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Parkinson’s Disease
Stacy Lee
Department of Health and Human Performance
University of Houston
Nutr 3334: Advanced Nutrition
Dr. Ann-Svendsen Sanchez
Nov. 10, 2023
2
Part 1:
Parkinson’s disease is one of the most well-known neurodegenerative diseases that is age-related, so you will rarely see this disease prevalent in the younger population but can be present. Since the disease is age-related, that means the disease needs time to develop to become fatal to a person, as the symptoms can cause complications. The life expectancy for this
disease is still decreased by “2.56 percent,” but it is not as lethal as some other diseases, so the life expectancy is close to normal. (Rizek et al., 2016) “Early onset of Parkinson’s is known for slower progression, but late onset is known for rapid disease progression and cognitive decline.” (Rizek et al., 2016) For causes of Parkinson’s there is a ratio of “3:2 for male to female” (DeMaagd et al., 2015) in regard to who can get this disease. As females have a delayed onset of the disease because of “neuroprotective effects of estrogen on the dopaminergic system.” (DeMaagd et al., 2015) This means that males have a higher chance of getting Parkinson’s over females. While many believe this disease is hereditary, in most cases it does not appear to run through families but can be traced to genetic variants. Researchers now believe that Parkinson’s disease is physically caused by a combination of genetic and environmental factors. Some of these environmental factors include the use of “pesticides, herbicides, and close proximity to industrial plants.” (Narayan et al., 2017) Some preventable factors that are most associated with a reduced risk in Parkinson’s is caffeine and cigarette smoking.” (Jankovic et al., 2020) There is a negative association between these two main variables and Parkinson’s so the more you smoke the less likely you are to develop this disease, and the same is for caffeine. One hypothesis on this topic is because “components of cigarette smoke stimulate the release of dopamine,” but is still being researched on. (Jankovic et al., 2020) While the physiological cause of this disease is the disorder of the basal ganglia which is the area of the brain that controls movement loses the excitation of the dopaminergic neuron. Having loss of this neuron causes the loss of dopamine which decreases excitement in the body which affects the person mentally and physically that cause some symptoms depending on the onset of the disease.
Some symptoms of Parkinson’s disease that affect the motor behavior include “bradykinesia, gait freezing, resting tumor, postural reflex impairment, rigidity,” etc. (Demaagd et al., 2015) There are also neuropsychological dysfunctions that include “depression, anxiety, apathy, psychosis, impulse control, dementia, and cognitive impairment.” (Seppi et al., 2019) Other symptoms include “autonomic dysfunction, disorders of sleep, and some others like pain and fatigue.” (Seppi et al., 2019) However, symptoms in patients with Parkinson’s disease vary, and early symptoms may not be as noticeable. There are 5 stages of Parkinson’s with stage 1 the symptoms are only present on one side, for stage 2 the symptoms become present on both sides of the body, but there is no impairment in balance, for stage 3 there is balance impairment and moderate disease progression, stage 4 there is severe disability but the person is still able to walk or stand unassisted, and stage 5 the patient will need a wheelchair or is bedridden. (Templeton et al., 2022) With early symptoms being hard to spot this makes diagnosing a patient with Parkinson’s disease challenging because it overlaps with many other neurodegenerative diseases that could be present. This means that “clinically diagnosing a
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person is submaximal in accuracy even after the disease is fully developed.” That means there is
no specific test for Parkinson’s, but it must involve a “neurologist and movement disorder specialist” (Tolosa et al., 2021) to be involved in a physical exam to diagnose this disease. There are a limited number of diagnostic tests that have been done for patients with Parkinson’s to solidify the clinical diagnosis of the patient, and some that have been consistent are “olfactory function testing and structural MRI (Magnetic Resonance Imaging).” (Tolosa et al., 2021) For olfactory testing it has been more “extensively tested” for Parkinson’s as it has been consistent for approximately 90% of patients rather than the structural MRI should be part of the screening, but the sensitivity for Parkinson’s is low around 50%.” (Tolosa et al., 2021) This also entails for no specific treatment to cure Parkinson’s, but there are some medicines, diets, and therapies to help relieve some of the symptoms for this disease. Some of these medications that help aid in depressive symptoms you may experience during Parkinson’s
disease are dopamine agonists. These are common for movement disorders like Parkinson’s disease and are meant to activate the dopamine receptors in your brain. The main drug that is labeled as efficacious for this category is pramipexole which has great safety, as it has as “acceptable risk without specialized monitoring” and is clinically useful. (Seppi et al., 2019). Another medicine category to treat depression symptoms is Tricyclic antidepressants, which include two likely efficacious medicines. These include Nortriptyline and Desipramine which have an acceptable risk without specialized monitoring and are listed as possibly useful. (Seppi et al., 2019) There is also medicine to treat pain but both drugs listed are Rotigotone and Oxycodone-naloxone prolonged release both have insufficient evidence for efficacy. (Seppi et al., 2019) Some medicine to treat fatigue is Rasagiline which is efficacious, possibly useful and an acceptable risk without specialized monitoring. However, the other drugs listed for fatigue like methylphenidate, modafinil, and acupuncture all have insufficient evidence. (Seppi et al., 2019) Pertaining to diet the only one that is seen to have a positive influence Parkinson’s onset and progression is the Mediterranean diet. (Bisaglia, 2022). According to Bisaglia they characterize the Mediterranean diet as having a high intake of fresh fruit and vegetables, legumes, seeds, whole grains, and nuts with a consistent amount of olive oil, with a moderate amount in dairy, eggs, fish, and poultry, and low amounts in red meat and saturated fats. While there are contradictions in research the overall presumption is that the MeDiet has a protective
effect on Parkinson’s and slowing the onset of it. As mentioned earlier there is not cure to Parkinson’s, but one of the ways to slow the onset of it is through therapy. Currently undergoing further research to ensure the safety and efficacy of it is stem-cell therapy. The most promising cell replacement therapy for Parkinson’s is Dopamine (DA) cell transplantation. (Liu et al., 2020) According to Liu and Cheung, by transplanting DA cells into the part of the brain that is depleted of dopamine it will restore the DA neurotransmission and replace those lost neurons. For physical therapy, the highest recommendations that should be implemented is “resistance training, aerobic exercise, balance training, gait training, task specific, and community-based exercising.” (Osborne et al., 2022) These are based off the clinical practice guideline, but you do not have to follow each guideline specifically, as the patient's therapy should be individualized.
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References
DeMaagd, G., & Philip, A. (2015, August). Parkinson’s disease and its management: Part 1: Disease entity, risk factors, pathophysiology, clinical presentation, and diagnosis
. P & T : a peer-reviewed journal for formulary management. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4517533/
Narayan, S., Liew, Z., Bronstein, J. M., & Ritz, B. (2017, October). Occupational pesticide use and parkinson’s disease in the parkinson environment gene (PEG) study
. Environment international. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5629094/
Seppi, K., Ray Chaudhuri, K., Coelho, M., Fox, S. H., Katzenschlager, R., Perez Lloret, S., Weintraub, D., Sampaio, C., & the collaborators of the Parkinson’s Disease Update on Non-Motor Symptoms Study Group on behalf of the Movement Disorders Society Evidence-Based Medicine Committee. (2019, February). Update on treatments for nonmotor symptoms of parkinson’s disease-an evidence-based Medicine Review
. Movement disorders : official journal of the Movement Disorder Society. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6916382/?report=classic
Tolosa, E., Garrido, A., Scholz, S. W., & Poewe, W. (2021, May). Challenges in the diagnosis of parkinson’s disease
. The Lancet. Neurology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8185633/?report=classic
Jankovic, J., & Tan, E. K. (2020a, August 1). Parkinson’s disease: Etiopathogenesis and treatment
. Journal of Neurology, Neurosurgery & Psychiatry. https://jnnp.bmj.com/content/91/8/795
Rizek, P., Kumar, N., & Jog, M. S. (2016, November 1). An update on the diagnosis and treatment of parkinson disease
. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5088077/
Bisaglia, M. (2022, December 20). Mediterranean diet and parkinson’s disease
. International journal of molecular sciences. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9820428/
Liu, Z., & Cheung, H.-H. (2020, October 29). Stem cell-based therapies for parkinson disease
. International journal of molecular sciences. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7663462/
Osborne, J. A., Botkin, R., Colon-Semenza, C., DeAngelis, T. R., Gallardo, O. G., Kosakowski, H., Martello, J., Pradhan, S., Rafferty, M., Readinger, J. L., Whitt, A. L., & Ellis, T. D. (2022, April
1). Physical therapist management of parkinson disease: A clinical practice guideline from
5
the American Physical Therapy Association
. Physical therapy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9046970/
Templeton, J. M., Poellabauer, C., & Schneider, S. (2022, August 18). Classification of parkinson’s disease and its stages using machine learning
. Scientific reports. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9388671/
Part 2:
You take your husband to the doctor’s today because for the past six months your husband Loid
Forger (62) has been experiencing some hand tremors, stiffness in posture with walking and sitting, and slight stiffness in his face mostly on one side of his body. To relieve some of his stiffness we put him on some medication like a muscle relaxer to help the tremors and stiffness.
However, after a year and a half of taking this medication, his symptoms have started to persist and have gotten worse by affecting both sides of his body now with issues in movement. From the slow progression of your husband’s symptoms, he may be experiencing Parkinson’s disease.
Parkinson’s is one of the most well-known neurodegenerative diseases that is specifically affected by the nerve cells in your husband's nervous system dying and preventing the production of dopamine. However, the fortunate part is that this disease must progress over an
extended period of many years, so in many cases and studies the life expectancy of a patient with Parkinson’s is close to normal. This disease is expected to develop in older age groups with
the average being 60 years old, so it is not rare that someone at his age develops Parkinson’s. There are many ideas for the cause of Parkinson’s as some believe it is hereditary, but there are
genetic mutations and environmental factors contribute to the cause. While there is still ongoing research some environmental factors that are seen to be part of the cause of Parkinson’s are exposures to pesticides, herbicides, or being in close proximity to industrial plants. So, whether you are regularly exposed to these factors through work or just casually gardening you can have a higher chance of developing Parkinson’s if you are not taking proper precaution with these chemicals. With Parkinson’s unfortunately there is no cure for the disease, but there are environmental factors that are still undergoing research that can help prevent the disease. The two factors that are known to have an odd relationship with Parkinson’s is caffeine and smoking
cigarettes. Through research it is seen that these two factors have a negative correlation with Parkinson’s, so with caffeine intake you are less likely to develop Parkinson’s and the same goes
for smoking as well. While there is no specific reasoning for this, the scientific approach to cigarettes is that certain components within the cigarette are able release dopamine within the body, and the same goes for caffeine as well. However, this should not be relied upon or taken in copious amounts, as it affects other areas of the body as well. For diagnosing Parkinson’s it is quite challenging as symptoms tend to overlap with other neurodegenerative diseases as well, but to get as much accuracy as possible there will be a neurologist and movement disorder specialist present for physically examining. For diagnostic testing there is not many tests that are specialized for those with Parkinson’s, but there are two tests that will be done which are olfactory function and a structural MRI. The olfactory function test involves detecting smells like
the Sniffin’ Stick test. This testing is one of the best for Parkinson’s, as it has been consistent for about 90% of patients and olfactory dysfunction is present in a large number of patients with
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Parkinson’s. For the MRI (Magnetic Resonance Imaging) it uses magnets and radio waves to produce images on a computer. Specifically, the MRI will be focused on your husband’s brain that can detect specific markers in his brain to tell that it is Parkinson’s present. For symptoms of Parkinson’s there are 5 stages of severity that your husband will go through. When given the first medication it appears he was at stage 1 of this disease, and now he may be transitioning onto stage 2. For stage 1 the symptoms appear to be on one side of the
body, during stage 2 it is present throughout the whole body but there are no balance issues, with stage 3 balance impairment is present with a moderate amount of disease progression, stage 4 he may experience extreme disability, but standing and walking unassisted should still be able to occur, and finally for stage 5 he will most likely be bedridden or unable to move without assistance. Some specific motor movement disabilities he may experience are gait freezing, bradykinesia, postural impairment, and rigidity. Gait freezing can start at an early stage of Parkinson’s and it is when your body becomes “stuck” in place, and you cannot walk or move forward. This can be seen as a continuation of all the stiffness you may be experiencing if you do not properly get treated for it. For bradykinesia it is known as having a slowness in movements, and once all these symptoms combine in the later stages of Parkinson’s that is when the disease can become fatal. There are also some neuropsychological dysfunctions that come from Parkinson’s as well you may experience such as depression, anxiety, and dementia. Unfortunately, with treatments for Parkinson’s it will not revert the symptoms you are experiencing but can slow down the progression of the disease. Some of the treatments entail certain medication, changes in diet, and therapies. For medicines there are Tricyclic antidepressants and dopamine agonists he can take. With dopamine agonists it helps activate the dopamine receptors in your brain, and almost “tricking” your brain into thinking the dopamine to activate those receptors are being produced. The medicine for this will be pramipexole as it has good efficacy and great safety for many patients. While there are other medications that can help the pain and fatigue, the main drug you will be prescribed is some dopamine agonist to replenish the missing dopamine in your brain. For your diet, what you will be focusing on is the Mediterranean diet. To follow the MeDiet you will need to have a high consumption of fresh fruits, vegetables, legumes, seeds, whole grains, and nuts with a consistent intake of olive oil, and moderate amounts of dairy, eggs, fish, and poultry, followed by low amounts of red meats and saturated fats. This diet has the most research on slowing the
progression of Parkinson’s, as it has a protective effect. For therapy there is ongoing research on cell transplantation, but the most promising type has been Dopamine (DA) cell transplantation. By taking part in this therapy, they will transplant DA cells into your brain, and it will replace the lost neurons on the side of your brain that cannot produce dopamine or is not
receiving the signal. However, this is still undergoing research as well as stem cell therapy, so the safest and most efficacious type you can participate in is physical therapy. According to a clinical practice guideline, what you will be focusing on during therapy is resistance training, aerobic exercises, balance training, gait training, task specific, and community-based exercises. However, you cannot only exercise during therapy, and must keep up with it outside of therapy to ensure the greatest number of benefits.
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References
Narayan, S., Liew, Z., Bronstein, J. M., & Ritz, B. (2017, October). Occupational pesticide use and parkinson’s disease in the parkinson environment gene (PEG) study
. Environment international. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5629094/
Lo, C., Arora, S., Ben-Shlomo, Y., Barber, T. R., Lawton, M., Klein, J. C., Kanavou, S., Janzen, A., Sittig, E., Oertel, W. H., Grosset, D. G., & Hu, M. T. (2021, April 13). Olfactory testing in parkinson disease and rem behavior disorder: A machine learning approach
. Neurology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166425/
Templeton, J. M., Poellabauer, C., & Schneider, S. (2022, August 18). Classification of parkinson’s disease and its stages using machine learning
. Scientific reports. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9388671/
Rizek, P., Kumar, N., & Jog, M. S. (2016, November 1). An update on the diagnosis and treatment of parkinson disease
. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5088077/
Bisaglia, M. (2022, December 20). Mediterranean diet and parkinson’s disease
. International journal of molecular sciences. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9820428/
Osborne, J. A., Botkin, R., Colon-Semenza, C., DeAngelis, T. R., Gallardo, O. G., Kosakowski, H., Martello, J., Pradhan, S., Rafferty, M., Readinger, J. L., Whitt, A. L., & Ellis, T. D. (2022, April
1). Physical therapist management of parkinson disease: A clinical practice guideline from the American Physical Therapy Association
. Physical therapy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9046970/
8
Part 3:
Parkinson’s disease is an age-related neurodegenerative disease that progresses slowly over many years. The life expectancy of Parkinson’s disease is close to normal as the symptoms take years to progress to the next. There are 5 stages to expect from Parkinson’s with the first stage being the least fatal as symptoms only affect one side of your body, then progresses to stage two where you feel it on both sides, stage three you will have balance impairments, stage four you will experience sever disability, but still be able to walk unassisted, and stage five you will be wheelchair bound and bedridden needing assistance to walk. Unfortunately, Parkinson’s is incurable, but there are diets and exercises you can follow to slow the progression. It is important to have a good support system when dealing with Parkinson’s as the more the disease progresses the more aid you will need from those around you. Your mental health may be greatly affected so online support groups are effective, as you can see those who are also going through the same things as you. Below are some resources as well as a graphic describing
the stages of Parkinson’s.
Resources:
Below there will be links provided for patients to access online support groups. While this is a tough time there will be links provided for the patients themselves and some for family members that may need some support during these challenging times. PD Online Support Group
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https://www.pdconversations.org/s/
https://www.apdaparkinson.org/article/want-to-join-a-virtual-support-group/
PD Online Support Group for Caregivers
https://www.healthyplace.com/parkinsons-disease/support/where-to-find-a-parkinsons-
support-group-for-caregivers#:~:text=You%20can%20easily%20find%20local,INFO
%20(473%2D4636
).
https://www.parkinsonsresources.org/programs/
Financial Assistance
https://www.apdaparkinson.org/resources-support/living-with-parkinsons-disease/insurance/
government-assistance/#:~:text=Current%20government%20assistance%20plans%2Fprograms
%20include%3A&text=Health%20Savings%20Accounts%20(HSAs),Supplemental%20Security
%20Income%20(SSI
)
Proposed Diet Plan:
The diet many should follow is the Mediterranean diet. It has a high intake of fruits and vegetables, nuts, seeds, legumes, and low intake of red meats and saturated fats. Below there is a pyramid with how often you should be focusing on each category of food, as well as a depiction of the types of foods in those categories. In case the pyramid is hard to understand here is a representation of your diet in a plate form, but you must include water as well as some fruits in your diet everyday as well.
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When diagnosed with Parkinson’s it is best to begin this diet at once as it can help slow the progression of the disease, and it is best to start early rather than later when the disease has progressed too far. While diet is important, another factor to keep in mind is the amount of exercise you are getting and the help you are receiving through physical therapy. Proposed Exercise Plan:
These are some exercise recommendations specifically with aerobic activities, strength/resistance training, balance, and stretching. Each is about 2-3 days per week and should be done for approximately 30 minutes. However, depending on your therapist and the stage you may be experiencing Parkinson’s you will not be able to
follow these recommendations. These are exercises you will be able to do independently if you are towards the earlier stages and
should be keeping up with. The graphic represents some of the components you will be exeriencing at physicaly therapy Sometimes your therapy will begin with a bike to get your muscles wamed up and ready to work before beginning stretching. For walking it might be assisted with your therapist.
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Exercises:
This graphic is some
exercises you can take
part in during the
stages of Parkinson’s.
You can make
modifications as well
to increase the
intensity and
incorporate yoga into
the routine to keep
up with flexibility and
balance. Early Stage:
For your chair squats
your goal is to not sit
completely onto the
chair while performing these but by tapping your bottom onto the chair and coming right back
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up. You can also do pushups on the floor or against the wall to get some upper body resistance training in as well. For your walk you start off at a pace that is comfortable to still talk at while feeling your heart rate increase. Over time you should be able to walk about three times a week
in thirty-minute intervals. Middle Stage:
The bridges are meant to strengthen your leg muscles and incorporate tightening your stomach
muscles to get into that complete bridge. With aerobic exercise you can either jog in place or dance for thirty minutes. Late Stage: The clam shell exercise is meant to strengthen your hip muscles to help you walk, and you can perform this exercise in bed. For your heel lifts they focus on your calves, so as a modification to increase strengthening you can add weight. References
New exercise recommendations for the parkinson’s Community and Exercise Professionals
. Parkinson’s Foundation. (2021, May 25). https://www.parkinson.org/blog/awareness/exercise-recommendations#:~:text=Aerobic
%20activity%3A%203%20days%20a,resistance%2C%20speed%2C%20or%20power
%20focus
Bottaro, A. (2021, September 23). What is it really like to live with parkinson’s disease?
Verywell Health. https://www.verywellhealth.com/facts-about-parkinsons-disease-5200700
Takano, J. (n.d.). Exercise may aid parkinson’s disease
. Pyro. https://www.pyroenergen.com/articles/parkinsons-disease.htm
Fielack, L. (2022, April 26). Updated exercise guidelines for individuals with parkinson’s disease
. Helen Hayes Hospital. https://helenhayeshospital.org/updated-exercise-guidelines-for-individuals-with-
parkinsons-disease/
Baum, I. (2022, November 7). Here’s what a healthy plate looks like on the Mediterranean diet
. Well+Good. https://www.wellandgood.com/mediterranean-diet-macros-portions/
Wilson, N. N. (2016, September 21). Mediterranean Food Pyramid
. Healthy Living. https://mamaslegacycookbooks.com/mediterranean-food-pyramid/
Tim Petrie, D. (2022, February 24). Home exercises for parkinson’s disease
. Verywell Health. https://www.verywellhealth.com/exercises-for-parkinsons-disease-5217557
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