The Progression of Parkinson’s Disease: What to Watch Out For
If your loved one has Parkinson’s disease, a chronic and progressive disorder that affects the motor system, you probably know the ins and outs of his treatment regimen and current symptoms. But it’s also important to know what to expect in the months and years ahead.
For some people, Parkinson’s can progress quickly and take a significant toll on quality of life. For others, the disease never reaches the advance stages. It’s important to realize that Parkinson’s affects every person differently, says Ihtsham Haq, MD, an assistant professor of neurology at Wake Forest Baptist Medical Center.
Parkinson's develops when nerve cells in the brain responsible for movement are damaged or destroyed. In healthy people, these nerve cells produce an essential chemical called dopamine. For people with Parkinson’s, the loss of these cells creates a shortage of dopamine, leading to movement problems, like tremors, stiffness, and trouble with balance and coordination, according to the National Institute of Neurological Disorders and Stroke.
Stages of Parkinson’s Disease
Over time, symptoms tend to worsen. To track the progression of the disease, doctors typically rely on a rating scale referred to as Hoehn and Yahr. This scale classifies Parkinson’s into five stages:
- Stage 1:Motor symptoms affect one side of the body.
- Stage 2:Symptoms spread to both sides of the body.
- Stage 3:Balance becomes impaired.
- Stage 4:Problems with walking and swallowing, and increased difficulty with balance and non-motor symptoms.
- Stage 5:Person becomes unable to walk without assistance.
Doctors can’t predict how long it may take before someone progresses from one stage to the next, Dr. Haq says. Because the rate of progression varies so much from person to person, the National Parkinson Foundation urges caregivers to avoid predicting problems or progression — instead, they should just be prepared for changes that may or may not come.
“This system of measurement has been misunderstood by some, and taken to mean that everyone with Parkinson's disease eventually progresses to profound disability," Haq says. "This is not true. Many patients with Parkinson's disease live happy and healthy lives throughout the course of their illness.”
Warning Signs of Progression
Doctors have no way of predicting which symptoms their patients will develop or how severe they will be, according to the National Institute of Neurological Disorders and Stroke. That’s why it’s important for caregivers to notice any changes in symptoms and to alert the doctor.
Symptoms that may develop as Parkinson’s progresses include:
- Problems swallowing:Warning signs of progression include drooling or spilling food or drinks from the mouth.
- Trouble with speech:This may mean talking too softly, too fast, or too slowly or slurring speech, making it difficult to understand.
- Trouble thinking:This includes being forgetful or seeming distracted. There may also be more difficulty with problem solving and learning new things.
- Movement problems:Symptoms like shaking and tremor may increasingly interfere with routine daily activities.
- Emotional or sleep changes:Keep an eye out for restlessness, trouble sleeping, anxiety, or symptoms of depression.
- Changes in bathroom habits:This can mean more frequent or intense urges to urinate, along with incontinence or constipation.
- Sexual problems:Since Parkinson’s affects nerve signals from the brain, the disease may lead to sexual dysfunction.
- Muscle cramps:This can take the form of sustained muscle contractions, especially in the legs and toes.
Response to Medications
In the beginning stages of the disease, medication may effectively ease many Parkinson’s symptoms. Drugs can help nerve cells make dopamine and replenish the brain's dwindling supply or mimic the role of the chemical in the brain, Haq explains.
But as the disease progresses, he says, medication may begin to “wear off” between doses and cause unwanted side effects, including involuntary movements. Eventually, all people with Parkinson’s will experience “wearing off.” This is because the loss of nerve cells in the brain reduces their ability to bank the dopamine they get from medication. “They become more dependent on the medication being in their bloodstream, and so patients notice their medication effect wearing off before their next dose,” Haq says.
The severity of this “wearing off” increases as the disease progresses. And that can take a toll on quality of life, according to a study published in February 2014 in Parkinsonism & Related Disorders.
How You Can Help
There is no cure for Parkinson’s, but there are ways you can help ease certain symptoms and support treatment as a caregiver. The Family Caregiver Alliance suggests:
Being aware.Take note if symptoms are worsening and communicate any concerns to a specialist. “Difficulty swallowing, gait freezing, and worsening cognition are all events that warrant further evaluation,” and there are also a number of treatment strategies doctors can use to minimize "wearing off," Haq says. The Family Caregiver Alliance notes that it's also important to track the time that medication is taken so you can monitor how long it helps control symptoms. This information can help doctors adjust treatment when necessary.
Being open.Don’t ignore any new symptoms that develop. Many problems — such as trouble sleeping, urinary issues, and sexual dysfunction — can also be side effects of medication and can be addressed.
Seeking help.There are a number of ways you can get help for your loved one. Massage and heat may help ease muscle cramps associated with the disease. A speech therapist can help ease the effects that Parkinson’s has on speech and swallowing. And you can also rely on physical therapists, dieticians, social workers, and more.
Video: Parkinson's Disease: The Basics
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