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06.10.2014

Fatigue and weight loss in parkinson's disease, insomnia symptoms and treatment - PDF Review

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Nerve cells in the substantia nigra send out fibers to the corpus stratia, gray and white bands of tissue located in both sides of the brain.There the cells release dopamine, an essential neurotransmitter (a chemical messenger in the brain).
CausesAlthough doctors don’t know exactly what causes Parkinson's disease, they think it’s probably due to a combination of genetic and environmental factors.Genetic FactorsSpecific genetic factors appear to play a strong role in early-onset Parkinson's disease, an uncommon form of the disease. Loss of dopamine in the corpus stratia is the primary defect in Parkinson's disease.Dopamine deficiency is the hallmark feature in PD. Dopamine is one of three major neurotransmitters known as catecholamines, which help the body respond to stress and prepare it for the fight-or-flight response. A higher incidence of parkinsonism has long been observed in people who live in rural areas, particularly those who drink private well water or are agricultural workers.Risk FactorsAgeThe average age of onset of Parkinson's disease is 55.
Loss of dopamine negatively affects the nerves and muscles controlling movement and coordination, resulting in the major symptoms characteristic of Parkinson's disease. Because Parkinson’s disease symptoms are due to a deficiency of the brain chemical dopamine, the main drug treatments help increase dopamine levels in the brain. Cigarette smokers appear to have a lower risk for Parkinson's disease, indicating possible protection by nicotine. The few studies on nicotine replacement as a treatment for Parkinson’s have not provided any strong evidence that nicotine therapy provides benefits.Coffee Consumption.
Unfortunately, many of these drugs can cause side effects and lose effectiveness over time.Physical Therapy. Rehabilitation can help patients improve their balance, mobility, speech, and functional abilities.Surgery. The disease progresses more quickly in older patients, and may lead to severe incapacity within 10 - 20 years. In some cases of advanced-stage Parkinson’s disease, surgery may help to control motor problems.
Older patients also tend to have muscle freezing and greater declines in mental function and daily functioning than younger people. Deep brain stimulation is currently the preferred surgical method.New Drug ApprovalIn 2012, the Food and Drug Administration (FDA) approved rotigotine (Neupro) for treatment of early and advanced stage Parkinson’s disease. If PD starts without signs of tremor, it is likely to be more severe than if tremor had been present.Parkinson's disease can seriously impair the quality of life in any age group. The disease process itself causes changes in chemicals in the brain that affect mood and well-being. Anxiety is also very common and may present along with depression.Some drug treatments (levodopa combined with a dopamine agonist) can cause compulsive behavior, such as gambling, shopping, and increased sexuality. Other small studies have suggested that dance styles such as the Argentinean tango may help with balance and mobility.
IntroductionParkinson's disease (PD) is a slowly progressive neurological disorder that affects movement, muscle control, and balance.
Deep brain stimulus (DBS) surgery may also increase the risk for compulsive gambling in patients who have a history of gambling.Cognitive and Memory ProblemsImpaired Thinking (Cognitive Impairment).
Parkinson’s disease is part of a group of conditions called motor system disorders, which are associated with the loss of dopamine-producing brain cells. Defects in thinking, language, and problem solving skills may occur early on or later in the course of the disease.
These problems can occur from the disease process or from side effects of medications used to treat Parkinson’s.
Parkinson's disease is a slowly progressive disorder that affects movement, muscle control, and balance.
Patients with PD are slower in detecting associations, although (unlike in Alzheimer's disease) once they discover them they are able to apply this knowledge to other concepts.Dementia.


Part of the disease process develops as cells are destroyed in certain parts of the brain stem, particularly the crescent-shaped cell mass known as the substantia nigra. Dementia occurs in about two-thirds of patients with Parkinson’s, especially in those who developed Parkinson’s after age 60.
Dementia is significant loss of cognitive functions such as memory, judgment, attention, and abstract thinking. There the cells release essential neurotransmitters that help control movement and coordination. PD marked by muscle rigidity (akinesia), rather than tremor, and early hallucinations also increase the risk for dementia. Some of the medications used for Parkinson's may cause vivid dreams as well as waking hallucinations.Sexual DysfunctionAlthough Parkinson's disease and its treatments can cause compulsive sexual behavior, the disease can also cause a loss of sexual desire in both men and women. For men, erectile dysfunction can be a complication of Parkinson’s.Bowel and Bladder ComplicationsConstipation is a common complication of Parkinson’s disease.
Weakness in pelvic floor muscles can also make it difficult to defecate.Patients with Parkinson’s disease frequently experience urinary incontinence, including increased urge and frequency. Parkinson’s can also cause urinary retention (incomplete emptying of the bladder).Sensory ProblemsDecreased Sense of Smell. Painful symptoms associated with Parkinson’s disease include muscle numbness, tingling, and aching. The tremor is often rhythmic, 4 - 5 cycles per second, and frequently causes an action of the thumb and fingers known as pill rolling.Tremors can occur when the limb is at rest or when it is held up in a stiff unsupported position. They usually disappear briefly during movement and do not occur during sleep.Tremors can also eventually occur in the head, lips, tongue, and feet.
It can cause chapped skin and lips around the mouth, dehydration, an unpleasant odor, and social embarrassment.DiagnosisParkinson’s disease can be difficult to diagnose in its early stages.
Doctors base their diagnosis on the patient’s medical history and symptoms evaluated during a neurological exam. If patients' symptoms improve when they take levodopa, they likely have Parkinson's, ruling out other neurological diseases.Tests for Depression and DementiaThe American Academy of Neurology (AAN) recommends the Beck Depression Inventory or the Hamilton Depression Rating Scale to screen for depression in patients with Parkinson's disease. The AAN recommends the Mini Mental State Examination (MMSE) and Cambridge Cognitive Examination (CAMCOG) tests to screen for dementia.
Parkinsonism refers to a group of movement disorders that share similar symptoms with Parkinson’s disease, but also have unique symptoms of their own. About 15% of parkinsonism cases are due to conditions called Parkinson’s plus syndromes (PPS) or atypical parkinsonism.
Marked by apraxia (inability to perform coordinated movements or use familiar objects), stiffness that is more severe than typical Parkinson’s disease, and twitching or jerking in the hand.Lewy body dementia. Symptoms include visual hallucinations and loss of spontaneous movement.Multiple system atrophy. Symptoms include fainting, constipation, erectile dysfunction, urinary retention, and loss of muscle coordination.Progressive supranuclear palsy. Marked by frequent falls, personality changes, and difficulty focusing the eyes.Patients with PPS often have earlier and more severe dementia than those with Parkinson’s disease. In addition, they do not usually respond to medications that are used to treat Parkinson’s disease.Other Neurologic Conditions. Hardening of the arteries (arteriosclerosis) in the brain can cause multiple small strokes, which can produce loss of motor control.
Alzheimer’s disease can share similar symptoms with Parkinson’s and the conditions can exist together.Medications. Several drugs, including antipsychotic and antiseizure medications, can cause Parkinson’s symptoms.TreatmentThere is no cure for Parkinson’s disease, but drugs, physical therapy, and surgical interventions can help control symptoms and improve quality of life.


Patients must work closely with doctors and therapists throughout the course of the disease to customize a program suitable for their particular and changing needs. Patients should never change their medications without consulting their doctor, and they should never stop taking their medications abruptly.No treatment method has been proven to change the course of the disease.
For early disease with little or no impairment, drug therapy may not be necessary.A number of issues must be considered in choosing medication treatment. Levodopa, or L-dopa, has been used for years and is the gold standard for treating Parkinson's disease. It is probably the most effective drug for controlling symptoms and is used in nearly all phases of the disease.
These drugs include pramipexole (Mirapex, generic), ropinirole (Requip, generic), bromocriptine (Parlodel, generic), and rotigotine (Neupro).Selegiline (Eldepryl) and Rasagiline (Azilect). Rasagiline (Azilect) is another MAO-B inhibitor used for treatment of Parkinson’s.Treatments for Off TimeDrug treatments for Parkinson disease do not consistently control symptoms. At certain points during the day, the beneficial effects of drugs wear off, and symptoms can return, including uncontrolled muscular motor function, difficulty walking, and loss of energy. These drugs slow the breakdown of dopamine that occurs naturally in the brain and dopamine produced from levodopa.Other dopamine agonists, such as ropinirole (Requip, generic) and pramipexole (Mirapex, generic), and the COMT inhibitor tolcapone (Tasmar) may also be helpful for treating off-time symptoms. Some studies have found that selective serotonin-reuptake inhibitors (SSRIs) -- which include fluoxetine (Prozac, generic), sertraline (Zoloft, generic), and paroxetine (Paxil, generic) -- may worsen symptoms of Parkinson's. Studies indicate that clozapine (Clozaril, generic) and quetiapine (Seroquel), antipsychotic drugs used to treat schizophrenia, may be the best drugs for treating psychosis in patients with Parkinson's disease.
The cholinesterase inhibitor drugs donepezil (Aricept) and rivastigmine (Exelon) are used to treat Alzheimer’s disease and are sometimes used for Parkinson’s. The benefit from these drugs is often small, and patients and their families may not notice much change.Daytime Sleepiness and Fatigue. Modafinil (Provigil), a drug used to treat narcolepsy may be helpful for patients with sleepiness related to their disease. Methylphenidate (Ritalin, generic) may be considered for patients who experience fatigue.Erectile Dysfunction. PDE5 inhibitor drugs such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) can be helpful for men with Parkinson's disease who suffer from erectile dysfunction. Glycopyrrolate, scopolamine, and injections of botulinum toxin may be used to relieve drooling symptoms.Treating Advanced DiseaseAdvanced Parkinson’s disease poses challenges for both patients and caregivers. Eventually, symptoms such as stooped posture, freezing, and speech difficulties may no longer respond to drug treatment. Patients become increasingly dependent on others for care and require assistance with daily tasks. The goal of treatment for advanced Parkinson’s disease should be on providing patients with safety, comfort, and quality of life.Levadopa (L-dopa)Levodopa, also called L-dopa, which is converted to dopamine in the brain, remains the gold standard for treating Parkinson's disease.
The standard preparations (Sinemet, Atamet) combine levodopa with carbidopa, which improves the action of levodopa and reduces some of its side effects, particularly nausea. Dyskinesia can take many forms, most often uncontrolled flailing of the arms and legs or chorea, rapid and repetitive motions that can affect the limbs, face, tongue, mouth, and neck.Low blood pressure (hypotension). However, proteins interfere with intestinal absorption of levodopa, and some doctors recommend not eating any protein until nighttime in order to avoid this interference.
However, some evidence suggests that it impairs areas of the brain related to other learning functions and social behavior.Sleepiness and sleep attacksLevodopa causes fewer psychiatric side effects than other drugs used for Parkinson's disease, including anticholinergics, selegiline, amantadine, and dopamine agonists.



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