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Human Development Psy.

127 4W2

Instructor Aileen McCabe


By Earl R. Lofland

August 30, 2018

Coping with the 5 stages of Parkinson’s Disease. Late Adulthood and living with

movement Disorders (PD Tremors. Essential Tremors and Dykinesia.)

This research paper is dedicated to Robert O. Lofland, my father, who worked for

Pennsylvania Railroad, Penn Central Railroad, and Conrail, 8th District. First as a track

laborer and advanced to bridge operator at the C&D canal. The 8th was recognized by

CONRAIL having the best safety records in the mid-Atlantic region, with no accidents in 34

years. Known as Pop or Dad to many, though I was his only son. He was first diagnosed with

Parkinson’s in 1993, his wife- my mother stayed by his side until passing away from

complications of Parkinson’s. He went to be with our Lord and Savior on Dec. 23, 1999 due

to health complications associated with Parkinson’s.

Also, my friend Dr. Kelly Lyons PhD who I had the honor to know while she was at

University of Miami. Dr Lyons became an Instructor in the Department of Neurology and a

Research Assistant Professor. She served as a Research Assistant Professor in the Department of

Neurology at the University of Miami from 1995-2003. Since that time, Dr. Lyons, alumni of the

University of Kansas, and native of the state, re-joined the faculty in the Department of

Neurology at the University of Kansas Medical Center. Today Dr. Lyons is a Research Professor

at the University of Kansas. (Ted,TV, 2013).


Human Development Psy. 127 4W2

Instructor Aileen McCabe


By Earl R. Lofland

August 30, 2018

Late Adulthood and living with movement disorders PD Tremors. Essential Tremors and

Dykinesia.

Though some of this Research paper will come from my own personal experiences while I was a

personal caregiver for my father. I will be adding vital information from the medical community

and its research teams, who have worked tirelessly to find ways to diagnose Parkinson’s Disease

earlier, and finding a cure for Parkinson’s. Many medical professionals around the world have

been responsible for ground breaking- new medical technology that is helping patients cope with

a variety of symptoms associated with Parkinson’s Disease as with providing a higher quality of

life to those in late adulthood battling diseases that cause movement disorders including

Alzheimer’s Disease as well as other movement disorders that are not discriminatory to age sex

religion or creed. Multiple Sclerosis, Early Onset Parkinson’s Disease. dyskinesia as well as

depression and anxiety that impact a wide number of people who may or may not have a

movement disorder. The most difficult part of this report will be keeping it brief.
Bibliography

Quentin Shires has taught psychology and other social science classes at the university level and
is considered a doctoral colleague at Capella University

Sietske N. Heyn is a medical writer with a PhD in neuroscience. Dr. Heyn's education includes a
BS with honors from the University of Oregon, and a doctoral degree in neuroscience from
the University of California at Davis.
Dr. J William Langston over 30 years of experience in the Parkinson’s field, known for
both clinical and basic research in Parkinson’s disease, as well as in day-to-day patient
care. Dr Langston has published about 400 scientific papers regarding disease -modifying
therapies for disease, ways to treat the side-effects of chronic levodopa therapy (in
particular levodopa-induced dyskinesias or Parkinson’s Disease Dyskinesia), the genetics
of Parkinson’s disease and related disorders and the epidemiology of the disease. He
originally gained national and international discovering the cause of parkinsonism in a
group of young heroin addicts in Northern California who after using a “synthetic heroin”
developed severe parkinsonism.

Dr. Kelly E. Lyons re-joined the faculty in the Department of Neurology at the University of
Kansas Medical Center in 2003 as a Research Associate Professor and Director of Research for
the Parkinson's Disease and Movement Disorder Center. Her primary areas of research are
Parkinson’s disease and essential tremor. She has over 200 articles and presentations in these
areas, and is co-editor of the Handbook of Parkinson’s disease, 3d, 4th, and 5th Ed. Therapy of
Parkinson’s Disease 3d Ed. And Handbook of Essential Tremor and other Tremor Disorders Dr.
Lyons is the President of the International Essential Tremor Foundation; Co-Editor in Chief of
the International Journal of Neuroscience, and Editor and Chair of the Movement Disorder
Journal CME committee.

Professor K Ray Chaudhuri is Consultant Neurologist and Professor in Neurology/Movement


Disorders at Kings College and Institute of Psychiatry, London an Academic Health Sciences
Centre and also principal investigator at the MRC center for neurodegeneration research at Kings
College, London. Dr Chaudhuri is the European Editor of Basal Ganglia, He is in the editorial
board of Parkinsonism and Related Disorders and Journal of Parkinson’s Disease and the leader
for London South CLRN neurosciences sub-specialty group.

Dr Emmanuel Pinteaux MSc, PhD Affiliations: Division of Neuroscience & Experimental


Psychology, Lydia Becker Institute of Immunology and Inflammation, School of Biological
Sciences. Dr. Pinteaux has over 57 publications on a variety of Neurological studies at the
University of Manchester, UK
ABSTRACT

Parkinson's disease (PD) is the second most common age-related neurodegenerative disorder.

Due to the progressive loss of substantia nigra pars compacta dopamine neurons the person with

Parkinson’s decreases in producing the neurotransmitter dopamine Dopamine levels affect bodily

functions such as movement, memory, sleep and mood. Dopamine is known as a part of the

reward center that is also associated with a variety of addictions. It is produced in the ventral

tegmental area (VTA) substantia Nigra pars compacta and the hypothalamus of the brain.

(Shires)

(image 1) his image is in the public domain due to being materials that originally came from the

National Institutes of Health.


OVERVIEW

Parkinson’s Disease is a movement disorder that can affect not only the physical aspects of

a person's life, that includes speaking, eating writing. As well as walking. It also has a role in the

mental health as well of a person battling the disease. There is no specific cause for Parkinson’s,

and currently there is also no cure for the disease. Most know this disease by the famous people

who have been diagnosed with the disease. Former Attorney General Reno. Pope John Paul.

Michael J. Fox. Evangelist Rev. Billy Graham and Actor Allen Alda

Symptoms and Treatments of Parkinson’s

Parkinson's disease is a neurodegenerative disorder Due to the loss of dopamine

producing brain cells PD progressively deteriorates the person with PD to manage

movement in their hands, arms, upper torso as well as their lower extremities, typically

called dyskinesia, that can be misdiagnosed for “tremors” and “rigidity”, also symptoms

of Parkinson’s. Discoordination is also prominent with Parkinson patients, both

externally and internally that increases the risk of falls often times causing orthopedic

injuries to the patient. Dyskinesia also affects the respiratory muscles and often times

goes unrecognized until the patient has reached the latter part of stage of 2 or stage 3 of

the five stages of Parkinson’s.. those in late adulthood are typically who are diagnosed

with PD (around 60 years of age and older). However, adults, as young as 18 years of age

have been diagnosed with “early-onset Parkinson's disease: (Heyn)


Primary symptoms include:

o Tremor

o Stiffness

o Slowness

o Impaired balance

o Shuffling gait later in the disease

Secondary symptoms include:

o Anxiety

o Depression

o Dementia

Though there are 5 stages and several symptoms that can be discussed. This paper give an

insight to Parkinson’s Disease Dyskinesia and parkinsonian tremor, that has a risk

of being misdiagnosed particularly when the patient’s medical history is the the

only primary source for making the diagnoses. It is critical to make the correct

diagnosis of either symptom due to how profoundly different the treatment for

either symptom can impact the patient’s treatment program. If a Parkinson’s

patient shows signs of dyskinesias that are affecting their quality of life, one

option would be to reduce the levodopa dosage. Levodopa is used to increase the

dopamine levels in the brain and body. Yet too much levodopa in the body will

cause the patient to have Dyskinesia. However, a patient with Parkinsonian

tremors, one form of treatment would be to, increase dopaminergic therapy using
levodopa or dopamine agonist such ropinirole or pramipexole. (Langston) another

treatment to reduce both Essential Tremors associated with MS and Parkinsonian tremors

is an invasive procedure known as Deep Brain Stimulation (DBS)

What is Dopamine?

Dopamine is a neurotransmitter created in three areas of the brain. The hypothalamus, the

Ventral tegamental area (VTA) and substantia nigra pars compacta responsible for

sending messages between the brain and different nerve cells of the body. Dopamine has

been identified as the body's reward activator, controlling the pleasure center of our brain

while encouraging us to engage in thrill-seeking activities. It is suggested that individuals

with low levels of dopamine are more prone to addictive behaviors, and are more likely

to use and abuse drugs consume too much food and have sexual addictions.

(image 2 courtesy "Medical gallery of Blausen Medical, 2014)

Parkinson’s has both motor and non-motor symptoms Most know about the motor

symptoms due to the symptoms being visible in the daily life of the patient. However

there are non-motor symptoms that are not as noticeable to others outside the patients
home. Some non-motor symptoms include hallucinations- seeing or hearing things not

there. blurry or double vision and uncontrollable sweating.(Lyons, 2013) Most patients

go undiagnosed with the disease until the motor symptoms have begun to impact their

life. Many times, not until after an individual has a Transient Ischemic Attack (TIA or

“mini stroke”) will the patient be diagnosed with Parkinson’s. Or, by that time the motor

symptoms are far advanced where they have lost motor functions that include walking

with a gait, or tripping caused by dragging their feet, shaking in their hand(s) or their

arms is not moving normally while they are walking. These and other similar symptoms

are typically associated with the latter part of stage 2 or the beginning of stage 3 of

Parkinson’s disease, where the brain is no longer producing adequate amounts of the

neurotransmitter, dopamine. While the non-motor symptoms go un reported by the

patient as well as being overlooked by clinicians, often times by those who have not been

around patients with Parkinson’s and are familiar with the non-movement symptoms

associated with PD. The non-motor symptoms are often occurring long before the motor

symptoms begin to occur. In an international survey conducted in 2010 as many as 62%

of PD patients didn’t declare non-motor symptoms such as apathy, pain, sexual difficulty,

bowel incontinence or sleep disorder, due to embarrassment or just being unaware these

symptoms may be linked to having Parkinson’s disease (Chaudhuri, et al. 2010).

Silent strokes often are unnoticeable. However, research suggests silent strokes have

lasting effects.

Dr. Pinteaux and a team of researchers induced a silent stroke like state (mild stroke) in

the striatum area of the brain of laboratory mice. Not surprisingly, he and his team

detected inflammation and damage in the striatum. Dopaminergic neurons in the


substantia nigra in the brain die. The substantia nigra is responsible for movement

coordination. According to Dr Pinteaux "At the moment we don't know why

dopaminergic neurons start to die in the brain and therefore why people get Parkinson's

disease. There have been suggestions that oxidative stress and aging are responsible.

What we wanted to do in our study was to look at what happens in the brain away from

the immediate area where a silent stroke has occurred and whether that could lead to

damage that might result in Parkinson's disease."

Recently ‘movement symptoms associated with Parkinson’s Disease had been a key

subject in providing Parkinson Patients who are stage four or higher, suffering with

Parkinsonian Tremors a less invasive procedure than Deep Brain Stimulation that also

does not have the health risks.

One such Treatment is Magnetic Resonance guided Focused Ultrasound. (MRgFUS

Though relatively safe, like any major surgery has its risks that include infection of the

wound as well as hemorrhaging or excessive bleeding to the blood vessels as well as

stroke (Mayo Clinic) as Deep Brain Stimulation does, where a small device (pacemaker) is

placed inside the patient’s chest and sends electrical pulses to the brain. The pulses block

nerve signals that cause tremors and other movement disorders. (WebMed). DBS has also

been used for treating patients with Obsessive Compulsive Disorders as well as depression.

More recently, a procedure incorporating Magnetic Resonance Imaging and Ultrasound

technology has been used to eliminate the symptoms of Dyskinesia This procedure is less

invasive and shows positive signs for not damaging other areas of the brain (Schlesinger, et al

2017) .
Currently there is no cure for Parkinson’s Disease. For some patients with PD MRgFUS

provides an alternative to treat the underlying disease pathology with potential of preventing

the progression of the symptoms as well as restoring motor functions

Some Advantages of MRgFUS Include (Focused Ultrasound Foundation 2018)

• Focused ultrasound is non-invasive – no incisions, holes in the skull, electrodes in the

brain – and therefore has reduced risk for infection and blood clots.

• Precise targeting minimizes damage to non-targeted healthy brain.

• Compared to deep brain stimulation, focused ultrasound is a single procedure, and does

not require subsequent procedures/visits to replace batteries, repair broken wires, or

adjust simulator settings. It also does not involve the collateral damage to healthy tissue

or the risk of infections associated with implanting a foreign body.


SOURCES

Heyn SN, Davis CP and Stoppler MC “Parkinson’s Disease Symptoms Cures, Stages,
Treatment, and life expectancy” MedicineNet
https://www.medicinenet.com/parkinsons_disease/article.htm#parkinsons_definiti
on_and_disease_facts

Dr. J.W Langston, “What is Parkinson’s Disease Dyskinesia?” Davis Phinney


Foundation https://www.davisphinneyfoundation.org/blog/what-is-parkinsons-
disease-dyskinesia/

TED TV, (2013) with Dr. Kelly Lyons “Redefining Parkinson's Disease
https://www.youtube.com/watch?v=gJidzMJERmw

Chaudhuri KR, Prieto-Juvcynska C, Naidu Y, et al The non declaration of non motor


symptoms of Parkinson’s disease to healthcare professionals. An international
survey using the NMSQuest. Mov Disord 2010;25:704–9. PubMed.gov
https://www.ncbi.nlm.nih.gov/pubmed/20437539?dopt=Abstract

WEbMed “Deep Brain Stimulation for Parkinson’s Disease


https://www.webmd.com/parkinsons-disease/guide/dbs-parkinsons#1

Parkinson’s Disease Volume 2017, Article ID 8124624, 5 pages


MRI-Guided Focused Ultrasound in Parkinson’s Disease: A Review
https://doi.org/10.1155/2017/8124624

Mayo Clinic,(2018) “Deep Brain Stimulation” https://www.mayoclinic.org/tests-


procedures/deep-brain-stimulation/about/pac-20384562

FOCUSED ULTRASOUND FOUNDATION; PARKINSON’S DIESEASE (APRIL 26


2018) https://www.fusfoundation.org/diseases-and-
conditions/neurological/parkinsons-disease