Parkinson's Disease: Manage 'Freezing' Episodes...Oral Care

Parkinson's disease (PD), a progressive neurodegenerative disorder primarily affecting motor function, is the second most prevalent neurodegenerative disorder in the US following Alzheimer's disease. Men are 1.5 times more likely than women to develop Parkinson's disease.

Risk Factors & Causes

• Age. Onset is usually around age 60 or older.
• Heredity. Having a family history of Parkinson's disease increases the risk of developing the condition, especially with multiple affected relatives.
• Sex. Men are more likely to develop Parkinson's disease than are women.
• Exposure to toxins. Ongoing exposure to herbicides and pesticides may slightly increase your risk of Parkinson's disease

Early Signs...Common Symptoms of Parkinson's Disease 

• Tremor. A rhythmic shaking starting in a limb, often in the hand, with a pill-rolling tremor. Can occur at rest but may decrease during activity.
• Slowed movement, known as (bradykinesia). Progressively slower movements affecting daily tasks like walking, sitting, and standing.
• Rigid muscles - FREEZING. Stiffness causing pain and limited range of motion.
• Impaired posture and balance. Stooped posture, balance issues leading to falls.
• Loss of automatic movements. Difficulty with involuntary actions like blinking and smiling.
• Speech changes. Soft speech, slurring, hesitancy, monotone voice.
• Writing changes. Difficulty writing, reduced legibility.

Chronic & Advanced Symptoms...

• Increased saliva production. Inability to retain saliva within the mouth (incontinence of
  saliva).
• Swallowing changes. As the condition advances the patient might encounter challenges with swallowing. Slowed swallowing can cause drooling and .
• Low blood pressure. 

• Constipation. Often attributed to a sluggish digestive system.
• Slowing of thoughts. 
• Decreased sense of smell. Difficulty recognizing specific odors or distinguishing between different scents.

Medication Management

• Carbidopa-levodopa (Rytary, Sinemet, Duopa, others). It is a potent medication for Parkinson's disease. It combines levodopa and carbidopa to reduce side effects like nausea. Side effects may include nausea, dizziness, and dyskinesia. Dosage adjustments may be needed over time. It is advisable to take the medication on an empty stomach for advanced Parkinson's disease unless instructed otherwise by healthcare providers
• Inhaled carbidopa-levodopa. Inbrija is a brand-name medicine delivering carbidopa-levodopa in an inhaled form. It may be helpful in managing symptoms that arise when medicines taken by mouth suddenly stop working during the day.
• Carbidopa-levodopa infusion. Duopa is a brand-name medicine for advanced Parkinson's patients, administered through a feeding tube to deliver carbidopa-levodopa in gel form to the small intestine. The infusion helps maintain constant blood levels of the medicines, but tube placement involves a small surgical procedure with risks like tube dislodgement or infections.
• Dopamine agonists. mimic dopamine's effects in the brain without converting into dopamine. They offer prolonged action and can complement levodopa therapy. Common agonists include pramipexole and rotigotine, while apomorphine provides rapid relief. Side effects may include hallucinations, drowsiness, and compulsive behaviors. Consult a healthcare provider if experiencing unusual behavioral changes.
• MAO B inhibitors (selegiline, rasagiline, safinamide). Prevent dopamine breakdown by inhibiting MAO B enzyme. They can help prevent wearing off when taken with levodopa but may cause side effects like headaches, nausea, and insomnia. When combined with carbidopa-levodopa, they may increase the risk of hallucinations.

Patient/Caregiver Teaching for Parkinson's Disease

Managing Nutrition with Carbidopa/Levodopa 

Some with Parkinson's experience the “protein effect” - dietary protein can interfere with absorption of Levodopa, a primary treatment if the disease.

Nutrition and Parkinson’s medications like Carbidopa/Levodopa directly affect one another. Carbidopa/Levodopa medications work best on an empty stomach. However some people experience nausea as a side effect of these medications, and taking them on an empty stomach may not be the best option. 

Recommend eating daily protein at the end of the day, to minimize the possible effective of protein malabsorption effect during active times. Advise the patient to take levodopa doses exactly as scheduled by the physician and to take with food if that is necessary to prevent nausea.

Advise the patient to eat foods that are rich in calories if weight loss is a problem. 

Managing Oral/Dental care with Swallowing Difficulty, Increased Saliva Production

• Remove dentures after each meal, brush and rinse them.
• Brush or clean them in a solution at night.
• Handle, insert or remove dentures over a soft surface or water-filled sink so they will not break if dropped.
• Suck on sugar-free hard candy or use artificial saliva substitutes to help regulate saliva production. Saliva aids denture retention.
• Discuss the benefits of implants with your dentist.
• Avoid alcohol, tobacco, spicy and acidic foods.
• If patient has swallowing difficulty, a speech therapy and/or nutrition consult is recommended.
  
  

Home Safety

Require the patient/caregiver to recall/demonstrate home safety strategies:

• Removing clutter
• Placing furniture in strategic areas so there will be something to hold on to as the patient walks around the house.
• Select chairs that will enable to sitting down and stand up.
• Group the things used most, such as reading glasses, keys, and the telephone, in one easy-to-reach place.
• Remove throw rugs or any other tripping hazards
• Put no-slip tape and handrails in the tub to prevent falls.
• Use a cane, walker, or scooter if the physician suggests it.
  

When to Call the Physician

• Feelings of depression
• Any injuries sustained because of impaired mobility
• Thinking or memory problems, confusion.
• Exacerbation of urinary issues or constipation.
• Feelings of depression.
• Dizziness
• Swallowing difficulties
  
  

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