According to the UN’s World Population Ageing Report 2015, the elderly population in India is estimated to grow rapidly.
Improving economic conditions and enhanced access to healthcare have increased the life span and caused a shift in disease patterns from communicable diseases such as hepatitis, cholera, malaria, tuberculosis and HIV to non-communicable diseases like Parkinson’s, Alzheimer’s, asthma, diabetes and heart disorders.
The burden of such diseases is projected to grow substantially over the next few decades as the size of the elderly population grows.
What is Parkinson’s Disease?
Parkinson’s is a progressive disorder of the nervous system that affects movement. It develops gradually, sometimes with a simple tremor in one hand, followed by stiffness of joints and slowing of movement.
Parkinson’s, commonly found in the elderly, can become a major healthcare challenge in the near future due to lack of awareness about the disease and its symptoms.
While the exact cause of the disease is yet to be understood, researchers speculate that both genetic and environmental factors contribute. Parkinson’s occurs when certain nerve cells called neurons in the brain gradually start degenerating or dying down.
Many of the symptoms occur due to loss of neurons which produce a chemical messenger in the brain called dopamine. When dopamine levels decrease, or not enough dopamine is made in the brain, movements become delayed or uncoordinated, showing up as symptoms of Parkinson's disease.
There is no single defining symptom or sign of Parkinson’s, but a combination of warning signs which each individual experience differently.
Following are the common early symptoms that hint Parkinson’s:
- Slowing down of activities of daily living
- Takes longer to do routine tasks
- Gain abnormality: short, slow steps with dragging of feet and stooping posture
- Emotionless face
- Shaking (tremors) of arms and legs
- Stiffness of arms and legs
Medication and Lifestyle Changes
Medication can initially help control the symptoms in Parkinson’s to a significant extent. Lifestyle changes, exercise and physical therapy that focus on balance and stretching are also recommended in addition to medication. A speech-language therapist can help improve speech problems.
Medications help in significant improvement of conditions and over time the patient can control the condition fairly well even when the benefits of the medicines diminish.
Medical Management of the Disease
The goal of medical management of Parkinson’s disease is to control the signs and symptoms while minimizing the adverse effects. The patient’s quality of life deteriorates if diagnosis and subsequent treatment are not initiated at the earliest. Parkinson’s is primarily diagnosed based on medical history of the patient, signs and symptoms. It is confirmed by neurological and physical examination.
Drawing definite diagnosis sometimes takes time and may need regular follow-up appointments. The disease can be treated through medication and lifestyle changes or surgical procedures.
Surgery as a Treatment Option
In advanced cases of Parkinson’s, surgery may be advised. Deep brain stimulation (DBS), which involves minimal permanent surgical changes to the brain, is prescribed to treat motor symptoms in Parkinson’s disease, such as tremor, rigidity, stiffness, slowed movement and walking problems.
Surgery is offered to patients who have had the disease for a long time and medications are no longer working.
In this procedure, surgeons implant electrodes into a specific part of the brain. These electrodes are connected to a pacemaker implanted in the chest near the collarbone that sends electrical pulses to the brain for reducing symptoms. The surgery is done using computerized techniques and micro-electrodes recording from depths of the brain (brain-mapping).
Like any other surgical procedure, there are certain complications associated with DBS as well, in a very small number of patients. However, in these patients suffering for a long time, DBS implant can be a game changer and restore independence to these immobile patients and enable them to carry on with their jobs and daily activities with ease.
(Dr V P Singh is the Chairman, Institute of Neurosciences at Medanta- The Medicity)
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