have Parkinson’s disease (PD), something that used to come as a matter of course to me is starting to deteriorate. PD has adversely affected my left side more than my right side. I find myself tripping more, since I tend to drag my left foot.

Walking now requires my conscious thought

Going for a walk is now more of a mindful task than an exercise for me. I find it much more therapeutic to focus on how I walk and be in the present moment than to think about the future and how my PD may progress. With each step I take, I concentrate on repeating to myself, “Heel, toe.”

My stride analysis

When there was snow on the ground, I decided to compare my walking steps when I did not focus on saying “heel, toe” with those from when I did. My footprints in the snow were very telling, so I took a photograph. On the left side of the photo are my steps when I was not thinking about my stepping patterns. You might notice that both feet show a bit of a drag in the snow. On the right side of the photo, as I moved forward, I really focused on flexing both of my feet and having my heel strike first. There are no signs of drag on either foot.

Am I putting too much thought into this?

Years of training to improve as a dancer and a cyclist have made analysis of my body movements come quite naturally to me. Whether it was improving my pedal stroke for more cycling power or perfecting my balance to do pirouette turns, I learned to be mindful and to be in touch with how my body was performing. Now I must use that skill to help myself be more attentive when I walk.

My neurologist says I tend to overthink things. I believe our greatest strengths can also be our greatest weaknesses. Sometimes, I do overthink, to the point of getting paralysis by analysis. However, I believe that mindful analysis of my PD symptoms (including my walking technique) is critical in helping me to create different ways of doing things that at one time (before PD) used to come as second nature to me.

Article by Jean Mellano for Parkinson’s News Today.

Brian Grant Foundation launches free PD exercise program

September 1, 2018 Education, Exercise, Life

The Brian Grant Foundation (BGF) has launched an online training program for physical therapists, personal trainers and group fitness instructors to develop safe and effective exercise classes for people living with Parkinson disease. The program is based on research from Oregon Health & Science University’s Balance Disorders Laboratory, which shows how to slow down the mobility problems associated with Parkinson’s using a variety of physical and cognitive activities.

Parkinson’s is a degenerative, neurological disorder that affects the cells in the brain that produce dopamine, a chemical that helps initiate and control movement. Although there is no cure for Parkinson’s, studies suggest a consistent, vigorous fitness routine may improve motor symptoms common in people with Parkinson’s, such as rigidity, slow and small movements, and impaired balance and coordination, along with non-motor symptoms such as depression, anxiety and sleep difficulties.

“After being diagnosed with Parkinson’s, I looked for ways to combat the symptoms that I was experiencing while keeping my physical abilities as long as possible,” said Brian Grant, former NBA player and BGF founder. “I learned the importance of staying flexible, keeping good posture and practicing specific movements to address symptoms of the disease.”

Getting people into Parkinson’s-specific exercise programs in the early stages of diagnosis is fundamental because the sooner a person with the disease starts a workout routine, the better their chances of slowing the progression of symptoms. Any exercise is better than none, but ideally, workouts should be higher intensity and include a variety of activities that have been shown to help target the common symptoms of Parkinson’s. For example, lunges are helpful for improving small movements while yoga increases flexibility and coordination.

That’s why the Exercise for Parkinson’s Training for Professionals program is such a game-changer. Instructors will learn how to safely and effectively train people with Parkinson’s using activities that offer the greatest benefits for symptoms. And most importantly, they’ll empower their clients to stay motivated, healthy and social by giving them the chance to work out with others who have Parkinson’s disease.

BGF is recognized by the National Academy of Sports Medicine (NASM) and Athletics and Fitness Association of America (AFAA) as an approved continuing education provider. Exercise professionals certified through NASM or AFAA will receive continuing education credit for completing the online Exercise for Parkinson’s Training.

Brian Grant Foundation: Founded in 2010 by former NBA player Brian Grant, who is living with Parkinson’s, the Brian Grant Foundation provides tools to improve the well-being of people with the disease. BGF’s programs focus on exercise and nutrition to help people with Parkinson’s manage their symptoms, improve their overall health and prevent other serious illnesses.

Information from Brian Grant Foundation.

8 Early Parkinson’s Disease Symptoms That Are Too Easy to Miss

June 5, 2018 Education

This movement disorder is more treatable when caught early, but Parkinson’s disease symptoms can appear quite differently from one person to another. Talk to your doctor if you’re worried about any of these signs.

Changed handwriting

If your handwriting starts to go from big and loopy to small and cramped, this could be one of the earliest Parkinson’s disease symptoms. “Teachers with Parkinson’s will notice students complaining that they can’t read their handwriting when they write on the blackboard,” says Deborah Hall, MD, a neurologist at Rush University Medical Center in Chicago. Look for letters getting smaller and words crowding together. Many patients have slower movement and trouble with repetitive tasks, like handwriting.

Reduced sense of smell

If you’re having trouble smelling pungent foods or no longer pick up your favorite scents, see a doctor. It’s not the most common symptom of Parkinson’s, but Dr. Hall says patients who suffer a loss of smell report it being the earliest sign they experience. The link between reduced sense of smell and Parkinson’s isn’t clear, but one theory is that the clumps of the protein alpha-synuclein, found in the brains of all Parkinson’s patients, may form in the part of the brain responsible for smell before migrating to other areas and affecting motor function.

Trouble sleeping

If you were once a peaceful sleeper, but now toss and turn, flail your limbs, or even fall out of bed, those sleep problems could be Parkinson’s disease symptoms. It’s normal to have an occasional restless night, but talk to your doctor if you or your partner notices extra movement when you’re in a deep sleep, or if you start sleep-talking. More research is needed to discover why disturbed sleep and Parkinson’s are related, but one theory is that the degeneration of specific regions of the brain stem that can cause disordered sleeping may play a role in other Parkinson’s disease symptoms.

Constipation

If you’re not moving your bowels every day, or are increasingly straining, this can be an early sign of Parkinson’s. The disease alters the body’s autonomic nervous system, which controls processes like digestion and bowel function. Constipation on its own isn’t unusual, but if you’re experiencing other symptoms like difficulty sleeping and trouble moving or walking, talk to your doctor.

Depression

Much has been made of the link between the late comedian Robin Williams’ Parkinson’s diagnosis and ongoing battle with depression. Sometimes patients can develop depression after learning they have Parkinson’s, but it’s also common for people to be depressed years before they start to exhibit physical symptoms, says Michele Tagliati, MD, director of the Movement Disorders Program at Cedars-Sinai Medical Center in California. “Parkinson’s is characterized as a movement disorder because of a lack of dopamine in the brain, but there are also low levels of other neurotransmitters like serotonin, which are intimately related to depression,” he says. Parkinson’s patients who are depressed tend to feel apathetic and generally disinterested in things they used to enjoy, compared to feeling intensely sad or helpless, as is common in primary depression. “They lose pleasure in the simple things of life, like waking up in the morning and buying the paper,” says Dr. Tagliati. Treatment for depression includes counseling, antidepressant medication, and in the most extreme cases, electric shock therapy.

Tremors or shaking when relaxed

Shaking can be normal after lots of exercise or if you’re anxious, or as a side effect of some medications. But a slight shake in your finger, thumb, hand, chin, lip, or limbs when your body is at rest and your muscles are relaxed could signal Parkinson’s disease symptoms, according to the National Parkinson Foundation. About 70 percent of people with the disease experience a resting tremor, and it can become more noticeable during stress or excitement. These are the most common symptom and often tip people off to the disease, but when Parkinson’s patients think back they realize they experienced loss of smell, disturbed sleep, or anxiety before the tremors began.

Stiffness and slowed movements

Watch for an abnormal stiffness in your joints along with muscle weakness that doesn’t go away and makes everyday tasks like walking, teeth brushing, buttoning shirts, or cutting food difficult. If you no longer swing your arms when walking, your feet feel “stuck to the floor” (causing you to hesitate before taking a step), or people comment that you look stiff when you haven’t been injured, the National Parkinson Foundation suggests seeing a doctor.

Softer voice, or masked face

Doctors say that a softer voice or masked, expressionless face is a common sign of the disease. Some patients with Parkinson’s disease symptoms may also talk softer without noticing or have excessively fast speech or rapid stammering. Parkinson’s causes disruption of movement, including facial muscles.

Article from Reader’s Digest.

Maximize your Mobility with Fall Prevention

April 1, 2018 Caregivers, Exercise, Life

https://vimeo.com/147745733

Video from Davis Phinney Foundation.

12 Medication Management Tips That May Save Your Life

December 1, 2017 Awareness, Education, Life

What can be done to help older adults take medications safely? Take care to avoid some of the more common medication mistakes, such as taking drugs incorrectly or taking more than is prescribed. Pill dispensers, organizers and even reminder services can also be useful tools for some.

That being said, nothing substitutes for responsible caregiver advocacy and being proactive about the drugs we and our loved ones are taking.

Here are some other tips to keep in mind:

1. Ask your provider if the dosage is age-appropriate.

Because of the way our bodies metabolize various drugs as we get older, seniors can be more sensitive to some drugs and less sensitive to others. They are also more likely to experience adverse effects. Double-check with your doctor or pharmacist to ensure that the dosage on the prescription is age-appropriate, and ask if it’s advisable to start with a lower dose and taper upwards.

2. Be aware of medications deemed unsafe for seniors.

The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, put together by the American Geriatric Society, is a list of medications that older adults should avoid or use with caution. Some pose a higher risk of side effects or interactions, while others are simply less effective. For instance, commonly prescribed sedatives in the benzodiazepine category, like diazepam (Valium), are on the “avoid for certain conditions” list because older adults may be more sensitive to these drugs. Ask your pharmacist if any of your loved one’s medications are on the caution list, and whether you should be concerned.

3. Bring a medications list — or the medications themselves — to the doctor with you.

Take your list of prescription medications — a list of over-the-counter drugs and any herbal supplements you might be taking — and bring it to the doctor’s office with you, or to a pharmacist. The more information your provider has, the more accurately they can pinpoint any potential adverse effects or drug interactions.

4. Check on prescriber behavior in Prescriber Checkup.

Rather alarmingly, Medicare may not monitor prescription safety as effectively or as closely as we might like, as noted in a ProPublica report. “In 2010 alone, health-care professionals wrote more than 500,000 prescriptions for the drug [carisoprodol] to patients 65 and older,” says the report — a drug that was pulled from the European market in 2007 and is on the Beers caution list. If you have concerns about a provider, or if you simply want more information about the drugs prescribed in your area, check ProPublica’s online Prescriber Checkup tool.

5. Closely monitor medication compliance in the cognitively impaired.

If your loved one shows signs of confusion about their medications, or has been diagnosed with cognitive impairment, Alzheimer’s disease, or another form of dementia, do not allow them to manage or take their own medications. If they are simply having trouble tracking their medications, a reminder system may be helpful, but the situation is more serious if your loved one is cognitively impaired. Taking medications incorrectly can be harmful or fatal.

6. Create and maintain an up-to-date medication list.

American Nurse Today says, “keep an accurate list of all medications, including generic and brand names, dosages, dosing frequency and reason for taking the drug.” This can help reduce the risk of polypharmacy.

7. Get a second opinion if you are uncertain.

Not all providers are alike, and there are, unfortunately, some doctors who prescribe medications inappropriately, in excess, or for unapproved uses. If you are concerned about a prescription or a diagnosis, don’t be afraid to seek out a second opinion.

8. Know the side effect profile of your medications.

Knowing the potential side effects and interactions can help you stay alert to any health changes that may occur in response to a new medication or combination of medications. If you do notice health changes, contact a physician right away. Some side effects can mimic other health conditions, including dementia, so make sure to bring a list of your medications to every doctor visit. This will help the provider properly diagnose the problem — and help the patient avoid unnecessary or dangerous medications.

9. Make sure the pharmacy label says why you are taking the prescription.

This is particularly important for older adults who are taking multiple medications, to ensure that they know what each medication is for and how to take it properly. It can also help caregivers police whether their loved one is being given too many medications to treat the same issue, or whether a less scrupulous provider has prescribed a drug for a purpose it wasn’t intended to treat.

10. Minimize the number of providers and pharmacists you use.

Keeping the number of doctors and pharmacies to a minimum is better for you and better for the providers who must coordinate care. “The primary-care provider and specialists must maintain good communication with each other to prevent or minimize problems,” says American Nurse Today. They also advise people to “use only one pharmacy to obtain medications; this adds another level of review to help ensure appropriate dosage and reduce the risk of adverse drugs effects and interactions.”

11. Talk to the pharmacist and ask questions.

If you have any concerns at all about the combination of medications you or your loved one is taking, or how a new medication will affect you, ask your doctor or pharmacist. Learn about the potential dosage, proper storage, side effects and anything else that will help you take medications correctly. You should also talk to your provider if you are thinking of stopping a medication.

12. Tell your provider about any previous adverse drug effects.

This one might go without saying, but if you or your loved one has had a bad reaction to any medication in the past, let your doctor and pharmacist know.

Article from A Place for Mom.