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Parkinson’s disease is defined as a chronic and progressive movement disorder that kills nerve cells in the brain. Some of those nerves contain a chemical called dopamine that sends messages to the part of the brain that controls muscle movement and coordination. As Parkinson’s disease progress the amount of dopamine produced by the brain decreases and the person cannot control their movements. Sixty thousand Americans are diagnosed with Parkinson’s disease each year.

There are four main symptoms of Parkinson’s disease as identified by the Parkinson’s Disease Foundation:

  • Tremor of the hands, arms, legs or jaw
  • Muscle rigidity or stiffness of the limbs and trunk
  • Slowness of movement
  • Impaired balance and coordination

Parkinson’s disease is progressive and gets worse over time. The rate at which symptoms progress is different for each person. Physicians use scales to rate worsening motor symptoms. It is important to be accurate about these scales and how they rate the disease’s progression so we will use the Parkinson’s Disease Foundation description of the scales:

  1. The first, known as Hoehn and Yahr, will rate your symptoms on a scale of 1 to 5.  On this scale, depending on a person’s difficulties, 1 and 2 represent early-stage, 2 and 3 mid-stage, and 4 and 5 advanced-stage Parkinson’s.
  2. Another scale commonly used to assess the progression of Parkinson’s is the United Parkinson’s Disease Rating Scale (UPDRS).  It is more comprehensive than the Hoehn and Yahr scale, which focuses on movement symptoms.  In addition to these, the UPDRS takes into account cognitive difficulties, ability to carry out daily activities, and treatment complications.

Parkinson’s disease symptoms are a way to judge its progression.

The severity of the symptoms increase over time. The symptoms may progress differently for each individual, but most Parkinson’s disease patients will experience the following general progression.

 Mild Parkinson’s

  • Tremors may occur on one side the body.
  • Movements may be inconvenient but do not interfere with activities of daily living
  • Posture may change, walking may become more difficult
  • Facial expressions may become less noticeable
  • Medications for Parkinson’s are effective

Moderate Parkinson’s

  • Symptoms begin to occur on both sides of the body
  • Body movements slow down
  • Balance and coordination are impacted
  • “Freezing” episodes — when the feet feel stuck to the ground — may occur
  • Parkinson’s medications may “wear off” between doses
  • Parkinson’s medications may cause side effects, including involuntary movements
  • Regular exercise and occupational therapy help with symptoms

Advanced Parkinson’s

  • Walking is very difficult
  • The person may spend most of the day in bed or in a wheelchair
  • The person is not able to live alone and needs help with all activities of daily living
  • Cognitive problems may be prominent, including hallucinations and delusions
  • Balancing the benefits of medications with their side effects becomes more challenging

Geriatric care managers can help

The progression of Parkinson’s disease is extremely difficult for the person who suffers from the disease as well as their family members. Geriatric care managers understand this. They have experience working with Parkinson’s disease and know what it means for the patient and family. As experienced healthcare professionals, care managers can help the family to plan for support and care in each of the disease’s stages.

Knowing and acknowledging what lies ahead can help the family plan and put proper Parkinson’s home care plans in place. The geriatric care manager can coordinate this planning, educating family members, advising them on the best types of care, and finding adequate resources in health care and the local community for them.

Planning for the progression of Parkinson’s disease is difficult for everyone involved. Not only does it involve many logistical, financial and insurance details but it is difficult emotionally as well. Geriatric care managers are trained to be the informative, supportive professional that families need at this time.


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