Monday, 23 November 2015

The 5 Stages of Parkinson’s disease

On August 11, 2014, the world woke up to the shocking news that the famous comedian and actor Robin Williams of Mrs. Doubtfire fame (the movie that inspired the making of Avvai Shanmugi) had passed away. Robin Williams had been afflicted with Parkinson’s disease, a degenerative disease that affects the nervous system. Apart from restrictive mobility, depression is one of the hallmarks of this disease.

The signs and symptoms commonly exhibited by someone afflicted with Parkinson’s are discernible as follows:

  • Lack of coordinated movement
  • Uncontrolled shaking or tremors exhibited by parts of the body (head, hands, etc)
  • Stiffness of the limbs
  • Slow movement
  • Standing up and balancing
  • Difficulty in speaking lucidly

These signs may differ from person to person, but as this brain disorder progresses, it only worsens through the stages. The progression of Parkinson’s has been mapped into 5 stages, which are:

Stage I: A person in this stage may show some mild symptoms, which are not alarming, and which do not prevent them from carrying out their daily tasks, nor does it affect their lifestyle. The tremors and difficulty in movement are very minimal and are usually restricted to one side of the body. These signs are so minimal that they can often be missed. When diagnosed and treated at this stage with medications, it does work to minimize the symptoms.

Stage II: This is considered the moderate stage and the symptoms become noticeable. Changes in facial expressions may begin to occur, and the trembling, tremors and stiffness in the muscles will be very perceptible. There is no impairment of balance, but stiffness in the muscles does elongate the time taken to complete tasks. Also at this stage, Parkinson’s affects both sides of the body and may cause speech difficulty. Progression from stage I to II can happen in months or may take years, and depends on each individual.

Stage III: This is still considered the mild stage and the symptoms are still the same as were in Stage II, but with the added symptoms of loss of balance and decreased reflexes. The chances of falling frequently are greater at this stage. Moreover, the patient will now find it more difficult to complete their daily tasks. Medication and occupational therapy can help decrease the symptoms now.

Stage IV: Dependency on others increases at this stage, as movement becomes very difficult indeed. The patient may be able to stand up without aid, but may require an assistive aid such as a walker to move. Performing daily tasks also becomes even more difficult, and the patient can no longer live alone.

Stage V: This is the final and most advanced debilitating stage in Parkinson’s disease. The stiffness is in an advanced stage, and upon standing, sometimes causes freezing of the muscles. The patient will require being in a wheelchair and may often be unable to stand without falling.

Therefore, the patient will require round-the-clock assistance. Furthermore, the patient will experience hallucinations and be occasionally delusional. The side-effects of medications at this stage counterbalance the benefits.
Age groups prone to Parkinson’s disease

The early stages of Parkinson’s set in usually around 62 years of age. Parkinson’s is also known to occur in people of younger age groups - 50 and below. Being affected by Parkinson’s below the age of 50 years is known as ‘young-onset Parkinson’s disease’.

Sunday, 1 November 2015

Stroke in the Elderly

Stroke, as per statistics, is the leading cause of impairment and the third leading cause of death among the elderly, in India. Stroke is also the cause of disability and pre-mature death in the rural, semi-urban and urban regions of India. To a large extent, the poor who have been exposed to the risk factors, basically have no knowledge of how to act in the event a loved one has an attack of stroke, nor do they have the means to meet the high cost for stroke care. 

The primary non-modifiable risk factor for an attack of stroke is age. The risk factor of a stroke attack for elders in the age group of 74-84 have been determined to be 60% and for those 85 years of age and beyond, the risk factor has been determined to be around 80%. The gender of the elder also plays a significant part in the outcomes, treatment and epidemiology of geriatric stroke. It is important to recognize gender differences to enable better outcomes and treatment. Though the entire aged population are at a risk of a stroke, the incidence of stroke is higher in men in the age group 65 to 84 years (men 52%, women 48%) but greater in women at 85 years and above (men 37%, women 63%). 

Some of the common disorders among the elderly include:

  • Silent Strokes
  • Other unrecognized brain abnormalities
  • Aneurysms
  • Benign Brain Tumors

Generally, the tendency of many people is to ignore the small stokes or in some cases, may be ignorant of the signs that are associated with a stroke. However, a stroke does give prior warnings of an impending attack. Therefore being aware of what those signs or symptoms are is important. A sudden attack of any of these symptoms is an indication of an impending attack of stroke.

  • Weakness, numbness or paralysis occurring in the facial region, arms or legs
  • Inability to speak properly, may feel confused or have trouble understanding
  • Temporary loss of vision in either eye, rarely in both
  • May feel dizzy, have trouble walking, maintaining balance or coordination
  • Severe headaches for no apparent reason

Strokes of any type are categorized under two major categories – Ischemic and Hemorrhagic. 

Ischemic Stroke

The term Ischemia refers to the condition where there is insufficient supply of blood to a particular region. Hence, blockages of blood supply to the heart, brain, etc are called an Ischemic attack. The more common of the two types of strokes, is Ischemic stroke. During an Ischemic stroke, blood clots or formation of plaque, block the blood supply to the blood vessels in the brain. The blood clot(s) forms along the walls of the blood vessel or in some cases fat deposits narrow the passage in the blood vessel, thus causing a thrombotic stroke. Many times, due to high blood pressure levels, the blood vessel may also be damaged. A blood clot or an embolus occurring in another part of the body, can travel to the brain region and block the blood vessel (s) there, causing an embolic stroke or cerebral embolism. An embolic stroke, more commonly occurs when the blood clot travels from the heart, after a heart attack or when atrial fibrillation (irregular heartbeats) occur. 

Hemorrhagic Stroke

When a blood vessel in the brain bursts or there is leakage of blood into the brain, a hemorrhagic stroke occurs. Hemorrhagic stokes do not occur as commonly as the Ischemic stroke. They are categorized into two types – Intracerebral and Subarachnoid hemorrhages.  

Leakage of blood from a broken blood vessel in the brain, damages the brain cells and also cells beyond the area of the broken blood vessels, which die due to lack of blood supply. This condition is referred to as intracerebral hemorrhagic stroke. 

In a Subarachnoid hemorrhagic stroke, a blood vessel that is close to the surface of the brain breaks, and the blood collects between the surface of the brain and the skull, causing irritation to the lining of the brain. This is also a very painful condition. 

Act on a TIA

Be aware of the mini stroke or Transient Ischemic Stroke (TIA), which is a temporary forewarning of an impending stroke. It may last for a few minutes or for an hour or two, as the block that occurs, quickly clears up by itself. However, this is definitely a sign / symptom of a full blown Ischemic stroke, which could occur anytime soon, even the same day. Consequently, an immediate medical evaluation will help stave off dire consequences.

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