According to the latest statistics, there are from 80,000 to 120,000 people with Parkinson’s disease in the UK, and the figures are rising, Findley (2000) therefore it is essential that health professionals understand the long term effects of not only the physical but social and psychological problems that Parkinson suffers experience. This assignment will focus on how the diagnosis affects the quality of life of those living with the disease and their carers. It will give an overview of physical aspect of the disease and focus on the social and psychological problems of living with a long term chronic illness and how the multidisciplinary team work together with patients and carers by assessing implementing and evaluating the problems that arise. Noble (2000)
Parkinson’s disease is a progressive, neurological disorder, occurring when nerve cells do not work properly in a particular area of the brain, called the substantia nigra, which is a pigmented nucleus in the brain stem. Alexander et al (2000).The substantia nigra forms part of the basal ganglia which consists of several clusters of cell bodies receiving impulses from different parts of the cerebral cortex.
These nerve cells produce and store dopamine and acetylcholine, the chemical messenger which co-ordinates the body’s movements, the chemical messengers work in balance to transmit messages between nerve cells and muscles enabling a person to perform a range of co-ordinated movements. Rutishauser (1999). In people with Parkinson’s this balance is upset because some of the dopamine-producing cells are lost resulting in stiffness in the muscles, slowness of movement, difficulty when starting movements and, in some people, tremor. Other significant symptoms are bradykinesia, involuntary movement and many other disabling effects. Scott (2002).
The symptoms of Parkinson’s do not appear until about 80% of the dopamine has been lost, and the level of dopamine continues to fall slowly over many years. However, each person with Parkinson’s is very different and the rate of progression will vary enormously from one person to another. It is extremely difficult to diagnose Parkinson’s as there is no routinely available test or scan that provides a definite diagnosis. However Brooks (1997) suggests CT scans may be considered to eliminate other disorders and that diagnosis should be based on clinical presentation.
Bradykinesia involves movement and can occur in any activity of daily living, walking, talking, dressing and swallowing. There could also be difficulty with hesitancy clumsiness, co-ordination and loss of facial expression. This can frustrate and distress the patient as not only do others assume that the person is either bored or uninterested but these symptoms often influence professionals working with the patient. Findley (2000).
Communication difficulties often increases as the disease progresses, the voice may become quite, hesitant and lack tune, in addition to communication difficulties 80% of patients will suffer from dysphagia. Pentland (1988). This is caused when a patient has a loss of automatic swallowing resulting in nutritional problems and drooling which both can cause anxiety and fear for the patient and the family. This can be helped by treatment but can cause embarrassment resulting in the patient becoming socially excluded. These problems can also contribute to weight loss which is common in Parkinson’s disease. Shaw and Power (1999).
The shuffling motion and lack of arm swing is called the gait, pivotal turning is impaired and turning in bed difficult, as the disease progresses patients may experience such things as stopping, which is known as freezing. Caird (1991). However little is known about gait as medical treatment is often not responsive, again nurses often feel that the patient is not trying, therefore more education is essential for community nurses to implement effective rehabilitation. Kemp et al (2002) Tremor is another symptom which often occurs at rest, it is not thought of as a major cause of disability, it can treated more effectively with surgical intervention than medical management, although up to 20% of patients never develop tremor at any stage of their illness. Clarke (2001)
Bladder and bowel dysfunction are both distressing for patients and family, bladder problems are associated with urgency and frequency which could be a result of an unstable or overactive bladder or a drug side effect. Other influences may be mobility problems and communication resulting in patients not getting to the toilet in time. Bajaj & Clough (2001). Bowel problems are just as distressing as constipation is associated with drug regimes, poor fluid intake and lack of mobility. Management should include a balanced diet and appropriate exercises with the physiotherapist, again communication and mobility problems must be taken into account. Caird (1991)
Night time may prove to be a distressing time for many suffers as hallucinations and vivid dreams are common, this is often associated with drug side effects, also they will encounter restless leg syndrome which presents itself as leg twitching, jerkiness and creeping sensations, this will urge the patient to stretch or stand to obtain relief. Bajaj and Clough (2001). Both sexes report that this problem has a profound impact on their sex life, which can often cause family conflict, depression fatigue and body image will also influence libido which may leave a patient feeling a lack of worth and unattractive. Welsh et al (1997).
The cause of Parkinson’s Disease is still unknown although it is thought that there seems to be a combination of factors that could be responsible, these are believed to be mainly genetic influences which, together with environmental triggers, such as weed killers which have been used by farming communities result in the gradual loss of neurones in the basal ganglia of the cerebral cortex of the brain. Noble (2000) For many years it was thought to be linked with age as there are 120,000 people in the UK with Parkinson’s Disease that are over the age of 70. Mutch et al (1986). However more recent studies have found that approximately one in 20 people diagnosed are under the age of 40. Bhatia (1998).
Following confirmation of the diagnosis of Parkinson’s disease, it is essential that the person and family are provided with information about the condition and the treatment options available, which should include access to the Parkinson’s disease nurse specialist, where available, and the multidisciplinary team. Information on the Parkinson’s disease Society (PDS) should also be provided as this is a good starting point for educational information, benefits advice and support through local branches. Parkinson’s disease Society (1998).
At present there is no cure for Parkinson’s therefore drugs are used to try to control the symptoms, the main aim of drug treatment for Parkinson’s is to restore the balance between dopamine and acetylcholine. This can be achieved by increasing the level of dopamine that reaches the brain, stimulating the parts of the brain where dopamine works, or by blocking the action of acetylcholine. Brooks (2002) in most newly diagnosed people improvements can be achieved by careful introduction of one or more anti-Parkinsonism drugs. There are many drugs that can be prescribed ranging from tablet form to injections, however often long term treatment of certain drugs can be complicated by motor response in relation to the drug doses.
Gould (2002) Fluctuations may occur which involves drugs having a good response then they become no longer effective, this is often called on off syndrome When an individual has only mild symptoms the GP/consultant and patient together may decide that the best option is to retain the drugs for later use and recommend a healthy lifestyle with exercise and relaxation as an interim measure, involving the Occupational Therapist and Physiotherapist for the use of valuable interventions. Hall (1999) However with or without drugs people with Parkinson’s disease can experience acute episodes of chest infections, falls and other symptoms which often result in people with Parkinson’s being admitted to hospital. Clarke (2001).