No hay un tratamiento estándar para la enfermedad de Parkinson (EP). El tratamiento de cada persona con Parkinson se basa en sus síntomas. Hay muchos medicamentos disponibles para tratar los síntomas motores del Parkinson y es común que las personas con EP tomen una variedad de estos medicamentos (en distintas dosis y momentos del día) para manejar los síntomas motores.

La impresión fue posible gracias a una subvención de Kyowa Kirin.

Everyone experiences changes in mood over the course of any given day, week, month and year. But “mood changes” is a broad term that can mean different things to different people. This guide explains what mood changes can happen in Parkinson’s disease (PD), why people with Parkinson’s might experience these changes and how to treat and cope with them.

Not everyone develops every symptom of Parkinson’s disease, but if you’re affected, non-motor symptoms including depression, anxiety, anger and irritability can have a huge impact on your quality of life and those around you. The information, tips and stories included here will provide answers, help you organize thoughts and questions for your medical team and remind you that you are not alone on this Parkinson’s journey.

This book is only available digitally to view, download or print. It is also available in Kindle and audiobook formats.

It is not uncommon for the stresses of daily life — feeling overwhelmed, under prepared and over stimulated — to cause anxiety and unrest. These psychological issues can impact your health and even exacerbate the symptoms of Parkinson’s disease (PD). That is why it is important to assess what may be causing stress and learn how to deal with the situations that give rise to anxiety. Meditation, yoga or Tai Chi and deep breathing can help restore a sense of calm. Whether you are living with Parkinson’s or caring for someone with PD, finding balance can help you cope with the daily stresses of life. This may mean limiting your exposure to environmental stressors or using complementary therapies. Such approaches are wonderful ways to lower anxiety, lower blood pressure and improve your all-around health.

Managing Stress

Identify stress triggers along with ways to help control your emotions and release anger in a safe way. Try writing in a journal or going for a walk when tension reaches a breaking point. Physical outlets, such as hitting a pillow, can help you vent frustration. If stress triggers are unavoidable, you need reliable ways to reduce and manage them. No method is too silly if it works.

Yoga or Tai Chi

Tai Chi is a moving meditation based on the circulation of “chi,” life’s energy force, believed by the ancient Chinese to be blocked in the presence of disease. It is comprised of continuous, flowing movements. Yoga, which originated in ancient India, can include holding stationary poses or moving into a flowing series of poses and aims to integrate the mind, body and spirit. Both can help with relaxation, which can help with PD symptoms. Additional benefits include:

• Increased awareness of movement and actions
• Better awareness of proper body alignment/ posture and enhanced flexibility
• Improved balance and core strength, which help to reduce fall risk
• Improved breath support and control

Breathing Exercises

Breathing exercises offer a simple and effective way to relax in moments of stress or anxiety. When you are stressed your body goes into a high state of physical arousal. You may notice muscle tension, a faster heart beat or shallow breathing.

3-minute Relaxation Routine

• Select a key word such as relax, calm or peace
• Concentrate on relaxing using your key word. Pay attention to your breathing. Take in one deep breath and hold it.
• While holding your breath, tense up a group of muscles, such as the muscles in your face, arms or legs.
• As you breathe out, relax the tense muscles and let go. Continue using your key word as you drop your shoulders.
• Repeat, alternating to different muscle groups, for 3 minutes.

Consider Massage Therapy

Many people with PD recognize the benefits of massage. Massages are available in a variety of settings, including many local malls. Specific benefits may include:

• reduction in rigidity and tremor
• improvement in sleep
• increase in daily stamina
• reduction in anxiety
• increased feeling of relaxation

In finding a massage therapist, it is important to find someone trained by an accredited school of massage therapy. Tell your medical team, family or friends that you are considering getting a massage. They may be able to provide you with a referral. You can also find a massage therapist by calling toll free 1-888-843-2682 or visiting the American Massage Therapy Association website: www.amtamassage.org/findamassage/.

Distinguishing Between Stress and Anxiety or Depression

Feeling stressed or worried is understandable when managing a chronic illness. It is important to remember that depression and anxiety play a key role in PD and its effect on quality of life. If constant worry or nervousness go beyond what is manageable, a person may be experiencing anxiety, which is more serious.

Remember, anxiety and depression often go together.

Symptoms of anxiety can include:

• feelings of panic
• fear and restlessness
• sleep disturbance
• poor concentration
• palpitations
• shortness of breath
• irritability
• dizziness.

Symptoms of depression can include:

• excessive worrying
• persistent sadness
• crying
• loss of interest in usual activities and hobbies
• increased fatigue and lack of energy
• feelings of guilt
• loss of motivation
• complaints of aches and pains
• feelings of being a burden to loved ones

If you think your stress may be a symptom of depression or anxiety, do not feel embarrassed to seek professional help or counseling. A social worker, psychologist or psychiatrist can help you pinpoint the causes of your distress and provide constructive ways to cope with the situation.

You may find Cognitive Behavioral Therapy (CBT), a non-drug approach to developing the skills and actions that change patterns of thought and behavior related to depression, to be a helpful tool.

Your mood is a critical aspect of living with PD that you can control. Talk to your friends, family and doctor about your feelings of stress, anxiety or depression.

For more resources on managing stress, anxiety or depression, call the Parkinson’s Foundation Helpline at 1-800-4PD-INFO (473-4636).

People with Parkinson’s disease (PD) are at a higher risk of hospitalization and face many challenges while in the hospital. This year alone, one in every six people with PD will experience avoidable complications in the hospital. As a person with PD, it is important for you to be aware of the risks, prepare ahead of time and know how to advocate for your needs while in the hospital.

Delayed, missed or contraindicated medications and limited movement in the hospital can lead to complications for people with PD. These problems set up a vicious cycle that puts you at risk for falls, muscle deterioration, medication side effects, mental and physical decline and decreased independence. This is known as the Symptom Spiral.

Common issues in the hospital include:

• Delayed or missed medications
• Use of contraindicated medications
• Limited movement
• Swallowing changes
• Worsening PD symptoms
• New symptoms, including thinking and behavior changes, may develop due to:
  • Stress
  • Infection
  • Fatigue
  • Sleep disturbances
  • Surgery

Communicating Your Needs

Hospital staff may not fully understand Parkinson’s symptoms, their fluctuations or the importance of timely medication. This lack of awareness may lead to longer recovery times and potentially serious complications.

Use these steps if you have trouble communicating your needs or have a care concern:

• Discuss your concern with your primary nurse.
• Involve the charge nurse.
• Ask to meet with the hospital doctor, who may consult with the hospital neurologist or pharmacist or contact your Parkinson’s doctor.
• If needed, ask that your concern be noted in your chart and speak with the Patient Representative or Advocate.

Prepare Your Hospital Care Partner

In the hospital, you may need help communicating your needs. Choose a trusted person to make sure your medication schedule is followed, listen to treatment instructions and advocate for you. Plan ahead with family or friends to select the best person for this role.

My Five Parkinson’s Care Needs

Careful preparation and clear communication can help minimize complications and recovery time. Use the Five Parkinson’s Care Needs listed below to communicate your PD needs during a hospital visit.

Need 1: I need my hospital chart to include my exact medications and match my at-home schedule.

Need 2: I need to take my Parkinson’s medications within 15 minutes of my usual schedule.

Need 3: need to avoid medications that make my Parkinson’s worse, including those that block dopamine, sedatives and certain pain medications.

Need 4: I need to move my body as safely and regularly as possible, ideally three times a day.

Need 5: I need to be screened for swallowing changes to safely maintain my medication routine and minimize my risk of aspiration pneumonia and weight loss.

Preparing for a Hospital Stay

• Review your Hospital Safety Guide.
• Carry Parkinson’s identification in case of an emergency.
• Prepare a hospital “go bag” using the information in the Hospital Safety Guide and keep it by the door.
• Choose a hospital care partner to accompany you in the hospital.
• Plan to communicate the urgency of your PD needs, including medications on time, every time.

Parkinson’s disease (PD) may turn out to be not one disease but a group of similar conditions with different genetic risk factors, varying symptoms, and courses. Different genes may have variations between them or even variations within the same gene, with implications for symptoms, progression, and treatments. To help uncover key mechanisms responsible for PD and its progression, the Parkinson’s Foundation has launched PD GENEration: Mapping the Future of Parkinson’s Disease to study the genetic makeup of 15,000 people with the disease. The two main genes targeted in the study are carried by a minority of people with PD, but they may offer insights into mechanisms of the disease that operate in the larger population. In this podcast, Parkinson’s Foundation Chief Scientific Officer Dr. Jim Beck describes the goals of this Parkinson’s study, how genes affect the course of the disease, and ultimately, how the results of the study may empower people to take better control of their disease.

Released: August 13, 2019

La telesalud o telemedicina es cuando los proveedores de atención médica brindan servicios e información relacionados con la salud utilizando tecnología. Las citas de telemedicina se están convirtiendo en una parte cada vez más importante de la atención médica. Además, los estudios demuestran que la atención brindada a través de la telemedicina es tan buena como la que se ofrece en un centro médico. De hecho, algunas personas prefieren las citas de telemedicina porque se sienten más a gusto en la comodidad de su propio hogar.

Razones para usar la telemedicina

Las citas virtuales son convenientes, ya que permiten a las personas en cualquier etapa de la enfermedad de Parkinson (EP) reunirse con su médico desde cualquier lugar, usando un smartphone, una tableta o una computadora con acceso a internet. A través de la telemedicina, un especialista en trastornos del movimiento (neurólogos con formación adicional en Parkinson) puede tratar y abordar la mayoría de los síntomas del Parkinson, ajustar los medicamentos, evaluar la progresión de la enfermedad y recomendar terapias adicionales.

Según la Encuesta sobre COVID-19 de la Parkinson’s Foundation, un 46% de las personas que han usado la telesalud durante la pandemia esperan seguir teniendo esta opción en el futuro, lo que indica que la telesalud puede ser un gran complemento para la atención médica en persona. Si bien la telemedicina nunca podrá reemplazar completamente las citas en persona, ofrece muchos beneficios:

• No hay necesidad de organizar el transporte
• Menos tiempo dedicado a ir y volver de las citas y en salas de espera
• Ayuda a quienes luchan contra la fatiga
• Reduce la exposición a los virus y bacterias
• Más cómodo que en un consultorio médico
• Ayuda a los profesionales de la salud a evaluar la seguridad en el hogar y realizar cambios en tiempo real
• Pueden acceder a especialistas que no se encuentran en la localidad

Tipos de citas

La telemedicina puede usarse para casi cualquier tipo de cita médica. La fisioterapia, la terapia ocupacional, la terapia del habla, los servicios de salud mental y algunas citas de neurología son sólo algunos ejemplos de citas que pueden hacerse virtualmente.

En la mayoría de los casos, el profesional de la salud dependerá de una cámara de video para llevar a cabo la cita adecuadamente, lo que requiere una buena conexión a internet.

Por supuesto, puede haber casos en los que las pruebas o citas específicas deban hacerse en persona. Hable con su médico sobre lo que se puede hacer virtualmente y en persona. Si tiene un sistema de estimulación cerebral profunda (ECP o, DBS, por sus siglas en inglés), éste puede tener una función que permita a su médico realizar pruebas, revisiones de rutina y ajustar los niveles para tratar los síntomas sin requerir una visita al hospital. Pregunte a su médico si esto es posible para su sistema de ECP.

Participar en Telemedicina sin Computadora o WiFi

Puede haber formas de obtener la atención necesaria si no tiene acceso a una computadora o a internet. Puede usarse un teléfono inteligente con capacidad de video para reunirse virtualmente con su médico. Verifique su plan de uso de datos celulares para evitar cargos por excederse del límite. Deberá apoyar y estabilizar su teléfono para que puedan hacer una revisión física si es necesaria.

Si no tiene acceso a una computadora o a un teléfono inteligente, comuníquese con su Agencia Local sobre el Envejecimiento (Area Agency on Aging) y pregunte si tienen computadoras o tabletas que pueda usar. Puede encontrar la agencia más cercana llamando al 1-800-677-1116. Si no tiene una Agencia local sobre el Envejecimiento cerca de usted o no puede encontrar recursos similares, puede llamar al 2-1-1 y pedir sugerencias de recursos.

Preparación para una cita de telemedicina

A continuación, diez consejos para ayudarle a prepararse para su próxima cita de telemedicina:

1. Prepárese. Prepare una lista de preguntas y síntomas antes de su cita. Considere invitar a un familiar o amigo para que le ayude a tomar notas y para obtener apoyo adicional.
2. Revise la medicación. Verifique si tiene suficientes píldoras en casa o si necesita resurtirse. Haga una lista de todos sus medicamentos para el Parkinson y para otras afecciones. Para descargar un formulario de medicamento, visite Parkinson.org/MedForm.
3. Descargue el software de comunicación. Pregunte a su proveedor de atención médica qué plataforma o aplicación de video necesitará descargar con anticipación.
4. Compruebe la tecnología. Asegúrese de tener buena conexión a internet. Cargue su dispositivo antes de que comience la cita o intente mantenerlo conectado.
5. Esté preparado para moverse. Dese espacio para moverse. Por ejemplo, un especialista en trastornos del movimiento o un fisioterapeuta pueden pedirle que camine o que realice alguna tarea.
6. Reúna sus herramientas. Tenga papel y bolígrafo a la mano, junto con cualquier artículo que su especialista en atención médica le haya pedido que traiga a su cita (por ejemplo, un termómetro, una báscula, frascos de medicamentos, etc.).
7. Prepare su espacio. Ponga su teléfono en silencio si no lo está usando para la cita. Limite cualquier desorden entre usted y la cámara. Evite la retroiluminación (como las ventanas a sus espaldas). Limite el ruido de fondo de un televisor, una unidad de aire acondicionado, mascotas o una ventana abierta.
8. Tome notas. Para referencia futura, anote cualquier información o sugerencia importante que su proveedor de atención médica comparta con usted.
9. Comunique las novedades. Informe al consultorio del médico si su farmacia, seguro o información de contacto ha cambiado.
10. Hable sobre el cuidado de seguimiento. Programe su próxima cita si es posible.

Conclusiones

Para obtener más información sobre telemedicina, visite Parkinson.org/TelemedicineTips

Estamos para ayudarle. Llame a nuestra línea de ayuda al 1-800-4PD-INFO (473-4636), opción 3 para español.

La impresión de esta publicación fue posible gracias a una subvención de Abbott.

Speech and swallowing challenges are common in Parkinson’s disease (PD) and can impact important parts of life, such as enjoying favorite foods or participating in conversations with family and friends.

Seeing a speech therapist and starting treatment early can improve your quality of life and help prevent more serious problems later on.

Quick Facts

• PD causes movements to become smaller and slower over time, which can affect how the face, mouth, throat and chest move during speaking and swallowing.

• PD can disrupt communication between the brain and the body, which may make it difficult to notice changes in speech and swallowing.

• Speech therapists are trained to support speech, communication and swallowing challenges in PD.

Speech Issues in Parkinson's

Voice and speech changes can be among the early signs of PD. Common examples include soft speech, monotone voice, slurred words and trouble finding the right words or starting sentences. Limited facial expression may cause others to misread emotions.

Speech Self-Check

• Do others have trouble hearing or understanding me?

• Do I avoid phone calls?

• Is my voice weak or does it tire easily?

• Do I struggle to find words or lose my train of thought?

• Do I feel left out of conversations?

Swallowing Issues in Parkinson's

Many people with PD experience swallowing difficulty (dysphagia). These can range from mild problems, such as taking longer to eat, to serious issues like weight loss, choking or aspiration pneumonia — a life-threatening infection caused by food or liquid entering the lungs.

Another common concern is excess saliva. This happens not because the body produces too much saliva, but because PD can make swallowing less automatic.

Swallowing Self-Check

• Do food or pills feel stuck in my throat?

• Do I clear my throat often when eating or drinking?

• Does it take longer to eat than others?

• Have I lost weight without trying?

• Do I have excess saliva?

• Do I often have heartburn or a sore throat?

Addressing Speech and Swallowing Issues

The main treatment for speech and swallowing issues is working with a speech therapist (also called a speech-language pathologist). Many speech therapists specialize in neurological conditions.

Adjusting PD medications may also help, especially if symptoms happen during “off” times.

Evaluating Speech and Swallowing Issues

A speech therapist will review your medical history and evaluate how your face, lips, tongue and jaw move, along with your speech and swallowing. If there are concerns about swallowing, the therapist might recommend tests like a video X-ray or a fiberoptic endoscopic evaluation (a test that uses a small camera to check swallowing).

What to Expect in Speech and Swallowing Therapy

Parkinson’s affects everyone differently, so your therapy plan should be tailored to your specific symptoms and goals. Typical therapy includes:

• Exercises, strategies and tools to improve speech clarity, strengthen muscles and enhance communication.

• Swallowing therapy to strengthen muscles for breathing, coughing and swallowing.

• Diet tips and safer mealtime strategies, if needed.

• Regular re-evaluations and “tune-ups” every few years.

Consistency is important for progress, so practicing at home is key. Singing can also help with breath control and vocal strength. Some local PD support groups and community centers offer choir opportunities.

Finding a Speech Therapist

Ask your doctor for a referral or contact our Helpline. Programs like Lee Silverman Voice Treatment (LSVT LOUD) and Parkinson Voice Project SPEAK OUT! focus on Parkinson’s speech challenges and offer online directories to help you find specialized speech therapists.

Tips for Clearer Communication

• Breathe before speaking to help control your voice.

• Speak louder than feels natural.

• Be face-to-face when communicating.

• Allow extra time for conversations.

Tips for Swallowing Safety

• Take small bites, chew food well and swallow completely.

• Reduce distractions during meals to focus on eating.

• Talk to your doctor if you have trouble swallowing pills.

​Aventurarse por el laberinto informativo sobre la nutrición y los consejos que hay a disposición del público es un reto, aun para los consumidores sanos. Si se le añade a la mezcla la enfermedad de Parkinson (EP, o PD, por sus siglas en inglés) dicho reto se complica aún más. Los problemas nutricionales que afrontan las personas con EP son complejos y diversos, y muchos de ellos no tienen una respuesta clara.

A continuación contestamos la pregunta ¿qué es lo que más importa? cuando se refiere a nutrición.

Coma una dieta balanceada

Es difícil para una persona sentirse bien y mantener su energía cuando no se está alimentando adecuadamente. Alimentarse adecuadamente implica comer regularmente (sin saltearse ninguna comida), consumir una variedad de alimentos de todos los grupos alimenticios (granos, vegetales, frutas, leche y productos lácteos, carnes y frijoles) y comer prudentemente para mantener un peso saludable. Aunque parezca un consejo sencillo, implementarlo puede ser un reto, particularmente si usted tiene un ajetreado estilo de vida o si los síntomas del Parkinson están afectando su capacidad de comprar, preparar y comer los alimentos.

Si usted no se está alimentando tan bien como debiera, sería conveniente que consultara a un dietista profesional que pueda ayudarle a evaluar sus necesidades en cuanto al consumo de alimentos y discutir con usted estrategias para mejorar su dieta. También podría ser conveniente buscar la ayuda de otras personas, tanto para comprar y preparar los alimentos, como para mantener a mano alimentos nutritivos y fáciles de comer. Si usted tiene problemas de depresión, esto podría interferir con su apetito; asegúrese de discutir el problema con su médico.

Mantenga sus huesos sanos

Las personas con Parkinson son propensas a la osteoporosis, una enfermedad causada por una baja densidad en los minerales de los huesos. Los factores de riesgo para la osteoporosis incluyen la edad madura, el bajo peso corporal, fumar, el consumo excesivo de alcohol, la falta de exposición a la luz solar, el consumo inadecuado de vitamina D y calcio, y la falta de ejercicios de resistencia o levantamiento de pesas.

La osteoporosis puede ser especialmente preocupante para una persona con Parkinson, quien afronta un mayor riesgo de caerse. El resultado inevitable es una mayor probabilidad de fracturas, las cuales son peligrosas y dolorosas, además de estar en detrimento de la calidad de vida de la persona. Pregúntele a su médico acerca de hacerse una prueba de la densidad de los minerales en sus huesos, llamada densitometría. Si resulta que es baja, existen tratamientos médicos a su disposición.

Para mantener la salud de sus huesos, asegúrese de que su dieta incluya abundante calcio y vitamina D. Las personas mayores de 50 años deberían consumir diariamente 1500 mg de calcio y 800 UI de vitamina D. La leche y los productos lácteos son las fuentes dietéticas más ricas en calcio. Se recomiendan tres porciones al día (una porción es una taza de leche o yogur, y una y media onzas de queso sólido). Aunque existen otros alimentos que contienen calcio (tales como el tofu, las bebidas a base de soya fortificadas, el jugo de naranja y las verduras de hojas oscuras), el calcio que no proviene de los productos lácteos puede ser difícil de absorber.

Usted también puede obtener vitamina D saliendo regularmente al aire libre y consumiendo alimentos ricos en vitamina D (tales como la leche fortificada con vitamina D, el yogur o los cereales de desayuno, y la grasa de pescado). Si usted vive en una zona donde la luz solar es limitada y/o no consume muchos alimentos ricos en vitamina D, se recomienda el uso de un suplemento nutricional.

Los suplementos vienen en varias formas. Unos son más fáciles de tolerar que otros. Su farmacéutico está en capacidad de aconsejarle sobre las diferentes clases disponibles.

Mantenga regular su digestión

El estreñimiento es común en la enfermedad de Parkinson. Aunque esto puede ser un asunto incómodo de discutir con su proveedor de atención médica, la prevención y el tratamiento del estreñimiento es de suma importancia, ya que un estreñimiento grave puede llevar a una obstrucción del intestino, lo que potencialmente puede poner la vida en peligro.

Aunque el estreñimiento observado en el Parkinson es debido en gran parte a la enfermedad misma, pueden implementarse ciertas medidas en el estilo de vida que podrían ayudar a manejarlo. Estas incluyen consumir alimentos ricos en fibra (panes de grano integral, cereales o molletes (muffins) de salvado, frutas y vegetales, frijoles [habichuelas] y legumbres, y ciruelas) además de beber abundante líquido. Luego, está el ejercicio, el cual ayuda a mantener la densidad de los huesos y aliviar el estreñimiento.

Si usted no es capaz de lograr la regularidad en su digestión por medio de su estilo de vida únicamente, podría requerirse el uso de laxantes y otras intervenciones para la evacuación de los intestinos.

Equilibre los medicamentos y los alimentos

Los medicamentos utilizados para tratar el Parkinson pueden causar efectos secundarios relacionados con la nutrición, tales cómo náuseas y falta de apetito. Típicamente estos efectos secundarios son más molestos al inicio del tratamiento. Normalmente, el cuerpo se va adaptando poco a poco y estos desaparecen. Sin embargo, algunos individuos continúan teniendo problemas con ellos. Tomar un pequeño bocado (como una ginger ale y unas pocas galletas saladas) junto con los medicamentos podría ayudar a controlar estos efectos secundarios. Si persisten las náuseas o la falta de apetito consulte a su médico, ya que estos síntomas pueden llevar a una indeseada pérdida de peso.

Los aminoácidos (de la proteína dietética) pueden interferir con la absorción de la levodopa en el cerebro. Si usted descubre (no todo el mundo experimenta esto) que comer alimentos ricos en proteína (tales como carne, pescado, aves y productos lácteos) disminuye la eficacia de la levodopa, mantenga su porción de carne aproximadamente del tamaño de una baraja de naipes y tome su Sinemet® media hora antes de una comida que contenga proteína.

No restrinja la proteína en su dieta; el problema, si descubre que lo tiene, tiene que ver más con el momento en que se consume la proteína que con la cantidad que se consume a lo largo del día.

¿Existe algún alimento “maravilla” o suplemento que retrase el avance del Parkinson?

Los suplementos (tanto nutricionales como herbales) y las terapias dietéticas están en los primeros lugares de la lista de terapias complementarias utilizadas por las personas con Parkinson. A pesar de las persuasivas teorías acerca de la eficacia de varios suplementos o factores dietéticos en el retraso del avance de la enfermedad, no existen respuestas definitivas basadas en la evidencia. Algunas terapias han sido estudiadas solamente en tubos de ensayo o en animales de laboratorio. Se han hecho pocos ensayos en humanos (por ejemplo los que examinan los suplementos de vitaminas antioxidantes), y la mayoría han producido resultados decepcionantes. La Coenzima Q10 es un suplemento nutricional que es considerado de interés en la comunidad científica y está bajo estudio para determinar si tiene algún beneficio potencial en la enfermedad de Parkinson.

Algunos alimentos que están en la categoría de los que “no hacen daño y podrían ayudar” (al menos en teoría) incluyen el café (varios estudios en la población sugieren que el café podría proteger contra el Parkinson, particularmente a los hombres), el té verde, una variedad de frutas y vegetales, los alimentos ricos en vitamina E tales como el germen de trigo, las nueces y semillas, y el aceite de origen vegetal. Si los antioxidantes citados no ayudan con los síntomas del Parkinson, pueden ayudar con otros aspectos de la salud, de manera que no hay ningún motivo por qué no usarlos.

Al pensar acerca del valor potencial de utilizar este o aquel suplemento, considere los factores de costo, seguridad y eficacia, y asegúrese de que no sean simplemente el producto de exageraciones publicitarias. Por ejemplo, un titular reciente decía: “La vitamina B6 puede reducir el riesgo de enfermedad de Parkinson.” Lo que el titular no mencionaba era que los hallazgos de este estudio, aunque interesantes, habían sido observados solo entre fumadores, y de lo que se hablaba era del inicio de la enfermedad de Parkinson y no de su avance.

Sin embargo, tan tentadores como suenan los alimentos “maravilla” y los suplementos, en este momento no existen evidencias que sugieran que desempeñan un rol de importancia.

Ajuste sus prioridades nutricionales a su situación y etapa de la enfermedad

Los síntomas del Parkinson varían de persona a persona y según la etapa de la enfermedad. Cada persona debe establecer cuáles son sus prioridades nutricionales basadas en los problemas que afronta. En los comienzos del Parkinson, debemos hacer énfasis en alimentarnos bien y mantener un peso saludable. A medida que la enfermedad avanza, debemos ajustar nuestras dietas para manejar nuevos síntomas específicos conforme estos vayan surgiendo (tales como dificultades para tragar, efectos secundarios de los medicamentos, problemas digestivos y retos alimentarios).

Most people with Parkinson’s disease (PD) have trouble getting a good night’s sleep. Both disease symptoms and anti-Parkinson’s medications can interfere with nighttime rest. Fortunately, there are effective medications for many sleep problems. Some common sleep issues for people with Parkinson’s are listed below, along with tips for better sleep. If you are experiencing any of these sleep problems, tell your healthcare provider. He or she can recommend a sleep specialist, if needed, and talk to you about medications and other possible strategies to help you sleep better.

Insomnia

People with Parkinson’s usually fall asleep without much trouble but wake up frequently throughout the night and have trouble falling back asleep. There are many possible reasons: Tremor may wake you up. Vivid dreams, a side effect of levodopa-based medications such as Sinemet, can disturb sleep. Difficulty getting comfortable, whether from pain or because it is hard to turn over in bed, can keep you awake. And people with PD often have nocturia — excessive urination at night. Getting up frequently during the night to go to the bathroom keeps you from sleeping.

Daytime sleepiness

Sleep disorders (like those below), medications, and mental health disorders (especially depression), among other things, can all lead to excessive daytime sleepiness. Furthermore, the same changes in the brain that lead to Parkinson’s motor symptoms can affect mood, thinking, and other aspects of your health, including the sleep-wake cycle.

Inverted sleep cycle

Napping during the day can make it harder to sleep at night. If you nap frequently, it may lead to a cycle of staying awake at night and spending more time sleeping during the day.

Early morning awakening

Whether it is a habit from old work schedules or because of an early bedtime, people with Parkinson’s often wake up early in the morning. It may become necessary to adjust your sleep schedule.

Sleep apnea

People with sleep apnea stop breathing for short periods of time during the night. This prevents them from entering the deep, restorative stage of sleep. A few common symptoms of sleep apnea are loud snoring, gasping or choking after a pause in snoring, and dry mouth upon awakening. In the general population, sleep apnea is associated with obesity and cigarette smoking, but this is not the case in PD. There are several treatments options for sleep apnea, depending on its severity.

REM sleep behavior disorder (RBD)

REM stands for rapid eye movement. This is the stage of sleep when dreams take place. People with REM sleep behavior disorder act out their dreams, which can be violent. RBD is one of the early warning signs of Parkinson’s. Healthy people with RBD have a higher risk of developing Parkinson’s. RBD can be treated with the drug clonazepam (brand name Klonopin and others).

Restless legs syndrome (RLS)

People with RLS feel unpleasant, uncomfortable sensations – often described as “creepy-crawly” – in their legs. This results in the urge to move the legs. Moving relieves symptoms, but only temporarily. Several medications are available to treat RLS.

Managing Sleep Problems

If you experience any of these sleep issues, speak with your healthcare provider to determine the best treatment options. As noted above, there are medications available for some sleep disorders. There are also many strategies that can help you sleep more soundly at night. Like brushing and flossing to maintain good oral hygiene, the following tips can help you maintain good “sleep hygiene.”

Daytime Tips for Better Sleep

• Wake up at the same time every day, using an alarm if you have to.
• Get out of bed right after you wake up. Too much time spent in bed can lead to more waking at night.
• Eat regular, healthy meals, and eat at the same time every day. Three to four small meals are better than 1-2 large meals.
• Limit daytime napping to a 40-minute NASA nap (yes, tested by astronauts!). Too many or too-long naps can make sleep at night more difficult.
• Do not drink coffee, tea, sodas, or cocoa after noon. They contain caffeine and can interfere with normal sleep.
• Do not drink alcohol after dinner. It may help you fall asleep faster, but makes sleep shallower later in the night. Alcohol can also make snoring and sleep apnea worse.
• Use caution when taking headache and cold medicines. Some contain stimulants that can affect sleep.
• Stop smoking. Cigarette smoking stimulates the body and makes sleep difficult.
• Increase or start doing daily exercise. Regular exercise helps to deepen sleep. Avoid heavy exercise 2 hours before bedtime.

Nighttime Tips for Better Sleep

• Get into bed only when you are sleepy. Learn to distinguish between fatigue and sleepiness.
• Use your bed only for sleep and sexual activity – not for reading, watching TV, arguing, catching up on work, etc. And no pets!
• If you are hungry at bedtime, eat a small snack or drink a glass of milk. Do not eat sugary snacks or chocolate or drink tea or coffee. Large meals before bedtime can worsen sleep.
• Develop a sleep ritual. Do something relaxing before bed such as reading or listening to music. This tells your body that it is time to settle down.
• A warm shower or bath an hour before bedtime can help you to fall asleep.
• End screen time at least an hour before bed. Rarely is the late-night news soothing or relaxing! If weaning yourself from a TV habit is hard, try a relaxation or nature sounds recording.
• Do not use over-the-counter sleep medications. They may help you fall asleep faster, but they do not help you get deeper sleep. They can also make snoring and sleep apnea worse.
• Keep light levels low. Use a bathroom or hallway nightlight to prevent falls.
• Keep the bedroom temperature cool for better REM sleep.
• Customize your sleep environment. Invest in a good mattress and pillows.
• Block out noise as much as possible. Occasional loud noises disturb sleep even in people who cannot remember them in the morning. The hum of a fan can help cover up some noise.
• Do not watch the clock and worry about lost sleep. Turn the clock face away.
• Do not try to force sleep. If you cannot fall asleep:
  • Get out of bed.
  • Move to another room and do an activity: read or listen to soothing music until you are sleepy.
  • Go back to bed.
  • If you still can’t sleep, get out of bed again and repeat the cycle.

While Parkinson’s disease (PD) is a broad category that includes similar symptoms, each person’s disease may have different features, rate of progression, needs and treatments connected to the specific underlying cause of that person’s disease. As we move towards “personalized” or “precision medicine,” which strives to treat each person’s condition according to their unique disease, research in neurology needs the tools to be able to define differences that can allow a truly personalized approach to treatment. Measuring biomarkers, measurable features that are characteristic of a disease, is one of these tools that provides a better understanding of the disease’s underlying biology and causes. They could be imaging such as MRI, chemicals in the blood or brain, brain wave patterns, or even specific signs and symptoms.

Knowing the underlying causes of the disease can help to design and test therapies that could slow down or stop PD. Using biomarkers would be especially helpful for the design of clinical trials for several reasons. It would allow researchers to segment testing of medications by individuals with similar underlying biology in order to understand if it works for all or just some types of Parkinson’s. It would also help us better monitor if and how a drug is working. Neurologist Dr. Alberto Espay of the University of Cincinnati proposes that Parkinson’s research requires a new way of thinking based on biomarkers to know precisely what kind of disease one is dealing with, especially when participating in clinical trials. Drugs that work for one form of PD may not work for another. Dr. Espay compares the precision of treating Parkinson’s today to where the cancer field was 30 years ago.

Released: July 16, 2019