Welcome to a vital conversation on Parkinsonism- often misunderstood but increasingly relevant as our population ages. This post explores early signs, dispels common myths, and offers practical steps for achieving better outcomes, drawing on clinical insights to empower you and your loved ones.

Definition

Parkinsonism is a generic term that is used to define a syndrome manifesting as bradykinesia (slow speed) with rigidity and or tremors. Among different forms of Parkinsonism, Parkinson’s disease is the most common(approximately 75% cases). It is the most common neurodegenerative disease after Alzheimer’s disease. It affects men and women of all races, occupations and countries. The mean age of onset is 60 years.

SIGNS & SYMPTOMS

Clinically, Parkinson’s disease is characterised by tremors, rigidity,

bradykinesia, gait impairment. These are the cardinal features of the disease. Additional features include freezing of gait, postural instability, speech difficulty, autonomic disturbanc

es, sensory alterations, mood disorder, sleep dysfunction, cognitive impairment, and dementia.

Causes of Parkinson’s Disease

Most of the cases occur sporadically (85-90%) and are of unknown cause. Some studies suggest increased risk with exposure to pesticides, rural living, and drinking well water. But no environmental factors have yet proven to cause typical Parkinson’s disease. About 10-15% cases are familial in origin, multiple familial in origin, multiple specific mutations and gene associations have been identified.

Myths  & Facts

Myth 1. Parkinson’s is only a motor condition.

Fact-  We all know PD is characterised by resting tremors, rigidity, bradykinesia, freezing gait, and postural abnormality. But all these conditions are motor symptoms. There are non-motor symptoms, also as speech difficulty, sensory alteration, mood disorders like depression, anxiety, cognitive impairment, and dementia. These sensory features can emerge with disease progression and not be adequately controlled by PD’s medications. In fact, these sensory symptoms are the primary source of disability requiring nursing home placement for patients with advanced PD.

Myth 2. Everyone with Parkinson’s has tremors

Fact- Resting tremors indeed are one of the cardinal features of PD. But not every resting tremor needs to be PD. Some people with PD never have tremor, and even those who do may not have it at the start of the condition.

Myth 3. Aside from medication, there isn’t much you can do.

Fact- Apart from medications, there are non-pharmacological therapies to improve the quality of life in patients with PD. For example, the Use of canes and walkers may become necessary to increase stability and reduce the risk of falling. Exercise, with a full range of active and passive movement, has been shown to maintain and improve function for  PD patients. And reduce the risk of arthritis and frozen joints. It is important to maintain the social and intellectual activities to the extent possible. Education, assistance with financial planning, social services and attention to home safety are important elements of the overall care plan.

Myth 4. Parkinson’s is fatal

Fact- PD is not a direct killer like stroke or heart attack. It much depends on the quality of care, both from the medical team and yourself. It is a progressive disease; as disease, as disease progresses, you may become more vulnerable. Infection is another problem. Urinary tract infection is the most common. In later stages, people miss those signals and may notice something is up until it’s too late. That can be fatal, so be sure to stay up to date with checkups.

Everyday Life Support to Live Well with Parkinson’s

Living with parkinson’s is very challenging both for individual diagnosed with the condition and for their caregivers. While at present there is no cure for it, various treatment options and lifestyle modifications can help manage symptoms and improve daily functioning. Here are some helpful tips to incorporate into your daily life while living with PD.

1.  Stay active: Regular exercise is crucial. Activities like walking, running, swimming, and tai chi improve balance, flexibility and strength.
2. Follow regular medication schedule: Consistency with medications is necessary for controlling symptoms.
3. Establish routines: Take things slowly and gradually adjust your schedule and stick to it. Predictable schedules provide structure and conserve energy; they allow extra time for tasks.
4. Nutrition: A  balanced diet rich in healthy proteins, fruits, vegetables, whole grains, and healthy fats may help ease PD’s symptoms. PD’s medication (esp Levodopa) may cause nausea, vomiting if taken empty stomach. And high high-protein diet decreases its absorption in the gut. Hence, consult your doctor about the right way of taking the drug. In the advanced stages, one may have swallowing difficulty. One to seek his /her doctor once the symptoms worsen. Keep yourself hydrated.
5. Sleep hygiene:  Numerous people experience insomnia. They find it manageable to unwind by taking a warm bath, engaging in reading and practising meditation at bedtime.
6. Freezing gait: It is a temporary, involuntary ability to move. It increases the risk of falls and may occur during transitions, turning,  stepping or stressful situations. It can be triggered by delayed medications, turning a corner, or multitasking. Management includes strategies to reduce falls and safely overcome freezing. Techniques to overcome freezing)March like a soldier: Kick one leg high up, keep your knee straight, then switch legs. b)Rock side to side: Shift your body’s weight from one foot to the other like swaying to music. Make a big lean to one side, then step with the other foot.                                            c)Dance to music: Put on your favourite song and step to the beat. If you freeze a lot, keep your phone in your pocket playing tunes or sing or hum or count 1-2-3 loudly.                d)Step over an invisible line:  Pretend there’s a line on the floor to jump over or pick a spot to step on.  e)Turn like a robot: Don’t spin in place, walk a big half circle or square instead, like drawing a curve with your feet.  f)The 4-s super trick: When you freeze, STOP everything, take a big SIGH, SHIFT your weight back and forth like rocking a boat, then take a giant STEP forward. You will be walking again
7. Getting Dressed: It is difficult for patients with PD due to tremors, dyskinesia and stiffness. One must sit and dress and try to dress when medication is most effective. Adaptive clothing, elastic waistbands, Velcro or magnetic closures, supportive shoes and assistive tools can simplify getting dressed. Caregivers can support with makeup and hair routine.
8. Home safety: These patients have a risk of falls due to freezing gait and vision changes. So, creating a safe environment at home, which can lower the risk of falls and injuries, keeps you ageing in place.  Try to follow this safety checklist:-                                                     a)Remove clutter to decrease the risk of tripping and falling. b)Make sure floors are non-slippery. Avoid excessive patterns. c)Ensure all furniture is secure, sturdy and does not swivel. d)Create good lighting throughout the home. e)Create wide walking paths for easy access to the use of a walker or wheelchair .f)Keep all the electric cords out of the way so no one can trip over them.

   Message to caregivers

Helping a loved one with Parkinson’s, already a super-hero. But our super-heroes also need a game plan. These tips make caregiving easier and keep your relationship strong.

1. Talk openly and honestly: Don’t take over everything. Agree on help with boundaries to avoid frustrations.
2. Learn about the disease/sickness
3. Go to a doctor’s visit: Go along, take notes, ask about sleep or mood issues they might skip. Use a calendar or keep notes for appointments, medications, and side effects.
4. Watch the money stuff: Learn about the insurance so everything gets covered.
5. Stay Watchful: Spot changes in walking, mood or safety
6. Nail medication time: Set phone alarm or wall charts together. Consistent medication brings better days for everyone.

Resources

1.           Hopkins Medicine
2.           Parkinson.org
3.           Kokilaben hospital
4.           Harrison(internal medicine) book