Living with Parkinson’s

Dr. Tan Kenny

Neurologist & Physician (Subspecialty in Parkinson’s Disease & Movement Disorders)
MD (UKM), MRCP (UK), Fellowship in Neurology (Mal.), Fellowship in Parkinson’s Disease & Movement Disorder (Northwestern University, USA), CMIA (NIOSH)

He is a Neurologist and Physician at Loh Guan Lye Specialists Centre. He has vast experience in diagnosing and managing various neurological conditions. He has special interest in treating Parkinson’s disease and movement disorders including tremors, involuntary movements and gait disorders. He is committed in creating awareness and education and holds the position as the Medical Advisor for the Penang Parkinson’s Disease Association, Honorary Lecturer for Penang International Dental College and Penang Medical College.

What is Parkinson’s Disease (PD)?

PD is a slow progressive nerve cell degeneration disease causing reduced production of dopamine, a brain chemical that is responsible for brain cell signal transmission. Lack of dopamine will cause PD symptoms like tremor, stiffness, slow movement and other associated complications like constipation, mood disorders (depression, anxiety), sleep disorders (insomnia) and memory decline (dementia).

There is an estimate of 10 million people worldwide having PD. It is the second most common neurodegenerative disorder after Alzheimer’s disease and it affects 1% of people above the age of 60. It may also affect younger individuals as approximately 4% of people with PD are diagnosed before age 50.

How to recognize PD? How does it affect people with PD?

The diagnosis of PD is a challenge as currently there is no lab investigation or imaging to confirm it. PD is a clinical diagnosis requiring specific neurological assessment skills to accurately identify the cardinal symptoms i.e. tremors, slow movement (bradykinesia) and stiffness (rigidity).

In the early stages, PD may be difficult to diagnose as symptoms are subtle like mild hand tremors, lack of facial expression and stooped posture. As the disease progresses, other symptoms may set in i.e. stiffness in the arms, difficulty getting up from bed and slow small steps when walking. Simple routine activities of daily living like eating, dressing and driving may become challenging as response and movements become slower, affecting dexterity as the disease progresses. At late stages, balance might be affected posing dangers to falls and injuries.

At times, people with PD may become socially withdrawn due to their motor limitations and PD features. They are often misunderstood as being inattentive or show lack of interest due to their limited facial expressions, slow responses and monotonous voice. Hand tremors and their slow, shuffling gait may cause psychological stress and embarrassment to both patients and their family especially when attending public functions. Some people with PD may concurrently have depression and anxiety that further inhibit their social circle.

What are the treatment options?

The treatment of PD needs to be individualized as no two patients are the same. Currently, there is no cure for PD but modern medicine aims at controlling symptoms to improve their quality of life. Besides oral PD medications, there are surgical options and advanced therapeutics with modern devices like deep brain stimulation for symptomatic control. With the help of advanced therapeutics, there can be better regulation of PD symptoms and less dependence on medications.

PD patients will require physiotherapy, occupational therapy and speech therapy as well. Some of the aspects that needs special attention include balancing, gait training, posture correction, fine motor skills for activities of daily living and speech training. These also include exercises to improve muscle strength, agility and stability.

Interestingly, new evidences show that some leisure activities can actually help to improve PD symptoms. Activities like dancing, cycling, tai chi and non-contact boxing are encouraged as they show promising results providing extra-benefits like relaxation, reduce falls, improve balance and coordination.

Any special diet required for PD?

There is no food restrictions or special diet for PD. Generally a healthy, balanced diet rich in vitamins, fiber and fluid help them stay energized and relieve constipation that is a common problem in people with PD. Adequate hydration is important to prevent dehydration as PD patients frequently experience low blood pressure which may cause dizziness or falls.

Both PD patients and their family members face daily challenges living with Parkinson’s. However, it is important to understand that PD is not a fatal disease as with adequate and appropriate treatment, they can have a normal and fruitful active lifestyle.