Abuhaidar 1

Musa Abuhaidar

Professor Hellmers

English Composition II

18 April 2021

Parkinson’s Disease

Imagine living a life where trembles, shakes, and difficulties with motor functions

hinders the way that a person lives their life. Jamil Khaled (my grandpa) suffered from

Parkinson’s disease (PD), as the illness affected his life terribly. “Long duration of PD was

associated with decreased mobility, communication and activities of daily living” (Wressle). He

experienced symptoms such as tremors and shakes; then, as he got older it affected his posture

and the way he walked. Mr. Khaled struggled with simple daily tasks, causing him to develop

depression, which 40%-50% of people who suffer from PD develop over time (McGlasson). In

the final years of Mr. Khaled’s time, PD had taken over his life and caused him to bedridden for

the majority of the time.

Parkinson’s disease (PD) is an illness that mostly affects the elderly, but there have been

people diagnosed at young ages. PD, which affects approximately 10 million people in the

world, causes motor functioning difficulties. It is a neurological illness that affects a person

mentally and physically. Although there are treatments for this disease, there is no cure.

PD dates back to the years of 175 AD and was described by physicians as “shaking

palsy” (Parkinson's Disease History). It is a familiar disease that people knew about, but the

cause of the disease was not yet understood. In 1817, a London doctor by the name James

Parkinson, wrote a detailed medical essay about Parkinson’s disease stating it was an illness

(Parkinson's Disease History). Throughout the years, neurologists began to research more about
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the shaking disease. Jean Martin Charcot named the disease after Dr. Parkinson and found two

types of Parkinson’s: the tremor stage and the rigidity stage. In the 1960s, development of

treatments for Parkinson’s disease became more available. The National Institute on Aging

published an article on Parkinson’s disease. They stated that, “Parkinson's disease is a brain

disorder that leads to shaking, stiffness, and difficulty with walking, balance, and coordination”

(Parkinson's Disease). Those are the symptoms that an individual will encounter if they have PD.

The root cause of PD is damage or death of nerve cells in the cerebellum, which causes

an important brain chemical called dopamine to decrease. The nerve cells in the cerebellum are

important for many functions in the brain; however, the production of dopamine is restricted due

to the damage of the cells. Dopamine is responsible for many functions in the human body, such

as its involvement in motivation, reward, memory, attention, and regular body movement

(Wressle). The decrease in dopamine causes the main symptom of PD, which is the difficulty

with movement.

Parkinson’s disease progresses over time. People that suffer from PD will begin to notice

minute symptoms such as tremors and shaky hands or feet (Parkinson's Disease). However, these

slight symptoms will progress and become worse due to more nerve cells becoming damaged.

PD is classified into five stages to assess the level of severity that the patient is enduring. Stage

1- unilateral symptoms only, Stage 2- bilateral symptoms, Stage 2.5 bilateral symptoms with

mild postural symptoms, Stage 3- bilateral symptoms with definite impairment of postural

reflexes, Stage 4- severe disability, but still is able to walk or stand, and Stage 5- the patient is

wheelchair bound or bedridden (Quality of Life in Parkinson's Disease). As the stages increase,

so does the severity of PD that the patient endures. PD is not fatal, but the complications that a

person encounters will cause their life expectancy to reduce dramatically.

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The symptoms of PD are not the only complication that a person will agonize from,

nonmotor symptoms have been shown from people. Depression is one of the nonmotor

symptoms that have been reported from people that have PD. The psychological illness

depression affects an individual's mood, which can cause an individual to act different or become

more sensitive towards certain situations. Research has proven that 40% of individuals that suffer

from PD have some sort of depression (McGlasson). Individuals may experience depression

because of one the most demoralizing facts about PD. It is not curable, atleast to our knowledge.

Not being able to cure a disease will affect a person mentally, due to the fact that their life will be

altered forever. However, “... depression in individuals with PD is also likely manifested because

of the actual neurodegenerative process” (McGlasson). The damage and deterioration of nerve

cells may be another underlying cause of depression with PD individuals. Depression with PD

may result in stronger or more motor symptoms from PD, which can also result in a person to

become in a more depressed state. Other complications that depression can result in, “... faster

overall progression of the illness, greater cognitive decline, and increased caregiver burden…”

(McGlasson). PD is not the only illness to worry about because depression can cause PD to

worsen and negatively affect an individual's life.

Furthermore, PD has triggered, “... generalized anxiety disorder, panic attacks, agitation,

and phobias are also realities for individuals with PD, with estimates ranging from 20% to 50%”

(McGlasson). PD symptoms and the progression of deteriorating nerve cells is the main cause of

these psychological illnesses. Similarly, depression and anxiety in individuals with PD, including

the underrecognition and undertreatment of the disorder are main causes because of the overlap

with actual PD symptoms (McGlasson). Both of these psychological illnesses have negative

results on the individual, but be the result of neurochemical changes in the brain stem. As a
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result, PD can have more than just physical symptoms, consequently psychological illnesses can

be a huge issue affecting an individual's life.

The daily life of an individual with PD is dependent on their condition. Being diagnosed

with PD in an early stage will result in symptoms such as slight shakes and tremors, which could

hardly affect a person's daily living (Parkinson's Disease). Research conducted in Sweden on 31

elderly cognitive well-functioning non-depressed patients with PD resulted in that as the

progression of PD increased, the quality of life decreased. Throughout the research of the

participants the most common problem was mobility: “... difficulty with carrying home shopping

(39%), problems, with walking half a mile (35%) and difficulty with engaging in leisure

activities (32%)...” (Wressle). Mobility was a major issue as seen by the results, but these are

everyday activities that a person endures. 52% of the subjects were in stage 1 (referring back to

the 5 stages), 32% were in stage 2, and 16% were in stage 3 (Wressle). The first statistical

percentage to comprehend is that approximately 85% of the group was stage 1 or 2, and a small

percentage (16%) is in stage 3 (bilateral symptoms with definite impairment of postural

reflexes,). The mean age was 77 years old, which represents that the elderly who are diagnosed

with PD are more towards the first or second stage.

PD is an incurable neurological disease affecting the cellular life of nerve cells, which

causes motor functioning difficulties; however, treatments have been discovered to help the

symptoms of PD. One form of treatment is by taking medical prescribed medication. Many of

these medications are prescribed in multiple ways, ranging from pills, inhalers, to gels.

Carbidopa-levodopa is one medication that is prescribed and is the most commonly used by

individuals. Carbidopa-levodopa being the “... most effective Parkinson's disease medication, is a

natural chemical that passes into your brain and is converted to dopamine” (Mayo Clinic).
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Levodopa being a natural chemical that passes into the brain makes it safer for the body because

this is a chemical that is already present in your body. If this chemical is already present, then it

is not a forgien substance that your body is trying to fight against. There is also an inhaler

version of Carbidopa-levodopa, which works by inhaling the medication into your lungs.

However this form of medication is best used when oral medication begins to wear off (Mayo

Clinic). Carbidopa-levodopa infusion is a gel drug, but this is infused into feeding tubes that

directs it to the small intestines for quicker absorption, however this is meant for individuals who

are relying on feeding tubes only (Mayo Clinic). Dopamine agonists is a medication that does not

convert into dopamine, instead it mimics dopamine; however, this drug has shown to not be as

effective as others (Mayo Clinic). MAO B inhibitors and Catechol O-methyltransferase (COMT)

inhibitors are drugs that help by inhibiting the brain enzyme monoamine oxidase B and Catechol

O-methyltransferase. Monoamine oxidase B and Catechol O-methyltransferase are responsible

for the breakdown of dopamine in the brain, so inhibiting the enzyme allows for the dopamine to

be longer present in the brain (Mayo Clinic). Anticholinergics is another medication that is

mainly used to help with tremors with PD. Amantadine will be prescribed to patients to have

mild or early symptoms of PD (Mayo Clinic).

Majority of the treatments that individuals are given are medical medications prescribed

by their physician; however, there are surgical methods to help treat the symptoms of PD. Deep

Brain Stimulation (DBS) is the main surgical method used to help with the treatment of PD. In

DBS, surgeons will implant electrodes into a specific area in the individual's brain. Then, there is

an electrical generator that will produce a current to help stimulate the specific area in the brain.

The electric generator is placed around the chest near the collarbone. Surgeons will adjust the

amount of electrical current traveling through the electrodes to help maximize your treatment
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(Mayo Clinic). The electrode will be placed into either three parts of the brain, “...the thalamus

(which relays and integrates sensory and motor information), subthalamic nucleus (which helps

direct movement preparation), or globus pallidus (which helps regulate intended movement)”

(Deep Brain Stimulation for Movement Disorders). The thalamus, subthalamic, and globus

pallidus are responsible for some portion of the individual motor functions. Implanting the

electrode into these specific areas will help with the treatment of PD. However, the surgery is

only given to candidates who are unable to take medications because the medication has no

effect on them.

Fig. 1. A visual image of Deep Brain Stimulation ( Clinic, Mayo)

Another form of treat for PD is therapy, which is a medical practice that focuses on a

specific issue, while trying to solve that issue usually by doing repeated movements correctly.

There are multiple methods of therapies used to help treat the symptoms of PD; one method of
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therapy is massage therapy. Massage therapy involves an individual receiving a massage on

muscle groups that are affected by PD, such as the hands, feet, legs, and arms. Massage therapy’s

purpose is to help relieve muscle tension in current muscle groups, which will then help elevate

discomfort, pain, shakes, and tremors (Mayo Clinic). Tai Chi is an ancient form of chinese

exercise that has shown to help improve movement of individuals with PD. Tai Chi’s method

uses, “... slow, flowing motions that may improve flexibility, balance and muscle strength”

(Mayo Clinic). By exercising the affected muscle groups, it can greatly improve a patients well

being and symptoms of PD. Studies have proven that Tai Chi may improve the balance of people

with mild to moderate Parkinson's disease more than stretching and resistance training. The

Alexander Technique is a method that focuses on muscle posture, balance and thinking about

how you use muscles (Mayo Clinic). Focusing on your posture, balance, and thinking about how

to use your muscle will help with building muscle memories, which trains the body how to do

specific movements without really having to do much thought. Furthermore, the Alexander

Technique may reduce muscle tension and pain, which will help with the symptoms of PD.

Mediation has been used to help with PD. It involves a person clearing their mind and focusing

on specific ideas or images. Mediation improves a person’s stress and pain by releasing tension

throughout the body (Mayo Clinic).

The symptoms of PD can be improved at home with home remedies and by altering your

lifestyle a speck. Adjusting your lifestyle can have great benefits for treating some symptoms of

PD. For example, adjusting how an individual eats can greatly benefit their well being, but also

treat PD. However no foods have been found to help with treating PD, but a symptom that a lot

of people struggle with is constipation. Staying hydrated and eating enough fibers will help with

constipation (Mayo Clinic). Also having a balanced diet with omega-3 fatty acids, which can
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help improve the longevity of nerve cells because omega-3’s are used in the cell membrane of

each cell. Exercising is another important lifestyle that individuals with PD should participate in.

This does not have to be ridiculous exercises; it can be walking around your neighborhood for

thirty minutes, doing basic stretches, or even using light dumbbells to do basic lifting exercises

(Mayo Clinic). Once an individual reaches the higher stages of PD life can become difficult and

falling can be a dangerous factor that individuals must watch out for. Falling can cause serious

injury especially at older ages where the body is more fragile and slower at healing. Methods to

help reduce the risk of falling are “Make a U-turn instead of pivoting your body over your feet,

distribute your weight evenly between both feet, and don't lean, avoid carrying things while you

walk, avoid walking backward” (Mayo Clinic). By avoiding these movements and activities it

can reduce the risk of falling and can cause great injury.

The treatments for PD have been a great help to some people; for example, taking

Levodopa has been the most effective PD medication. However, all medications have their side

effects. Levodopa can cause nausea and lightheadedness; when taking higher doses an individual

may experience involuntary movements (dyskinesia), and the effect of the Levodopa will begin

to wear off once an individual’s PD has progressed too far (Mayo Clinic). Ingesting Levodopa

can greatly improve an individual’s by decreasing the shakes and tremors associated with PD.

Also, every drug has a limit to what it can treat. Once PD reaches the higher stages (3-5)

Levodopa may become less effective. This is a fact that individual’s will have to live with

knowing that at some point their medication will become less effective. Carbidopa-levodopa

infusion requires a feeding tube, which has to be surgically implanted and there are “Risks

associated with having the tube include the tube falling out or infections at the infusion site”

(Mayo Clinic). Carbidopa-levodopa infusion is utilized on patients who are towards stages 3-5,
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but still respond to levodopa. The small surgery required to receive this type of treatment is

something that can draw people away and possibly the risks of the tube of falling out, or the

infusion sight becoming infected. The small surgery could be the only method of treating the

severe symptoms of PD, and if an individual is cautious about the tube and correctly cleans it,

they he/she should not have issues with this method of treatment. Levodopa is the most effective

medication to take because it has shown to work the best for most individuals and it is proven by

research that it is the most effective.

From the surgical standpoint Deep Brain Stimulation (DBS) has been proven to help an

individual significantly. Their motor skills are significantly improved by DBS, however DBS is

not a cure for PD and is only offered to candidates who suffer from extreme PD symptoms

(stages 4-5). DBS utilizes electrodes that are implanted in specific areas in the individual's brain.

Then there is an electrical generator that will produce a current to help stimulate the specific area

in the brain. The electric generator is placed around the chest near the collarbone. Surgeons will

adjust the amount of electrical current traveling through the electrodes to help maximize your

treatment (Mayo Clinic). DBS for PD has a 10-year survival rate of 51%, which is effective at

enough to improve the living of an individual by a decade (Deep Brain Stimulation for

Movement Disorders). With DBS the usage of PD medication can be lessened.

Therapies are another great treatment for PD; however, Tai Chi, the Alexander

Technique, and frequent exercise have shown the most effective results. Tai Chi’s method uses,

“... slow, flowing motions that may improve flexibility, balance and muscle strength” (Mayo

Clinic). The slow stretching motions of Tai Chi is a productive way to help lessen the symptoms

of PD. The Alexander Technique which is similar to Tai Chi, but focuses more on muscle posture

balance, and thinking about moving your muscles is another therapeutic method used in physical
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therapy (Mayo Clinic). Furthermore, frequent exercise which is suggested by a lot of physicians

is another great treatment for PD. Exercise helps to condition the muscle, while keeping them

strong. Individuals do not have to do difficult movements, instead walking, yoga, stretching, and

doing light lifting can be enough to have positive effects on your symptoms. Altering an

individual's diet can be another effective way to help a person with PD. Even though

transitioning to a healthier diet has not proven treatment for PD, altering a person's diet can

improve the health of a person making them feel healthier and more. Consuming more omega-3

fatty acids, which can help improve the longevity of nerve cells because omega-3’s are used in

the cell membrane of each cell. The deterioration of nerve cells will begin with the cell

membrane and consuming more omega-3’s will improve the survival of the cell membrane.

Jamil Khaled (my grandpa) suffered from Parkinson’s disease (PD). The illness affected

his life terribly; “Long duration of PD was associated with decreased mobility, communication

and activities of daily living” (Wressle). He experienced symptoms such as tremors, and shakes,

then as he got older it affected his posture and the way that he walked. Mr. Khaled struggled with

simple daily tasks, which caused him to develop depression, which 40%-50% of people who

suffer from PD do develop over time (McGlasson). In the final years of Mr. Khaled’s life PD had

taken over his life and caused him to bedridden for the majority of the time. PD is a neurological

illness that affects a person mentally and physically, though there are treatments for this disease,

there is no cure. PD is a neurological disease that causes damage and deteriorates nerve cells

located in the cerebellum. The deterioration of nerves cells causes symptoms such as tremor,

shakes, and if the progression of PD reaches a severe stage, then the individual can become

bedridden. PD is an incurable disease, but treatments have been established to help with the

symptoms. Medications such as Carbidopa-levodopa, MAO B inhibitors, and Amantadine are

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used to help with tremors and shakes. Deep Brain Stimulation is a surgical procedure that has

had great success with the treatment of PD, but is only available for people that have severe

symptoms. Different methods of therapies such as Tai chi, Yoga, the Alexander technique, and

meditation have been used to treat the symptoms of PD. PD is a disease that affects the lives of

millions of people world wide and is a growing disease, however with time research and

scientists will develop more effective treatments, and maybe even a cure.
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Works Cited

Clinic, Mayo. Deep Brain Stimulation , Mayo Clinic , 7 Aug. 2020,

www.mayoclinic.org/tests-procedures/deep-brain-stimulation/about/pac-20384562.

“Deep Brain Stimulation for Movement Disorders.” National Institute of Neurological Disorders

and Stroke, U.S. Department of Health and Human Services, 11 June 2020,

www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Deep-Brain-Stim

ulation-Movement-Disorders-Fact.

Mandal, Dr. Ananya. “Parkinson's Disease History.” News, News Medical Life Sciences, 5 June

2019, www.news-medical.net/health/Parkinsons-Disease-History.aspx.

McGlasson, Terencio Daunte. Beyond the Tremors: What Counselors Should Know About the

Mental Health Needs of Clients Diagnosed With Parkinson’s Disease, ADULTSPAN

Journal, 27 Oct. 15AD, eds-b-ebscohost-com.sinclair.ohionet.org/eds/pdfviewe

r/pdfviewer?vid=3&sid=5fc1b975-0330-4a83-a9f9-7c3dd9745016%40sessionmgr101.

“Parkinson's Disease.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 8

Dec. 2020, www.mayoclinic.org/diseases-conditions/parkinsons-disease/diagnosis-treat

ment/drc-20376062.

“Parkinson's Disease.” National Institute on Aging, U.S. Department of Health and Human

Services, 16 May 2017, www.nia.nih.gov/health/parkinsons-disease.

Wressle, Ewa, et al. “Quality of Life in Parkinson's Disease at a Geriatric Outpatient Department

in Sweden .” Shibboleth Authentication Request, International Journal of Therapy &

Rehabilitation, Aug. 2006, eds-b-ebscohost-com.sinclair.ohionet.org/eds/pdfviewer

/pdfviewer?vid=9&sid=6f714dc2-981b-49bf-88de-86a7226c8ff9%40sessionmgr4008.
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