CHRONIC CONFUSION: PARKINSON’S DISEASE

This is a condition that most people have heard of but very few know about. It was first described by James Parkinson in 1817 and his description of his first six cases has never been bettered.
He worked as a doctor in Shoreditch in the East End of London, and whilst out in the market one day he saw two men, both were running but the front one was upright and the one behind severely stooped and only kept from falling by the front man’s hand under his chin. He watched them run daily through the market area, and gradually got to know them. They were brothers, and as one became more bent over he could only stagger forwards, getting raster and faster, and would fall over without his brother’s help. Parkinson made a study of the stooped brother and over the years round five other cases that he wrote up for the medical journals, describing them as having the ‘shaking palsy’. His detailed assessment of the condition, later to be known as Parkinson’s disease, missed very few symptoms and signs. Parkinson did however state that he thought that in this condition the intellect was spared. This is now being questioned.
Parkinson’s disease is one of the most common neurological disorders of the elderly. It has many special features. One is the tremor of the fingers and hand. This usually starts on one side and is very rhythmical; the fingers are said to resemble someone who is ‘pill rolling’. There is difficulty in starting a movement so that getting out of a chair or bed can be very difficult. The muscles become more stiff and rigid so that movements are slow and the face becomes blank and staring as the facial muscles become affected. All movements become disordered and the person tends to fall easily because they cannot balance well, and as the disease progresses they tend to stoop forwards and hence fall forwards. To try and prevent overbalancing the person takes little fast steps and may find themselves at a trot like Parkinson’s first case.
The natural arm-swing goes, so the arms hang by the side and even the muscles in the gullet can be affected, making swallowing difficult. The skin can become very greasy with a tendency to spots, and the bladder can be affected, causing extreme urgency to pass urine and often incontinence. All these features may not occur at all in some people when the disease is very mild; for others the symptoms and signs described come on over years but can cause increasing severe disability – all aspects of daily life can be affected, even down to handwriting, so that letters and cheque signing become impossible and buttons and laces something to avoid.
It is not surprising that depression is very common in this condition. The expressionless face and slow, often whispered, speech can lead people to think that the person behind the mask is simple. As we shall see, chronic confusion can be a feature of the condition but for most sufferers their mind is alert, seemingly trapped in a body that won’t do what they want it to. The greasy skin and tendency to drool at the mouth adds to the distress and misery. Depression should always be looked for because it is, amenable to treatment and can make a lot of difference to the quality of life of the person with Parkinson’s disease.
Unfortunately, as the disease progresses, there is a tendency for the sufferer to become confused. At the end stages of the condition there appears to be an overlap with Alzheimer’s disease and the same changes are found in the brain. For many, this intellectual impairment occurs at the same time as the disease stops being sensitive to drug therapy and the two systems’ failures are often a terminal event. For some, however, the mental deterioration appears to occur earlier and this makes their management especially difficult. There is still debate as to whether these people are subjects with Parkinson’s disease who have also developed Alzheimer’s disease or whether their chronic confusion is another manifestation of the Parkinson’s disease.
*23/128/5*

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Posted on Tuesday, September 14th, 2010 at 2:36 pm and is filed under General health. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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