Progressive disorder

The aim of this literature review is to write a multi-disciplinary review on the elderly and Parkinson’s disease. Parkinson’s disease is a slowly progressive disorder that affects movement, muscle control, and balance this is because it is a degenerative disease of the brain that affects nerve cells. Parkinson’s disease is referred to as idiopathic, which means that the cause is unknown. In addition to its effects on motor control, Parkinson’s disease is now recognized as a broader condition that can include cognitive and behavioural disturbances, sleep disorders, speech difficulties, and other problems. The key themes in this review include the diagnosis of Parkinson’s disease and how reliable is diagnosis, whether Parkinson’s causes dementia and also the treatment/relief of Parkinson’s disease.

To review the literature review the following approaches were made. Three electronically databases were searched: Journals@Ovid FT 2000-2007, AMED 2000-2007 and the BMJ 2000-2006 to find the relevant information for this review. This was done using the following search terms; elderly, later life, over the age of 80, Parkinson’s, Parkinson’s disease, Parkinson’s disease diagnosis, parkinsonism, Parkinson’s disease dementia, dementia, cause and symptoms. Also a search was done on “Google” for articles and health sites using the same search terms as for the electronic databases. Some of the main sites used were NHS, BBC articles and Parkinson’s disease society/association.

It is known that the average age for developing Parkinson’s disease is around the age of 65 years old and one in 10 of these sufferers develop it in there 40s and 50s. The European Parkinson’s Disease Association (EPDA, 2006) found that Parkinson’s affects around 6.3 million people suffer from Parkinson’s disease and that one in ten percent are diagnosed before they are 50. Symptoms of Parkinson’s disease appear slowly and develop over time there are so many symptoms of this disease the four main ones are shaking, stiff muscles, slow movement and balance but they can appear in no particular order and at any time. But not everyone who has Parkinson’s disease will get all the symptoms and each sufferer will have different reactions to treatment.

Looking at four studies that look at the accuracy of diagnosis of Parkinson’s disease from a Community-based population shows that three of the studies (Schrag et al., 2002., Meara et al., 1999., Lees et al., 2001) were done by a specialist and that the diagnosis of Parkinson’s disease was based upon the UK PDS brain bank criteria. But in the other study (Jankovic et al., 2000) the experts diagnosis was based on the investigator’s confidence in the diagnosis that the patient had Parkinson’s disease by the presence of atypical features, findings of imaging studies, response to levodopa and also the results of autopsy examinations.

The criteria for the initial diagnoses were not specified in any of the studies. These studies were also performed on prevalent rather than incident PD populations. These studies only provide detailed evidence on the diagnosis ability of the experts against the non-experts. However, they show that the diagnosis of Parkinson’s disease is can be wrong and is quite a hard disease to test for many cases of diagnosed or undiagnosed Parkinson’s may have the wrong diagnosis. As there is also a disease called Parkinsonism which is a term uses to distinguish Juvenile Parkinson or other diseases that have the same symptoms as Parkinson’s disease but is not Parkinson’s disease. Parkinson’s disease is only applied to patients who have a disease that, at autopsy, is characterized by a loss of cells in the substantia nigra and the presence of Lewy bodies in the remaining (and presumably degenerating) cells (Lieberman, 2004).

Bonuccelli (2004) wrote a paper on Parkinson’s disease and dementia he found that about forty percent of patients that have Dementia also suffer from Parkinson’s disease. The development of dementia in patients with Parkinson’s is up to six times that in a healthy person. A journal written by Marinus et al. (2003) backs up this information that forty percent of Parkinson’s sufferers also have dementia it also states that the pattern of cognitive decline in Parkinson’s disease is different than that from that found in Alzheimer’s disease. There are two different types of dementia that is found in patients with Parkinson’s disease.

The first one develops when Lewy bodies occupy the brain and the brain stem. The more prevalent type is caused by Lewy bodies in the brainstem and Alzheimer’s changes in the brain. Both of these types of dementia medicines can help to improve the early symptoms, although some of the anticholinergic drugs may actually increase cognitive problems (Hubble, 2004). This may suggest that dementia may be caused by something other than Parkinson’s disease this include delusions and language difficulties. If these factors are present, tests can be done like looking for Vitamin B-12 deficiency or an under active thyroid gland. Depression is also common symptom in Parkinson’s disease patients and can show the same symptoms as dementia and so anti-depressant tablets can often help (Merino, 2004).

For years doctors were searching for a treatment for Parkinson’s disease since it was discovered about 2000 years ago. It was not until the late1960 that pharmacological therapy was discovered. This treatment involved the administration of a drug such as L-dopa that acts as dopamine this will enhance the dopamine levels is the surviving cells that have not been damaged by Parkinson’s disease. This treatment noticeably reduces tremors and increases movement but it only delays the disease and does not cure it. So other treatments were searched for including electrical stimulation which also reduces the symptoms.

Then in the 1980 researchers began transplanting dopamine-containing cells such as stem cells which has given some Parkinson sufferers remarkable symptom relief (Rosenzweig et al. 2005). Today researchers still do no not fully understand stem cells but they know that it can be used for curing age related diseases such as Parkinson’s disease and there are some expects that believe that it can reverse the effects of aging. Stem cell treatment is still being researched and a cure for Parkinson’s has not been discovered from it (Blanplain et al. 2004). Several newspapers reports have been written by various newspapers on the possible new breakthrough in the treatment of Parkinson’s disease.

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