Parkinson's Disease has been known as a cruel and complex complaint, mainly affecting the elderly. Known until the early nineteenth century as the Shaking Palsy or Paralysis Aqitans, it was first given a thorough clinical description in 1017 by a London medico, Dr James Parkinson.

The incidence of the disease is worldwide, no race or class being exempt from attack.  It is not hereditary, nor is it infectious.  Statistically one in a thousand of the total population will contract it, but more significantly one in a hundred people in the over 60 age group will be a victim.

As yet there is no cure for the disease, but modern research has progressed a long way towards effective management of its insidious characteristics. Deep within the substance of the brain in a part not directly connected with intelligence or thinking is a complex structure which controls the muscles.  Its function is to manufacture the chemical dopamine. The outward signs of this deficiency are well known, namely shaking, stiffness and slowness, severity and distress to the sufferer.

What an onlooker observes is that the sufferer is prone to shake, to hesitate, to stumble, to fall, to develop a stoop, to present a fixed or glassy appearance, to dribble, to speak inaudibly. All these observable characteristics are directly due to the muscular impairment caused by dopamine deficiency.

As though to add insult to injury observed physical defects are often misinterpreted.  Suffers are considered drunk, high on drugs or senile.  Their re-action is unstable, they become shy, reclusive,  unsocial and lonely, their physical disabilities compounded by psychological barriers

The good news is that in recent years there have been highly effective discoveries in medication by comparison with earlier treatments.  In consequence the quality of life for Parkinson sufferers has greatly  improved.  Some are able to maintain former life styles for extended periods beyond initial diagnosis.

Intensive research into the cause of the disease and its cure and prevention is proceeding in the United States, the United Kingdom , on the Continent and in Japan as well as here in Australia.

Communication

People with Parkinson's Disease may experience a variety of speech difficulties, any of which can affect their ability to communicate with other people.  In addition, the disorder of movement, which is a major factor of this disease, reduces their capacity to make use of non-verbal means of communication.  Parkinson's Disease can present a very baffling picture to nurses on a busy ward and create a misleading impression of the patient to other people. This can result in misunderstanding which is extremely frustrating and socially isolating for the patient.  Any anxiety causes the symptoms of Parkinson's Disease to worsen.

Isolation & Social Factors

Lack of body language and verbal signs can cause the Parkinson's Disease patient to become increasingly isolated.  Plenty of stimulation and encouragement are needed.  The temptation, however, is either to  take over and "mother" the patient or to ignore them because of the limited response.  This is very demoralising for the patient.

Factors causing distress, frustration and social isolation include:

• Lack of stimulation
• Lack of communication
• Loss of control of environment
• Loss of Privacy and independence and subsequent decreased quality of life

Taking medicine alone is not enough

• It is imperative to balance drug therapy with emotional and psychotherapy.
• Confusional state often can be reduced or reversible by adjustment of drug and emotional support from love ones.
• Careful, sympathetic management is necessary from carers and friends.  Counseling and respite care is vital.

Tension and Stress

• Tension has the effect of delaying the response to drug.

Environmental effect

• Peace and tranquility are important in facilitating a better drug regimen.
• Being transplanted into an alien environment without social, psychological and emotional support would be traumatic in the extreme.
• The rigidity of hospital/ nursing home routine is a fearsome experience to PD sufferers.
• A restricting environment is disastrous.

Exercises and Activities

• Mental and physical exercises are of great benefit.
• Patients should be encouraged to remain as active as possible and to continue with social and leisure activities to avoid boredom and apathy.
• It is important to keep alive the patient's desire to communicate.

Other behaviourial symptoms

• A variety of behaviorial changes vary considerably from patient to patient.
• Some PD sufferer may be frightened easily.
• Depression is a common feature of Parkinson's Disease.
• Some may even develop clinical depression with sadness, lack of interest, lethargy and even suicidal tendencies.
• Apart from the visible mobility problem PD patients are especially prone to behavioral and effective disorder.

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