Parkinson’s Disease by Dr T K Khoo
Parkinson’s disease (PD) is a common, chronic neurodegenerative disease that has a predilection to the elderly. With an estimated 1% of people over the age of 60 years affected, this condition is becoming increasingly prevalent with increased longevity that has resulted from better healthcare, especially in developed nations. At present, 25 people are diagnosed with PD every day in Australia (Parkinson’s Australia Inc). The significance of PD in Australia is further underpinned by population demographics that veer towards one of an ageing nation.
‘Parkinsonism’ refers to the cardinal clinical motor features (i.e. movement issues) of idiopathic Parkinson’s disease (PD), namely tremor, rigidity (‘stiffness’), bradykinesia (‘slowness in initiating movement’) as well as problems with posture and balance. These features contribute towards core features of diagnostic criteria in PD but can also occur in other conditions. As diagnostic criteria often relies on accurate clinical history and findings, it is important to have annual review to ensure diagnostic accuracy.
Besides motor symptoms, many ‘non-motor symptoms’ often occur throughout the course of the condition. Examples of these non-specific symptoms include constipation, sleep disturbances, urinary urgency, mood disorders (e.g. depression, anxiety) and impaired attention span. Current evidence indicates the burden of these non-motor symptoms can be more significant than the motor symptoms of disease, thus dictating the need for prompt detection and treatment of these symptoms. Screening of these symptoms are done in collaboration between patient and the responsible health professional whilst it is often recommended that management is led by a medical practitioner with sufficient experience in Parkinson’s disease and other movement disorders. Patient-reported questionnaires such as the Non-motor Symptoms Questionnaire (NMSQuest) are also freely available and completion prior to medical consultation is often helpful in indicating the presence of these symptoms.
Treatment in Parkinson’s disease can be broadly divided into non-pharmacological, pharmacological and surgical treatment. Studies have indicated the importance of lifestyle interventions that involve exercise which is known to be beneficial even in people without PD. Neurobiochemical evidence indicates exercise is a useful promoter of various neurochemicals that nourish and prolong the life of nerve cells. Levodopa replacement therapy forms the cornerstone of pharmacological treatment in PD. Various classes of medication are now available and indicate ongoing advances in treatment since the discovery of the neurochemical precursor in the 1960s. Besides levodopa replacement therapy, targeted symptom management should also occur when required. Other more advanced therapies include apomorphine, Duodopa and deep brain stimulation.
The basic principle in medicine still applies with regards to treatment whereby ‘beneficence and non-maleficence’ must be considered, thus often necessitating the need for appropriate patient selection when it comes to treatment decisions which ideally should be done in concordance to patient wishes.
♥ University Lecturer & Meditation Practitioner
♥ Credentialled Diabetes Educator
♥ WEIGHT & PAIN Management Consultant
♥ Consultant Clinical Pharmacist
