Moderate Phases Of Parkinson's
Moderate Phases Of Parkinson's
Neal Hermanowicz (Director of the Movement Disorders Program) gives expert video advice on: How does moderate phase Parkinsons affect dexterity?; How does moderate phase Parkinsons affect body motion?; What are the sexual effects of moderate Parkinson's? and more...
What signs of tremor do people have in the moderate phases of Parkinson's?
The tremor may become more persistent, or increase in amplitude, be more prevalent during the course, and a bit more troubling to people as time goes by. But we're talking about years in the course of Parkinsons Disease. So just a more persistently present tremor, and maybe a bit more conspicuous to people, and troubling to them, as well. People may notice the tremor when they're just out for dinner with their friends. It's not that tense a situation, but people are socially on, and alert, and even during happy moments, the tremor may become more apparent. When people are watching the Super Bowl, and are energized and rooting for their team, the tremor may become more apparent. People who are giving public presentations, or at work and speaking before a group of people, they may not be nervous. This may be something that they've been doing for years. But all of us, when we're talking to a group, are on, and anticipating the situation. The adrenaline levels go up a bit. In that circumstance, people do have increase of tremor, at least temporarily. When the situation is over, things calm down and the tremor will subside again.
What signs of rigidity do people show the moderate phases of Parkinson's?
They may feel a sense of stiffness, again, getting up out of a chair, or just moving in and out of a car. They sense feeling stiff on doing so. Or getting in and out of their clothes they may have a sense of stiffness, or sense of awkwardness caused by that rigidity in getting their arm into a sleeve of their shirt or their blouse.
How does moderate phase Parkinsons affect dexterity?
Somebody with moderate Parkinsons disease, dexterity may make it very difficult to fasten buttons. They made occasional assistance from their spouse, and particularly fastening the smaller buttons of the collars or their sleeves. On occasions people may need some assistance cutting certain foods that are tougher to cut. Certain kinds meats, for example, things that are awkward for all of us to cut may be harder still in someone with increased rigidity in moderate Parkinsons disease.
How does moderate phase Parkinsons affect posture?
The posture change in moderate Parkinsons disease can be subtle to the patient who has it, but spouses or others around them may notice, say, a stooped posture, and leaning forward while standing and walking. There may also be a tilt of one shoulder being held higher than the other while walking or standing, and sometimes these postural changes also contribute to back pain.
How does moderate phase Parkinsons affect body motion?
They might be slower in their daily routine - slower walking, slower getting up and moving about, slow in dressing and bathing and doing their normail daily routine, and they'd be slower in general fashion.
How does moderate phase Parkinsons affect the face?
The facial changes in moderate Parkinsons Disease may involve just a lessening further of facial expressiveness. People may have not exactly a fixed expression on their face, but it may be conveyed as distinctly less expressive in conversation - a sense that the patient does appear to be sad or depressed or angry in some fashion, more persistently during the course of the day. I have to emphasize this doesn't affect everybody. I certainly have lots of patients who have what I would call moderate Parkinsons Disease, who are still pretty good at their facial expressiveness. But in some people, it will be exacerbated as the disease changes over time.
How does moderate phase Parkinsons affect the voice?
Well, this is a problem for many people with Parkinson's and their family members because as later, the voice changes can be more softness or reduction in volume, a lessening of the inflection of the voice. It can have an impact on communication. It can be sort of a source of tension between the patient and their spouse. For example, you're speaking too softly or your hearing is affected and it may be a combination of the two. But that's a pretty common discussion that I've heard from my patients and their spouse with somebody who is affected by Parkinson's disease. It can be improved upon by training and by practice. By using techniques of speech therapy that can be improved upon.
What are the sexual effects of moderate Parkinson's?
The sexual concequences can be the same as in early Parkinsons disease, with difficulty with performance with erectile disfunction. This is a pretty common feature among men with Parkinsons disease, and frankly it's a pretty common feature among men as we age. People above the age of 70, men above the age of 70, have erectile dysfunction fairly commonly - even more so in people with Parkinsons disease. Again, interest in sexual activity may decline with Parkinsons disease, as the disease continues.
What signs of restlessness do people show in moderate phase Parkinson's?
A feeling of inner restlessness may occur in people with Parkinsons disease, especially if their medicines are not lasting quite long enough. There's this phenomonon of so called end of dose wearing off when people take a medication, and it doesn't quite reach until their next scheduled dose. When it starts going down, they may have sort of a vague, hard to define sense of being ill at ease, which can be improved upon in many people by more frequent dosing, or alternating their medication regimen in some way.
What emotional problems are common during moderate phase Parkinson's?
Depression is a problem in any stage of Parkinsons disease, at any point that it needs to be thought about and, if present, attended to. It doesn't necessarily increase as the disease changes or as years go by. It's something that I think about all the time in my patients, whether it's somebody recently diagnosed or who's had it for ten years or fifteen years.
What kind of pain does a person feel in the moderate phase of Parkinson's?
Pain may be more of an issue as stiffness increases and slowness increases, and, again, I think we need to be more attentive to this in our evaluation of people with Parkinsons Disease when they come in to see us for their visits. Often it can be improved by the adjustment of medication.
How can the autonomic system be impaired during moderate phase Parkinson's?
The autonomic nervous system controls many of our routine functions of our body that we don't think about. Things like adjustment of our blood pressure and our pulse, things like production of saliva or sweating, and also bladder and bowel function. Unfortunately, this is also affected in Parkinsons disease, so that people with Parkinsons disease pretty commonly have bladder dysfunction; they have urgency and frequency of urination. And that torments them; that's a very troubling symptom. Constipation, unfortunately, is a very common finding in Parkinsons disease as well. Some people have difficulty with excessive sweating, particularly at nighttime. They may have drenching sweats that causes them to have to change their pyjamas or their sheets once or more during the course of the night. This is sometimes related to the medications not working long enough, and there's some literature supporting the idea that additional medication or extending the duration of medication will help alleviate the sweating.
How does moderate phase Parkinsons affect swallowing?
Swallowing is affected in Parkinsons disease, and very commonly so. What people notice mostly is that things are just a little bit slower and harder to go down. They have to think about it more, maybe chew their food a little bit more completely than they had been accustomed to in the past. Most people don't develop swallowing problems to the point that they are having serious problems with this. It does happen on occasion, but that's uncommon. The more common problem is just sort of a slowness, and a difficulty, occasional coughing, or choking with eating or drinking as a consequence of the swallowing difficulties.
How does moderate phase Parkinsons affect sleep?
The majority of people with Parkinson's disease have sleep problems unfortunately. It can show itself in many ways including fragment sleep at night which is quite common. Actually as we grow old, that's a very common problem even more so in the case of Parkinson's disease. People will fall asleep in the night have difficulty staying asleep. They will wake repeatedly during the course of the night and sometimes they will have difficulty going back to sleep. Another problem is daytime drowsiness just for dozing off in the chair while reading or looking at the television for example. Medications may have some impact on creating this daytime drowsiness but it's not necessarily the so-called Parkinson's disease itself can cause daytime sleepiness. Very common feature of Parkinson's disease most people with Parkinson's disease have this at some time.
What treatments are available for moderate phase Parkinson's?
The treatment for Parkinson's Disease relies upon many areas. Medications are very important but not the sole treatment of Parkinson's Disease. The comprehensive care of somebody with Parkinson's Disease usually involves medication but also an exercise program. I encourage my patients to be physically active, hopefully on a daily basis. It doesn't have to be anything hugely exertional but just even daily walking can be helpful to maintain mobility. What is not good for somebody with Parkinson's Disease is to stay put in a chair most of the day or have a marked reduction of daily activity and mobility or exercise. So medications, exercise, also being socially engaged I think is critical to optimal care of somebody with Parkinson's Disease. There is sort of a tendency for people with this diagnosis to become socially withdrawn which I always discourage. I don't think that's a good thing. It's good to be connected socially and keep intellectually engaged as well, to keep those wheels in the brain turning as much as possible, So medication, exercise, social and intellectual engagement. For some people, not the majority, but for some people, surgery is also an option for the treatment of Parkinson's Disease. When medications are working but not working long enough or causing some complications like involuntary movements, some people may be good candidates for surgical treatment of Parkinson's Disease.
What are the side effects of drug treatments for moderate phase Parkinson's?
Medication side effects can include things like nausea or drowsiness, or sense of lightheadedness due to low blood pressure. But even more so, if the medications need to be increased during the course of the disease, these things can become more prominent. Other things may occur with certain medications. Visual hallucinations occur in about one third of people with Parkinsons disease at some point. They're not necessarily terribly disruptive but they could be at some point, so I'd make note of those and caution people about that potential side effect. Some of these medications may produce some personality changes. People may develop so-called compulsive behaviors or impulse control disorder, where they have a tendency to engage in activities that they wouldn't do otherwise; things like increased interest in gambling, spending, shopping, eating or even some sort of sexual change that may occur as a consequence of the medications.