Disabilities Associated with Aging

Maiya Kano Camry Hintze

Billy Graham: “Growing old has been the greatest surprise of my life.”

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Table of Contents

Introduction…………………………………………………………………………………..2 What is Aging? Increasing Quality of Life through Therapeutic Recreation

Dementia………………………………………………………………………………………3 Definition Causes Symptoms Types Population Affected Treatment and Prevention

Alzheimer’s Disease…………………………………………………………………………9 Definition Population Affected Characteristics Symptoms Prognosis Progression Specific Needs Medications TR Implications Resources

Parkinson’s Disease………………………………………………………………………….16 Definition Characteristics Symptoms Prognosis Progression Specific Needs Medications TR Implications Resources

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Introduction

Aging is a process that reflects all the physical, mental and social changes that occur throughout life. Aging is reflected on a numerical continuum. With increased age comes increased likelihood of disease and disability. “Older adults have the highest morbidity rates of all age groups due to the prevalence of chronic conditions” (Ferrini & Ferrini, 2013). The study of gerontology allows a closer look into the effects of the aging process and how to apply this knowledge and implement it into programs and practice.

The demographics of the aging population has been growing at unprecedented rates because American’s are living longer and the baby boomer generation is now older. An estimated 89 million Americans are aged 65 and older. Not only are there millions of older adults, but 80% of the previous demographic are non-Hispanic white.

Through Recreational Therapy, accessibility through social, leisure and community interactions can be made regardless of age. Any person, young or old, has the ability to find greater quality of life through the use of recreation. Activities are adapted to the individual's needs, but focus on bringing out his/her strengths. Therapeutic environments should support individuals to cope with the stress that comes as a result of their age-related disability. Such activities could include; music therapy, walks, art, gardening, cooking, fishing, crafts, animal therapy, singing, dancing.

Individuals, regardless of age related disabilities, have the opportunity to use their environment as a resource for supporting the remaining cognitive, physical and intellectual capacities. Such environmental conditions have the potential to assist individuals in overcoming barriers by providing modifications to certain activities. However, some individuals who are aging desire to remain in the same environment for as long as possible. However, aging in the same palace may be compromised your environmental barriers, especially in the homes of these older adults. Major barriers in include those serving as tripping hazards, or height of tables and bathroom fixtures. Physical disablement disallows many individuals to access certain items in a kitchen or restroom due to height, high or low. These places become inaccessible to those who are unable to bend low or reach high.

Therapeutic environments for those who are aging should promote overall quality of life and increased levels of wellness by supporting individuals in coping with the stresses that accompany age-related disabilities. Promoting physical and intellectual recreational activities for the purpose of serving as a treatment modality offers individuals with age-related disabilities the opportunity to improve their quality of life. You never know what you are capable unless you try. Don’t let your age define you, define your age.

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Dementia

Definition

Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. It is not a specific disease. Its overall term describes the wide variety of symptoms associated with memory decline and cognitive skills, which are severe enough that they reduce the individual’s ability to perform daily activities. In particular, alzheimer’s disease accounts for 60 to 80 percent of dementia cases.

Although dementia is often found in the elderly, it is not a symptom of old age. Just because someone loses memory due to old age does not mean they have dementia. Other symptoms such as stress, anxiety, and depression can cause memory loss. Dementia is most common among those 60 and older, but early onset can occur.

Many forms of dementia are progressive, meaning the symptoms start out slow but gradually get worse. Early diagnosis of dementia allows an individual to get maximum benefits from the available treatment.

Causes

Dementia is caused by damage to brain cells. This damage interferes with the ability of brain cells to communicate with each other. When brain cells cannot communicate normally, thinking, behavior and feelings can be affected.

The brain has many distinct regions, each of which is responsible for different functions (for example, memory, judgment and movement). When cells in a particular region are damaged, that region cannot carry out its functions normally.

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Different types of dementia are associated with particular types of brain cell damage in particular regions of the brain. For example, in Alzheimer's disease, high levels of certain proteins inside and outside brain cells make it hard for brain cells to stay healthy and to communicate with each other. The brain region called the hippocampus is the center of learning and memory in the brain, and the brain cells in this region are often the first to be damaged. That's why memory loss is often one of the earliest symptoms of Alzheimer's.

While most changes in the brain that cause dementia are permanent and worsen over time, thinking and memory problems caused by the following conditions may improve when the condition is treated or addressed:

● Depression ● Medication side effects ● Excess use of alcohol ● Thyroid problems ● Vitamin deficiencies

Symptoms

Symptoms of dementia vary depending on the part of the brain affected. Different types of dementia affect people differently. Most common symptoms include issues with the following:

● Memory- difficulty recalling events that happened recently ● Communication and language - difficulty following a conversation or finding the right

words ● Ability to focus and pay attention- difficulties making decisions, solving problems and

carrying out tasks ● Reasoning and judgment ● Visual perception - problems judging distances ● Confusion- losing track of the day, or where they are

Not only are there these cognitive symptoms, but a person with dementia may have

changes of mod, unusual behaviors such as pacing, or repetitive questioning, or experience physical symptoms like muscle weakness and weight loss.

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Types

There are many diseases that result in dementia. This happens when different types of dementia affect the brain. The following are the most common types of dementia.

Alzheimer’s Disease: This is the most common. It accounts for 60-80% of cases. It occurs when brain cells are surrounded by an abnormal protein and their internal structure is damaged. Chemical connections between brain cells are lost and some even die. Most common symptom at first is memory. Other progressive symptoms include impaired judgment, disorientation, difficulty speaking, swallowing, and walking.

Vascular Dementia: The symptoms associated with this form of dementia often overlap with those of Alzheimer’s. Vascular Dementia is caused when the oxygen supply to the brain is limited due to a narrowing or blockage of blood vessels, which cause brain cell damage or extinction. Initial symptoms include impaired judgment, and the ability to plan, think quickly or concentrate. There may also be short periods of confusion.

Mixed Dementia: Is defined as when someone has more than one type of dementia and has a mix of symptoms. For example, it is common for an individual to have Alzheimer’s and Vascular Dementia.

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Dementia With Lewy Bodies (DLB): This type concerns abnormal structures called Lewy bodies developing in the brain cells. Lewy Bodies are clumps of abnormal protein called alpha-synuclien, These bodies interrupt the brain's chemistry and kill the brain cells. Initial symptoms include fluctuating alertness, difficulty judging distances and visual hallucinations. DLB has some of the same symptoms as Parkinson’s disease.

Parkinson’s Disease: This type of dementia is similar to DLB and Alzheimer's. It is the result of a group of conditions called motor system disorders, which result from the loss of dopamine-producing brain cells. Parkinson’s is most often associated with difficulty of movement, because the neurotransmitter dopamine helps to regulate movement. As these dopamine producing cells degenerate, so does the physical movement of individuals and what results is tremors, impaired balance and slowness of movement.

Frontotemporal Dementia (FTD): In FTD, the front and side parts of the brain are damaged over time when clumps of abnormal proteins form inside nerve cells, and kill the cells. Major symptoms include those associated with changes in personality and behavior, and progressive aphasia.

As diseases of dementia progress, the brain become more affected. In later stages of dementia, individuals will need more help carrying out everyday tasks. Many people may however, maintain independence and quality of life for years after being diagnosed.

Population Affected

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Dementia affects mainly those over 65 years of age. However, young people can be affected. Dementia affects both men and women. Scientists are investigating the possible ways dementia might be genetic. Large number of people will inherit a combination of genes that may increase or decrease their rise of inheriting dementia.

Treatment and Prevention

Treatment of dementia depends on its cause. Because the diseases is progressive, there is no cure or treatment that will slow or stop such progression. But, there are medications to temporarily improve the symptoms. The path to effective treatment, as such international organizations have pushed for, will require increased research and funding for clinical studies. Even with the “no cure” answer to treatment possibilities for dementia, person centered support and approaches should be used to ensure the value of the individual is placed above the disease.

Activities such as talk therapies may help some come to terms with their diagnosis and help with depression or anxiety. Cognitive rehabilitation can also enable individuals to retain mental skills and help boost lost confidence. Pill boxes, calendars, to-do lists and practical tips can help individuals break down their takes into smaller step to make them more manageable. Activities which keep the mind active, or are cognitively stimulating are methods used to enhance memories and improve mental abilities and overall well being.

It is important for those diagnosed with dementia to stay as active as possible physically, mentally and socially. Meaningful recreational activities not only improve one’s overall sense of well-being, but boost confidence and self-esteem in everyday life.

Prevention of dementia includes the following focus on cardiovascular fitness, physical fitness, and diet.

The brain is fed by our bodies richest network of blood vessels. Any damage to such vessels in the body can affect the brain. It is important to not deprive these brain cells of food and oxygen. Any changes in the blood vessels may cause a faster decline and progression of the disease. Ways to protect the brain and the heart include the following: don’t smoke; maintain healthy blood pressure, cholesterol, blood sugar, and weight levels.

Regular physical exercise may also lower the risk of dementia. Exercise directly benefits the brain cells as increased blood flow and oxygen run through your body and into your brain.

Diet may have the largest impact on brain and heart health.

There is no one test to diagnose dementia, but doctors will carefully examine an individual's’ medical history, physical condition, blood test, changes in behavior and cognition. Often times doctors will diagnose “dementia” but not a specific type, as most cases have

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overlapping dementias. Specialists such as neurologists and gero-psycholgoists may be seen to determine a diagnosis for more specific forms of dementia.

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Alzheimer’s Disease Definition

According to the Alzheimer’s Foundation of America, Alzheimer’s disease can be defined as “a progressive, degenerative disorder that attacks the brain's nerve cells, or neurons, resulting in loss of memory, thinking and language skills, and behavioral changes.” Population Affected

There are approximately 5.1 million Americans that have Alzheimer’s disease. To provide a little bit of perspective, Utah has a population of almost three million. That would mean that individuals with Alzheimer’s would fill Utah more than one and a half times. Patients with this disease are generally an older population, as Alzheimer’s is an aging disability. The risk for developing the disease increases as aging occurs. Research has shown that for every five years after the age of 65, the prevalence of Alzheimer’s doubles. The generation of Baby Boomers are now reaching the age at which they are at risk of developing Alzheimer’s disease, this means an increase in the prevalence of the disability. This generation will make up 20 percent of the country’s population within the next 30-40 years. While the disease is primarily associated with aging, there are about half of a million Americans younger than 65 that have some form of dementia.

Characteristics

Alzheimer’s has to do with changes in the brain due to age. Some of these changes include shrinking in certain areas of the brain, also known as atrophy, as well as inflammation, unstable molecule production, and failure within a cell to create energy.

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Research has found through genetic testing that there can be an increase in the risk of developing Alzheimer’s disease if the person contains certain genes, specifically the apolipoprotein E gene. There are also other rare genes that have been directly connected to causing Alzheimer’s.

Lifestyle factors can also have an effect on the development and progression of Alzheimer’s disease. There is a connection between cognitive decline and metabolic and cardiovascular conditions. Things like heart disease, stroke, high blood pressure, diabetes, and obesity can affect the process of the brain. However, research still needs to be done to understand if reducing these conditions will reduce the risk of Alzheimer’s.

Symptoms

There are two categories of symptoms: cognitive and psychiatric. The difference between the two is important to know so they can be treated appropriately. The symptoms within the cognitive category are divided into four groups, these are considered the four As of Alzheimer’s, they are: amnesia, aphasia, apraxia, and agnosia.

Amnesia is memory loss. You are unable to remember any facts or events that have taken place. There are two types of memory, short-term and long-term. In Alzheimer’s disease the short-term memory is the first to go.

Aphasia deals with the ability to communicate. There are two types of aphasia, expressive aphasia and receptive aphasia. Expressive aphasia has to do with the ability to speak and write. Having this means the individual may forget words or have a difficult time with grammar. Receptive aphasia has to do with comprehending the communication. The

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individual may not understand what is spoken or read. However, nonverbal communication is still understood.

Apraxia deals with motor skills. Functions that are performed daily may be forgotten. The more difficult motor skills that required more comprehensive learning, for example job-related skills, are the first to be lost. Following this basic skills, like getting dressed, are impaired. In the most severe phase of Alzheimer’s, functions like walking and eating are lost.

Agnosia is a loss of one’s ability to decipher their own five senses. Sensations that were once familiar are no longer recognizable, including people and objects. One also loses sense of their own body, unable to recognize when they’re in pain or uncomfortable.

The other side of symptoms, the psychiatric symptoms include personality changes, depression, hallucinations, and delusions, to name a few. Personality changes usually appear early on in an Alzheimer’s diagnosis. Withdrawal, irritability, and apathy are just a few signs of this. Another psychiatric symptom is depression. This can appear any time throughout the disease and is treatable. In the middle stage of Alzheimer’s disease is usually when hallucinations and delusions can start appearing. They are made worse by sensory impairments that the individual already has. These psychotic symptoms can be very bothersome and create feelings of fear and anger. Psychiatric symptoms can cause more behavioral problems in individuals with Alzheimer’s, but they can be treated through medication.

It is important to note that just because you may see a few of these symptoms it does not mean that the individual has Alzheimer’s disease. There is a list of criterion given by the DSM V that should also be taken into account by a medical professional.

Prognosis

There is no cure for Alzheimer’s, there are medications individuals can take, but they do not slow down, prevent, or cure the disease, they only help with the symptoms to make the individual feel better. The life expectancy varies depending on the age of the individual, the onset of the disease, as well as many other health related factors, therefore life expectancy is difficult to predict.

Progression

Alzheimer’s disease gets worse over time, and the lifespan of an individual with this disease can range from two years after diagnosis to 20 years. Changes in the brain can even occur prior to the diagnosis of the disease. Once diagnosed, there are three general stages of Alzheimer’s, these are categorized into mild, moderate, and severe Alzheimer’s disease.

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Mild Alzheimer’s is also known as the early-stage. The individual is able to function independently at home, work, and in society, but lapses in memory will begin to occur. During this stage family and friends will begin to notice the memory difficulties.

The middle-stage is known as moderate Alzheimer’s disease. This tends to be the longest stage and can last for years. At this stage the individual will need more care. Their memory is disrupted even more and they may begin to forget their own history or personal information. They also may begin to withdraw. The continued damage to the brain makes routine tasks difficult to perform. It also becomes difficult to express thoughts. Personality changes are not unusual during this stage.

Severe Alzheimer’s disease is the last stage, also known as the late-stage. Individuals need extra help for daily functions, especially as their physical abilities decline making is difficult to walk, sit, and even swallow. At this point people with Alzheimer’s will usually reside in a care facility. Individuals lose sense of their surroundings and no longer respond to their environment, including communicating with others.

Everyone with Alzheimer’s disease will experience it differently, with different symptoms as it progresses. The individual will not always clearly fit into one stage as the stages can overlap.

Medication

There are different medications that can help with Alzheimer’s disease, however it is vital to note that these medications do not cure, prevent, or slow down the progression of the disease. They are only meant to help with the symptoms.

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There are two main medications that are usually prescribed to those with the disease: cholinesterase inhibitors and memantine. They are both taken to help with the cognitive symptoms such as memory loss or problems with thinking and reasoning. In the mild to moderate stages cholinesterase inhibitors are prescribed. This medication keeps the chemical messenger intact that helps with learning and memory. It also helps with the communication of nerve cells within the brain. Memantine is usually prescribed for those in the later stages. It helps with glutamate, a different chemical messenger than the one involved in cholinesterase inhibitors, but is also associated with cognitive abilities such as memory and learning.

Specific Needs

In the early stages it is beneficial to keep the patient at home surrounded by familiar things. Make sure the home is a safe environment, this includes keeping the house well lit, locking hazardous areas - including medication cabinets/drawers, and removing dangerous objects

TR Implication

Since Alzheimer’s is a disability involving the aging population, there will obviously not be any rigorous physical activity involved in their recreational therapy. However, this does not limit the activities that individuals with Alzheimer’s can participate in. Their focus will be on the skills and interests they already have as a way to prompt their memories, it is very individualized. Some interests may include cooking, gardening, art, music, and even interacting with animals. Recreational therapy can be very effective as it can help with the behavioral symptoms of Alzheimer’s like frustration and depression and is most effective with individuals in the mild and moderate stages of Alzheimer’s disease.

Resources

Local - There are many assisted living centers and care facilities found everywhere you go that have staff trained to help those with Alzheimer’s disease, The following are just a few found in Utah county.

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State - There is a state chapter of the national Alzheimer’s Association. One of their most popular fundraisers is the Walk to End Alzheimer’s.

National - The Alzheimer’s Association is the most well known resource for those who have been affected by Alzheimer’s disease. It even promotes a nation Alzheimer’s month which is in November.

International

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Online Resources

www.alzfdn.org

http://www.alzfdn.org/AboutAlzheimers/statistics.html

https://www.nia.nih.gov/alzheimers/topics/causes#other

http://act.alz.org/site/PageServer?pagename=walk_about_alzheimers

http://www.alz.org/alzheimers_disease_steps_to_diagnosis.asp

http://www.alzfdn.org/AboutAlzheimers/symptoms.html

http://www.alz.org/facts/overview.asp

http://m.alz.org/stages-of-alzheimers.asp

http://www.alzheimers.net/2014-05-29/care-options-for-alzheimers/

http://www.alz.org/alzheimers_disease_standard_prescriptions.asp

http://psychiatric-disorders.com/alzheimers/therapeutic-recreation-for-alzheimers-disease/

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Parkinson’s Disease

Definition

Parkinson’s is a chronic and progressive movement disorder, which means the symptoms continue and worsen over time. Parkinson’s is also known as HRS, or hypokinetic rigid syndrome. It is a degenerative disorder of the CNS, central nervous system.Parkinson’s belongs to a group of motor system disorders, which result in a loss of dopamine-producing brain cells. Healthy brain cells should produce the chemical ‘dopamine’, which sends signals to the brain to control movement. It allows a persons to move thiourea muscles smoothly and voluntarily. However, in Parkinson’s the nerve cells break down and do not produce dopamine, interfering with an individual's movement.

Primary symptoms that help to identify Parkinson’s include the following: tremor, trembling in hands, arms, legs, jaw and face; rigidity and stiffness in muscles; Bradykinesia, slowness of movant, postural stopping, imbalance and loss of coordination.

More than 1 million Americans live with Parkinson’s, which is more than the number of people diagnosed with multiple sclerosis, muscular dystrophy and Lou Gehrig’s disease. It is approximated that 60,000 Americans are diagnosed with Parkinson’s each year, not including those who have gone undiagnosed. More than 10 million worldwide are living with Parkinson’s Disease. The incidence of Parkinson’s increases with age, but at least 4% of people are diagnosed with Parkinson’s before the age of 50. Parkinson’s is prevalent in both men and women, but men are 1.5 times more likely to have it than women. Medication can be used to treat symptoms, but there is no definite cure. However, the disease is not life threatening or terminal.

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Characteristics

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The image above is a representation of what characterizes those with Parkinson’s. In the brain, the basal ganglia is the source of the neurotransmitter dopamine It is responsible for voluntary motor control, learning, cognitive and emotional functions. There are two exclusive disorders of the basal ganglia, exclusively Parkinson’s and Huntington’s disease. This area of the brain is located at the base of the forebrain and is strongly connected to the cerebral cortex and thalamus. It is in charge of motor movements and requires a proper balance of the chemicals dopamine and acetylcholine to transmit nerve impulses effectively.

With Parkinson’s, the cells that produce dopamine degenerate, and the balance between the two chemicals aforementioned is thrown off, and affects neurotransmission between the brain and the body. In more specific terms, cell loss in Parkinson’s happens in the substantia nigra part of the brain, which appears dark under a microscope. These neurons are in charge of producing the dopamine. However, the loss of dopamine is the reason why many medications and treatment options for Parkinson’s focus on increasing the dopamine levels in the brain.

Diagnosis of PD is dependent on the four most common symptoms, and in addition, other non-motor symptoms. Such symptoms will be discussed further below in a section entitled ‘Symptoms’.

It is important to understand that each individual diagnosed with Parkinson’s will experience different symptoms, or if the same, experience such symptoms differently. The disease is often known to begin on one side of the body and then over a period of time affect the other side. However, the initial side is always more severe than the other.

Symptoms

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Symptoms for Parkinson’s vary depending on the person. However, there are some general and common motor and nonmotor symptoms that define the disease. The nature of Parkinson’s as a movement disorder means there are general symptoms, but such symptoms depend on the brain region affected. Symptoms range from primary motor , secondary motor and nonmotor.

Primary Motor Symptoms:

Resting Tremor:

Nearly 70% of people in the early stages of Parkinson’s experience a slight tremor in the jaw, hand, foot or face. A tremor is defined as a shaking or oscillating movement that usually appears when the muscles are relaxed. The affected areas of the body tremor when at rest, hence the term ‘resting tremor’. It is usual for fingers or hands to tremble when down by one’s side or laying on one’s lap. The tremor will usually subside when the muscle is in action. Some have been able to control their tremor by keeping clenched fists or moving the arms. The tremor action can be made worse during stress or excitement. One of the most common tremors is called a ‘pill rolling’ tremor, where an individual will rub their thumb and forefinger together, back and forth. As the disease progresses, tremors will move from the side that was not originally affected. But the most severe effects will occur on the initially affected side. It is important to note, all people with PD will not develop tremors.

Bradykinesia:

Bradykinesia means ‘slow movement’. As this condition occurs it may appear that an individual is unusually still or has decreased facial expression. Bradykinesia causes difficulty in quick or repetitive movements, such as tapping the fingers or toes. Hence, small fine motor skills decrease. Life becomes increasingly difficult as individuals have difficulty cutting up and eating food, brushing teeth, brushing hair, buttoning a shirt or typing. Simple tasks are made difficult and time consuming People may also walk in narrow, short, shuffle like steps, as this condition limits the range of movement. As individuals drag there feet along, it becomes difficult to walk, and hence difficult to move at all. Speech is also affected, as it may become quiet and less distinct.

Rigidity:

In Parkinson’s, muscle tone of the affected area is always stiff and does not relax, which also contributes to a decrease in range of motion or flexibility . Rigidity is noticeable when a person does not swing arms when walking. It is often

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painful and uncomfortable. Most common reports of pain in people with Parkinson’s occurs due to tightness in neck, shoulders, and legs.

Postural Instability:

Individuals with Parkinson’s have a tendency to be unstable when standing upright, as they have lost the tone and reflexes needed to maintain the upright position. Some people might adapt to this instability by swaying backwards when rising from a sitting position, creating a danger for falls. Making any kind of pivoting or turning action becomes difficult. One test doctors use to test for postural instability is called the ‘pull test’. This means the doctor will give a backwards tug on the individual who is standing, and see how the person recovers from such tug. Most people will step backwards to prevent a fall, but those with Parkinson’s cannot recover and would tumble backwards if there wasn’t a doctor to catch them.

Secondary Motor Symptoms:

Freezing:

Freezing occurs when an individual hesitates to take steps forward. They feel like their feet are glued to the ground. Freezing is often temporary and once an individual has taken the first few steps, a normal gait can commence. Freezing often occurs in specific situations like when an individual is starting to walk, crossing a doorway, approaching a chair or couch. Freezing can be a serious problem as it increases the risk of the individual falling forward.

Micrographia:

Micrographia concerns the shrinking of handwriting as Parkinson’s progresses. Often time individuals believe their handwriting has just gotten worse. This is a result of bradykinesia, where difficulty with repetitive actions occurs.

Mask-like Expression:

This expression means a person’s face appears less expressive than usual, as there is a decrease in facial muscle movement.

Unwanted Accelerations:

occasionally , on with Parkinson’s will experience movements that are too fast, not too slow. These movements cause problems with speech and general day to day movement. People who speak fast, or produce a rapid stammer, are difficult to understand. Those who experience an uncontrollable increase in speed of gait, or what is called festination, are at risk for falls.

Additional secondary motor symptoms may include the following: ● stooped/leaned forward posture

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● Dystonia ● Impaired gross motor skills ● Akathisia ● Difficulty swallowing ● Sexual dysfunction ● Cramping ● Drooling and excess saliva

Nonmotor Symptoms

A majority of individuals with Parkinson’s will not only experience motor symptoms but also those associated with mind and body. Although these symptoms may be invisible, they often cause more trouble for those with PD than motor impairments.

Most nonmotor symptoms occur before motor symptoms. The most recognizable include the following, but occurrence of following symptoms does not ensure the prognosis of Parkinson’s. These symptoms serve to better understand the diseases and its progression.

● Loss of sense of smell ● Constipation ● Insomnia ● Mood disorders ● Hypotension

Other common nonmotor symptoms can include the following:

● Constipation ● Vision problems ● Excessive sweating ● Dandruff ● Incontinence ● Speech problems ● Bladder problems ● Sexual problems ● Dental problems ● Weight loss and weight gain ● Fatigue and lethargy ● Depression ● Fear and anxiety ● Skin problems ● Cognition problems, such as memory loss, slowed thinking, confusing and dementia

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● Impulsive behaviors due to medication side effects Prognosis

Although some people who develop Parkinson’s disease become severely disabled by the condition, some might just experience minor motor impairments. It is not currently possible to predict the symptoms or the intensity of the symptoms that affect individuals, as such symptoms vary from person to person. There is no cure for Parkinson’s, but there are medications to decrease the effects such symptoms have on the body and mind. Parkinson’s is progressive, meaning the symptoms will grow worse over time, but it is not a fatal disease.

Progression

The progression of Parkinson’s varies among all individuals. Because Parkinson’s is chronic and progressive, kites progression is different for everyone. For example, movement symptoms vary and so do their progression. Some people will develop mild symptoms quite quickly, while others develop dehabilittg motor difficulties more quickly. The nonmotor symptoms as described above often affect individuals through every stage of the disease and sometimes interfere more with day to day activities and living than the primary and secondary motor impairments.

Progression of Parkinson’s occurs in 3 stages: mild, moderate, advanced. Each stage of progression will be described further below.

Mild Parkinson’s:

● Movement symptoms may be inconvenient, but do not affect daily activities ● Movement symptoms, often tremor, occur on one side of the body ● Friends may notice changes in a person’s posture, walking ability or facial

expression ● Parkinson's medications suppress movement symptoms effectively ● Regular exercise improves and maintains mobility, flexibility, range of motion and

balance, and also reduces depression and constipation

Moderate Parkinson’s:

● Movement symptoms occur on both sides of the body ● The body moves more slowly ● Trouble with balance and coordination may develop ● “Freezing” episodes — when the feet feel stuck to the ground — may occur ● Parkinson's medications may “wear off” between doses

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● Parkinson's medications may cause side effects, including dyskinesias (involuntary movements)

● Regular exercise, perhaps with physical therapy, continues to be important for good mobility and balance

● Occupational therapy may provide strategies for maintaining independence

Advanced Parkinson’s:

● Great difficulty walking; in wheelchair or bed most of the day ● Not able to live alone ● Assistance needed with all daily activities ● Cognitive problems may be prominent, including hallucinations and delusions ● Balancing the benefits of medications with their side effects becomes more

challenging.

Specific Needs

It is necessary to help those with Parkinson’s maximize their independence by helping them understand their emotions and helping them find a new balance in their life. It is important that caregivers of those with Parkinson’s understand reactions to medication and how to handle mood and cognition changes safely. Caregivers must be patient, flexible, and adaptable, have empathy, not expect more than can be given, take things slow and encourage and inspire, allowing for those they serve to feel independent and in control yet cared for.

Medications

Most medicines for Parkinson’s are called dopaminergic, meaning they aim to replenish and mimic the action of dopamine. These drugs reduce muscle rigidity, improve speed and coordination of movement and lseen tremor.

Medications for Motor Symptoms: ● Levodopa - converted into dopamine for the nerve

cells to use a neurotransmitter

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● Dopamine Agonists - activate the dopamine receptor and mimic the function of dopamine in the brain

● Amantadine - increases the amount of available dopamine ● Anticholinergic Drugs -restores balance of dopamine and acetylcholine in the brain ● COMT inhibitors - retains dopamine so it can be used more effectively ● MAO-B inhibitors

Surgical Treatment Options:

● Deep Brain Stimulation ● Thalamotomy ● Pallidotomy ● Subthalamotomy

Other Options:

● Flexibility exercises ● Aerobic activity ● Resistance training or strengthening exercises.

Complementary Medicines:

● Antioxidants Vitamin C and E, the Mediterranean Diet ● Calcium and Vitamin D ● Coenzyme Q10 ● Folate (Folic Acid) ● Ginger (Zingiber Officinalis) ● Gingko Biloba ● Green Tea Polyphenols (GTPs) ● Milk Thistle (Silybum Marianum) ● St. John's Wort (Hypericum Perforatum) ● Vitamin B12

TR Implications

"Aging is not lost youth but a new stage of opportunity and strength." Betty Friedan

In all the stages of Parkinson’s from mild to severe, therapies can prove effective at easing symptoms and making it possible for individuals with Parkinson’s to maintain and improve their quality of life.

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Therapeutic recreation is a holistic process that uses recreational leisure of all different kinds to bring about positive change, either socially, emotionally, intellectually, physically or spiritually, in an effort to maintain and improve the quality of life With accessibility to recreation and leisure education, community and home life can be enjoyed, rather than painfully lived through. Everyone, no matter age, disease or disability, can find a greater quality of life through participating in recreational leisure. Sometimes activities have to be adapted and modified for those who are unable to pursue the original activity, but such modification do not take away from the enjoyment of pursuing recreational activities. Possible recreational activities that can be used for people who have Parkinson's include the following:

● Art therapy ● Reading books ● Solving puzzles ● Walking and Hiking ● Gardening ● Swimming ● Cooking and preparing meals ● Yoga ● Sing-a-longs ● Music therapy

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Resources

Online resources

http://cirrie.buffalo.edu/encyclopedia/en/article/189/

http://www.sciencedirect.com/science/article/pii/S0966636216300819

http://content.ebscohost.com/ContentServer.asp?EbscoContent=dGJyMNLr40SeqLM4zdnyOLCmr06ep7NSrq64TLKWxWXS&ContentCustomer=dGJyMPGuskyurK5IuePfgeyx43zx1%2BqE&T=P&P=AN&S=R&D=pbh&K=114652988

http://www.sciencedirect.com/science/article/pii/S096663621630008X

http://www.sciencedirect.com/science/article/pii/S0167945716300239

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