Early Parkinson’s Disease (PD) is characterized by the motor symptoms of tremor, rigidity and slowness of movement. These symptoms are — to varying degrees — related to a lack of dopamine (a chemical in the brain) output and often initially respond robustly to medications that affect dopamine (dopaminergic). However, it has long been known — although only recently widely recognized — that PD is a disease of the whole brain that affects numerous brain chemicals and body systems. PD symptoms not related to movement are referred to as non-motor symptoms (NMS). Some NMS, such as constipation, sleep disruption and loss of smell, can begin up to 20 years prior to the onset of motor symptoms, while others develop later in the disease.
Problems in Progression of PD
While the progression of PD is different for every patient, there are several very common problems that arise. The first problem is the progression of motor symptoms. Fortunately, there are numerous treatment options for motor symptoms, including adjustment of medications and deep brain stimulation surgery.
The second problem is the development of complications related to dopaminergic therapy. These include abnormal movement, fatigue, sleep attacks, compulsivity, head rush, nausea, dry mouth, lower body swelling, confusion, and hallucinations. Addressing these side effects requires maintaining a delicate balance between the need to maintain motor function and the need to mitigate disabling side effects.
The third problem is the development of postural instability, soft speech, and difficulty swallowing. These motor symptoms often do not respond to dopaminergic medications, which can lead to falls, choking, pneumonia and loss of independence. The only recommended treatments revolve around speech and physical therapies.
The final problem is the development of NMS such as depression, pain, urinary dysfunction, overproduction of saliva, fatigue, head rush, and dementia. In the mid and later stages of PD, it is often these NMS that have the largest effect on the lives of not only patients, but also their family and caregivers. These symptoms can be overwhelming for a single clinician to manage.
With such a complicated array of motor and non-motor symptoms, it is important that patients have access to a comprehensive treatment team. The Oregon Clinic Neurology understands the complexities of PD care and the need for a team approach to tackle this complicated disease. That is why we started our multidisciplinary clinic at Legacy Emanuel Medical Center. In this clinic, patients and their caregivers see a neurologist, physical therapist, speech pathologist and social worker in one afternoon.
As opposed to the common PD treatment, where a patient has separate appointments with their providers and communication between providers is often fragmented — our clinic brings all aspects of care under one roof. The single appointment saves patients time and energy while providers are able to produce a unified and comprehensive treatment plan that addresses the patient and their caregivers as a whole. The comprehensive care plan and recommendations are also provided to primary care providers to ensure coordination of care and timely follow-up for these patients and their caregivers.