Parkinson’s Syndrome

Parkinson’s syndrome occurs in middle-aged and older adults due to degeneration of the substantia nigra and the nigrostriatal pathway. According to the American Parkinson’s Disease Association (APDA), individuals who develop the disease before the age of 40 are considered young-onset Parkinson’s disease patients. The cause of primary tremor paralysis remains unclear, with around 10% of patients having a family history. Some patients may develop Parkinson’s syndrome due to encephalitis, cerebral arteriosclerosis, brain injury, hypoparathyroidism, poisoning from carbon monoxide, manganese, mercury, cyanides, reserpine, phenothiazines, antidepressants (monoamine oxidase inhibitors, etc.).

The disease progresses slowly and gradually worsens, with symptoms including:

1. Posture and Gait: A rigid, mask-like face with a forward-leaning head, trunk bent forward, and slightly flexed elbow and knee joints. Walking involves small steps, starting slowly and getting faster, with a shuffling gait and no arm swing.
2. Tremors: Commonly in the head and limbs, especially the hands, with large, rhythmic tremors, often appearing at rest and disappearing during voluntary movement and sleep. Emotional stress can worsen tremors.
3. Muscle Rigidity: Increased tension in both extensor and flexor muscles, creating a “gear-like” or “lead-pipe” resistance during passive movement.
4. Movement Disorders: Difficulties in daily activities like speaking, writing, eating, and personal care due to muscle rigidity.
5. Others: Emotional instability, occasional impulsive behavior, increased sweating, drooling, and a reduction in dopamine and its metabolites in cerebrospinal fluid and urine.

Since the disease is related to reduced dopamine levels in the brain and relative excess of acetylcholine function, treatment typically involves increasing dopamine and decreasing cholinergic function, as follows:

• Dopamine Replacement Therapy: Levodopa is the first choice, starting at 500 mg/day, divided into two doses after meals. The dose is gradually increased by 250-500 mg/day every 3-5 days until optimal effect with minimal side effects, typically 2-4.5 g/day, but should not exceed 5 g/day. Amantadine is useful for mild cases, starting at 100 mg three times a day.
• Anticholinergic Drugs: Common options include Artane (2-4 mg, three times a day), Scopolamine (0.2-0.4 mg, three times a day), and Benztropine (5-10 mg, three times a day).
• Acupuncture Therapy: For treatment-resistant cases, acupuncture targeting the tremor and movement areas may be used.

For more severe or younger patients, surgical treatment may be considered if medications are ineffective.

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Parkinson’s Disease Diagnosis

Parkinson’s disease is typically diagnosed based on clinical presentation, often in people over 60, although some cases begin earlier. The main symptoms are:

• Tremors: Usually, the first symptom, often starting in one hand or limb and spreading.
• Muscle Rigidity: Occurs in both extensor and flexor muscles, causing stiffness and discomfort.
• Bradykinesia: Slowness of movement, especially when starting, with difficulty performing repetitive tasks.
• Postural Abnormalities: A stooped posture and walking difficulties such as shuffling, small steps, and difficulty stopping.

Dietary Considerations

1. General Recommendations: The elderly often have diminished digestive functions, so a balanced diet with adequate fiber is crucial. Foods like fruits, vegetables, and water-rich foods are beneficial.
2. Protein Control: Excessive protein can interfere with levodopa effectiveness, so protein intake should be controlled. Adequate protein (0.8-1.2 g/kg body weight) is necessary for overall health.
3. Specific Nutrients: Ensure sufficient intake of vitamins and calcium, especially through dairy products. Protein should be distributed in meals to avoid interfering with drug absorption.

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Rehabilitation and Family Care for Parkinson’s Syndrome

1. Exercise: Keep the body active to prevent muscle stiffness, focusing on walking, rowing, stretching, and other mobility exercises.
2. Daily Activities: Try to maintain daily work or hobbies to prevent stiffness from inactivity.
3. Diet Control: Watch weight and avoid excessive consumption of vitamin B6, which can interfere with levodopa.
4. Infection Prevention: Prompt treatment of coughs and fevers to avoid infections like pneumonia.
5. Constipation Management: Encourage exercise, hydration, and fiber-rich foods.

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Exercise for Rehabilitation

1. Relaxation and Breathing Exercises: Deep breathing to relax the body and mind.
2. Facial Exercises: To reduce the “mask-like” face, try exercises that involve smiling, frowning, and blowing kisses.
3. Neck and Trunk Exercises: Focus on mobility in the neck and spine to prevent further rigidity.
4. Upper Limb and Shoulder Exercises: Stretch arms and shoulders regularly to maintain mobility.
5. Lower Limb Exercises: Include sitting on the floor or bending and stretching legs.
6. Balance and Walking Exercises: Practice walking with larger strides and maintain a stable posture.
7. Speech and Swallowing Therapy: Focus on improving speech with tongue and lip exercises, and practice loud speaking.