Courage, Tenacity and Love Meet Parkinson's Disease
MAY 9, 2015 THE THREE FACES OF PARKINSON'S DISEASE
Parkinson’s is called a Movement Disorder, as though the most important aspect of it is the effect it has on a person’s ability to move. The four cardinal movement symptoms are: bradykensia (slowness of movement), rigidity, tremor and difficulty with balance. A good Movement Disorder Specialist (MDS) can identify a person with Parkinson’s based on assessing those four issues alone, even though the patient often exhibits other physical symptoms as well, such as loss of smell, constipation, sleep disorder, shuffling gait, etc. But slowness, rigidity, tremor and balance are the keys they assess.
In my experience, movement issues are only one third of the unhappy triangle that defines the disease. The other two thirds are the intellectual or cognitive effects of Parkinson’s and the emotional deterioration that accompanies PD.
People with Parkinson’s have an accelerated loss of executive function. As the disease progresses we are not able to plan, organize, multi-task, analyze or do the higher order thinking that we used to do with ease. Even finding our way around familiar routes is increasingly difficult. Dementia is all too often an end point of this loss of executive function, but long before anyone identifies dementia, little things go haywire. Reading becomes difficult, as does the capacity to recall what is read or how it all fits together. Forming clear sentences and carrying on intelligent conversations, particularly with groups of people, is increasingly challenging, often impossible. Even selecting what to wear to any function or what to make for dinner or how to make it gets more and more difficult. If the person looks pretty much normal, friends and acquaintances often miss subtle indicators of loss of executive function. For the person with the disease it is excruciatingly painful to recognize incremental losses of intellect.
Emotional deterioration is perhaps the cruelest leg of the triangle. To see humor, experience love, be entertained and have no reaction is incredibly painful. Sometimes you can make yourself laugh, but you do not feel other people’s pain in the way you know you formerly would. Emotional loss manifests itself in both a flat affect, an expressionless face, and a “whatever will be will be” attitude, difficult for the person with Parkinson’s and frustrating for those who have to endure the changed relationships it inevitably engenders.
Can anything be done to change this scenario? Not much, but not nothing. We say that PD accelerates the subtractions of age. Through physical exercise, not just ambling along, but putting out real effort for extended periods of time, many people mitigate many of the physical symptoms of PD. The physical exercise also affects the intellectual losses we experience, or at least slows them down. Forcing oneself to engage in community and to do for others goes a long way toward turning around emotional deterioration. The subtractions of age will still be with us, but perhaps by recognizing the three faces of PD and taking action, we can make the subtractions go one by one instead of ten by ten.