Parkinson’s and Role of Carers


11th April 2021, Parkinson’s is one of the most common neurologic disorders, affecting 1 in 37 people alive today will be diagnosed with Parkinson’s in their lifetime, causing progressive disability that can be slowed but not halted, by treatment. Around 145,000 people in the UK have Parkinson’s.

Parkinson’s Disease-An Overview
It is a progressive neurodegenerative disorder that affects brain functionality due to low levels of dopamine. Parkinson is one of the diseases in which family of patients are suffered too.

The 2 major neuropathologic findings in Parkinson’s disease are loss of pigmented dopaminergic neurons of the substantia nigra in the brain and the presence of Lewy bodies(abnormal protein formation in the brain) and Lewy neurites(damaged neurons).

Clinical Signs and Symptoms of Parkinson’s Disease

The classic motor features of Parkinson’s disease typically start insidiously and emerge slowly over weeks or months, with tremor being the most common initial symptom. The three vital signs of Parkinson disease are resting tremor, rigidity, and bradykinesia(slowness of movement). Postural instability (balance impairment) is sometimes listed as the fourth cardinal feature.

Other features include Soft voice, Decreased facial expressions, Sleep disturbance, Decreased sense of smell, Sexual dysfunction, General body weakness, Depression and slowness in thinking.

Management of Parkinson’s disease patients

The goal of medical management of Parkinson disease is to provide control of signs and symptoms for as long as possible while minimizing adverse effects. Pharmacological treatment of Parkinson disease is mainly divided into symptomatic and neuroprotective (disease-modifying) therapy. 

Symptomatic Treatment includes
1-Levodopa, coupled with carbidopa, a peripheral decarboxylase inhibitor (PDI), keeping it at the top as a gold standard of symptomatic treatment for Parkinson disease.
2-Monoamine oxidase (MAO)–B inhibitors are considered for initial treatment st early disease stages.
3-Other dopamine agonists (eg, ropinirole, pramipexole) are used as monotherapy in early disease and adjunctive therapy in moderate to advanced disease stages.
4-Anticholinergic agents (eg, trihexyphenidyl, benztropine) used as second-line drugs for tremors only.

Symptomatic anti-Parkinson disease medications usually provide good control of motor signs of Parkinson disease for 4-6 years. After this, disability often progresses despite best medical management. Unfortunately, many patients develop long-term motor complications.

Neuroprotective therapy:

It aims to slow, block, or reverse disease progression; such therapies slow down the underlying loss of dopamine neurons.

What Carers can do to support person living with Parkinson’s?

Carers should acquaint themselves with a proper understanding of Parkinson's disease, its symptoms, needs of the sufferer, behaviour of the patient, medication timings, and highs and low of patients’ environmental pursuance.

Patients must be ensured of having enriched meals as suggested by the health care provider in a proper timing along with medication schedule. Diet is an important factor toward their bone and muscle strengthening.

Psychological adjustment is the key factor when it comes to neurodegenerative diseases such as Parkinson’s disease or dementia. Psychological adjustment is important for both caregivers and the care receivers.

Other issues that commonly need to be addressed at appropriate times in the disease course include cognitive decline, personality changes, depression, dysphagia, sleepiness and fatigue, and impulse control disorders. Additional information is also often needed for financial planning, insurance issues, disability application, and placement (assisted living facility, nursing home).

What are those essentials carers should concentrate upon?

Patients with Parkinson’s disease should be encouraged to participate in decision making regarding their condition. Carer should also be knowing the information that is appropriate for the disease state and its expected challenges. Psychosocial support and its concerns should be addressed and must be referred to a  psychologist, as needed.

The most Important non-pharmacological key management points are :

1- Cognitive Therapy

Cognitive-behavioural therapy (CBT) can help to control impulsive behaviours. It significantly not only improves symptom severity, neuropsychiatric disturbances but also helpful in reducing depression and anxiety levels.

2-Physical Therapy

Physical therapy in patients with Parkinson’s disease using a variety of physiotherapy interventions may play a role in improving gait, balance and flexibility, aerobic capacity, initiation of movement, and functional independence.

3-Sleep Therapy

Sleep hygiene techniques include avoiding stimulants/fluids near bedtime, avoiding heavy late-night meals, and following a regular sleep-wake schedule. It is advised that patients with Parkinson disease and sudden-onset sleep must avoid driving and take necessary precautions against potential occupational hazards.

4-Speech Therapy

Speech therapy plays a key role in the disease's vocal treatment regimen. Speech therapy is effective in treating the laryngeal manifestations of Parkinson diseased patient. The Lee Silverman Voice Treatment (LSVT) is an effective program designed to increase vocal intensity in patients with Parkinson disease.

5-Dietary Considerations

Levodopa competes with amino acids for absorption in the gut. Therefore protein-rich diet decreases the absorption of Levodopa in the intestine. Some patients report that when they are "on" and they eat a protein meal, they turn "off." Others find that if they eat a protein meal, their next levodopa dose does not kick in. These patients may benefit from a low protein or a protein redistributed diet.

Long Term Considerations

Patients with Parkinson disease must have regular follow-up care to ensure adequate treatment of motor and behavioural abnormalities. Once patients are stable on a medication regimen, provide follow-up care at least every 3-6 months, and periodically adjust medication dosages as necessary. Patients also need to be monitored for adverse events, including somnolence, sudden-onset sleep, impulse control disorders, and psychosis. That’s why caregivers need to have a keen eye on all the gestures of Parkinson’s diseased patient.

How homecare company like Home Instead Greenwich & Bexley can help people living with Parkinson’s?

Home Instead Greenwich & Bexley is a CQC outstanding rated homecare provider in Greenwich that supports older people, including people with Parkinson’s, in their own homes so that they can live independently with assistance for highly trained CAREGivers.

On 25th March 2021, Home Instead formulated a partnership with Parkinson’s UK where by Home Instead CAREGiver will be access the bespoke training programme about the condition, which will enable Home Instead CAREGivers to gain the knowledge and skills so that they can provide tailored care to their clients living with Parkinson’s. Speaking about working with Parkinson’s UK, Home Instead Greenwich & Bexley director, Fatta Thapa said: “People living with Parkinson’s should be able to live their life in their own homes, where they are most comfortable and with our specialised care services for people living with Parkinson’s, it will be absolutely possible”.

You can find more information on the condition as well as advice and support on the Parkinson’s UK website at www.parkinsons.org.uk.

For more information on Home Instead Greenwich & Bexley Parkinson’s care services, please call us on 0203 771 8424 or visit our website at www.homeinstead.co.uk/greenwich-bexley

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Home Instead CAREGiver supporting a person living with Parkinson's