A large proportion of the information about Parkinson's disease focuses on treatments and therapies that may become available someday. However, most of you that read this information are facing an immediate reality. You need to know what you can do today to yield more high-quality days with loved ones.
You want to enjoy more outings pursuing a favorite activity, or have more time to contribute your passion and skill to your work, or a cause that you love. You need to know how to minimize the impact of this disease over the months and years to come.
We asked Giselle Petzinger, M.D., Assistant Professor of Clinical Neurology at the University of Southern California, about therapies for current Parkinson's disease patients. Dr. Petzinger has a keen interest in Parkinson's disease. She estimates that more than 95 percent of her clinical practice is dedicated to patients managing Parkinson's disease.
She's also actively involved in Parkinson's disease research at USC, and receives support from foundations, and federal sources, including the U.S. Army. Her research lab is run with her colleague and husband, Dr. Michael Jakowec, and together they recently received a $1 million endowment for the lab from Dr. George and Mary Lou Boone to help support their research in PD.
First, it is important to talk with your neurologist about the problems you are experiencing. Dr. Petzinger calls this "targeting based on functional issues."
"You might say, 'I used to play golf, but find I am unable to keep playing because I am too slow on the course, or my tremor makes it to hard for me to putt,'" Petzinger says. "And then you and your physician can work on trying to improve your ability to play golf by optimizing your medications and starting physical therapy with exercises that may improve your endurance and your ability to keep golfing. When your physician understands your needs, he or she can recommend a combination of drug, physical therapy, and other treatments that are most likely to help you reach a higher level of functionality and an improved quality of life."
The primary strategy for treating Parkinson's disease is medication. "We have some excellent medications, that when properly optimized can provide tremendous benefit," she said. There is no need to close up shop and hide. Many patients can maintain a lot of function."
The most important thing is to review specific details regarding self-care activities, domestic and social activities and those required at the work place. While sometimes it may not always be possible to review all of them, it is OK to prioritize what may be the most important at any one time. It is also always important to review possible medication side effects so that medications may be adjusted. Sometimes combination therapy works better than any one drug by itself. Finally it is helpful to let a physician know how active the patient is during the day and how much exercise he or she may be doing during the week.
Staying active is one thing a patient can do that may impact PD. "One of the most therapeutic environments is to be up and out, moving and thinking," according to Petzinger. "We call this the 'use it or lose it' phenomenon. Staying engaged with your environment, by participating in activities is another way to stay active. In general, the strategy is to make sure that you are doing activities you like to do."
More and more research, as well as the experiences of successful patients, points to the importance of exercise as part of engaging in your environment. Dr. Petzinger, with Drs. Jakowec and Fisher and several other colleagues at the University of Southern California are interested in studying the effects of exercise on the brain, and in particular those areas of the brain important to PD. Some of their research involves examining the effects of high intensity exercise (exercise that involves skill and intense practice) on the brain, and how certain types of exercise may help the brain function better.
The work of Dr. Petzinger and colleagues is ongoing, and has led to human studies examining the long-term effect of high intensity treadmill training in individuals with early PD. While there is still more research to be done, preliminary data does suggest that exercise can indeed affect the brain, and that more studies should be performed. One thought is that exercise may also optimize the effects of surgery or medications in PD patients.
Finally, Dr. Petzinger points to the role of caregivers. "Caregivers are helpful because they can help the patient and physician target the problems that patients are having," she says. "There is a large range of symptoms in this disease, and the caregiver can point those symptoms out to the patient and physician."
Dr. Petzinger notes it is important for caregivers to be at appointments. They need to bring up social issues. They can help recognize clinical symptoms, including depression and anxiety. Furthermore, the caregiver may experience frustration and fear. As they attend appointments they will have opportunities to bring up the challenges of caregiving.
Dr. Petzinger summarizes her thoughts stating: "Combination therapy, which includes optimization of one or more medication, along with an exercise regimen may offer a powerful treatment effect leading to the best function of the patient. Patients need to review with their physician their day-to-day functions and limitations, and target specific problems. I know you've got Parkinson's disease. What do we need to do now to keep you functioning? Using a combination of medication, that has been properly optimized, with exercise, we have a much better chance of maintaining your quality of life for years to come."
Note: Special Thanks to Dr. Petzinger. She was generous with her time and effort. She really was a coauthor on this post.
