Clinical tips: Parkinson’s Disease

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Pharmacists can make small changes that can greatly help patients with movement disorders, writes Karalyn Huxhagen

Parkinson’s disease (PD) comes in a variety of forms. While it may start slow it can speed up and slow down and move down different pathways.

Some very famous people live with Parkinson’s disease. One of these, Michael J Fox, has partnered with researchers to try and find a cure in our lifetime.

April 11 it is World Parkinson’s day. Shake It Up Australia has partnered with the Michael J Fox Foundation for Parkinson’s Research to raise awareness and funds for research into better outcomes and hopefully a cure for Parkinson’s disease.

The Shake It Up campaign is designed to give support to organisations to raise awareness of the ongoing need for funds for the research needed to battle this crippling disease. Consider whether your pharmacy would like to host an event.

Parkinson’s’ disease is just one of a large variety of movement disorders.  This week I performed a home medicine review for a lady with a diagnosis of Parkinson’s disease living at home alone.

Her major issue has been falls at night time. The simple addition of a night light to her bathroom has happily fixed that issue. Her gait and tremor are well controlled with regular Sinemet.

For this lady, her bigger issue is that she cannot easily recall what she wants to say in a sentence and when she does recall it she cannot put the words in the sentence. It frustrates her greatly but there is very little that can be done for this issue except keep her brain as active as possible with word and brain exercises such as puzzles and crosswords.

Another patient that I saw is starting to drag her feet more and even though she has a fairly level living area there is a small lip to her toilet and bathroom area. She has had three falls in a short period of time and is now at high risk. The physiotherapists are being utilised to try and strengthen her ability to lift her feet better as she walks.

A recent patient in the pharmacy expressed an unwillingness to take the antibiotic horse tablets that the GP had prescribed as she just cannot swallow such large hard tablets. Swallowing large and difficult masses can be a significant problem for patients with PD. 

Her tremor worsens when I ask her to concentrate to sign her prescriptions. We let her take her time to make her best effort on each prescription. The dispensary technician suggested that she signs the prescriptions that she wants while sitting quietly at home at her kitchen table. The customer thought that would be a very good idea and now presents with her prescriptions signed and dated in a more legible fashion.

One of the exciting research developments this year in relation to Parkinson’s disease has been the development of a new mapping system that can identify whether dopamine cells are depleted. In Parkinson’s disease dopamine cells degenerate and this loss leads to the symptoms of Parkinson’s disease that we are familiar with e.g. shaking, slowness of movement, loss of balance, difficulty in walking.

This research is hoping that by early identification of a loss of cells that treatment to enhance and protect viable dopamine cells may arrest the loss of function in the cells.

While current treatment for Parkinson’s disease is aimed at arresting the decline and improving function the more advanced research is looking at stopping the degradation and loss of function at a cellular and transporter chemical level. 

All of the movement disorders are very hard work to manage with medication. The importance of taking the medicine on time and at the correct strength is a message that all patients need to have explained to them constantly.

These disorders require collaboration between many health providers and these patients need advanced health care plans to maximise the support that we can contribute to. The various state bodies of the Parkinson’s support groups and bodies are all very active and provide excellent patient resources. These resources are also of value to families and carers and work mates who need to understand the symptoms and limitations of the disease.

The support of foundations such as the Michael J Fox Foundation allows for the breakthroughs in research to be funded to optimise the improvements in patient care. Many of the current research targets early stage Parkinson’s disease in an effort to arrest the deterioration that occurs with this disease.

While the new therapies will also be trialled on the advanced patients the major focus is on identifying early stage patients and stopping the progression of the disease.

Please visit the Shakeitup Australia website and consider supporting World Parkinson’s day on April 11 in your pharmacy.

Karalyn Huxhagen is a community pharmacist and was 2010 Pharmaceutical Society of Australia Pharmacist of the Year. She has been named winner of the 2015 PSA Award for Quality Use of Medicines in Pain Management and is group facilitator of the Mackay Pain Support Group.

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