Parkinson's disease (PD) Q&A
by Dr Chung Tin Hei
Q: How can the diagnosis of PD be firmly made?
A: PD basically is a clinical diagnosis. There are no definite blood tests or imagings that can confirm the diagnosis.
Q: Is PD is a hereditary disease?
A: No. Only several families were reported as hereditary in the world. Most cases are sporadic.
Q: Is PD preventable?
A: No. PD is a neuro-degeneration disease of unknown pathogenesis, no specific food, herbal medication, healthy product nor medication is proven to prevent PD.
Q: Is PD curable?
A: No, the control of PD is only symptomatic.
Q: In what ways PD is fatal?
A: Accidents and aspiration pneumonia are the two most common life-threatening conditions.
Q: Do the PD patients have weaker muscle strength?
A: No. PD affects patients’ coordination instead of muscle strength. The so-called weakness is likely to secondary to lack of adequate exercise or psychological issue.
Q: Do PD patients have a shorter life expectancy?
A: No, PD is not related to cardiovascular disease or cancer. Most patients died of other co morbid disease.
Q: Why do PD patients complain of unexplained pain or numbness over the body?
A: Sensation manifestation is part of PD. For instance, shoulder pain (frozen shoulder) and temperature perception change are common in PD patients. Of course, please seek help from doctors to rule out other conditions such as nerve entrapment.
Q: Is dementia equivalent to PD?
A: Both are neuro-degeneration diseases. Dementia can be a psychiatric manifestation of PD. Patients of PD can have co-existing Alzheimer’s disease. Lewis body dementia is another differential diagnosis.
Q. I felt unhappy, what can I do?
A. Depression is present in 30-40% of PD patients. Antidepressant agent (SSRI) can be used successfully. Referrals to social worker, psychologist or psychiatrist are required in some patients.
Q: Any standard drug regimen applicable to all PD patients?
A: No such standard protocol existed. The drug regimen should be individualized made in each PD patient. The principle is to achieve “continuous dopaminergic stimulation”, in which fluctuations can be ameliorated both by stabilising circulating drug levels and by normalising some of the central pharmacodynamic alterations attending chronic, non-physiologic, intermittent stimulation.
Q: Should PD medication be taken before or after meal?
A: Either is OK if medication is taken one hour before or after meal.
Q: Any difference between brand named and generic drugs?
A: We should focus on the active ingredient of the drug. The generic drugs prescribed by Hospital Authority have passed strict pharmacological tests, to ensure their bioavailability is close to original brand named drugs.
Q: How to tackle constipation?
A: The causes of constipation in PD are multi-factorial. Exercise, fiber rich food, and adequate water intake can help. However, some patients need laxatives.
Q: Is stem cell therapy as a treatment option?
A: Not yet at the moment. Only deep brain stimulation is the approved surgical treatment modality.
Q: Can PD patients take herbal medicine for other reasons?
A: Please consult your doctor first. In general, herbal medication should be consumed 4 hours after the PD medication.
Q: Can all the PD features be controlled with medication?
A: No, the cardinal PD features such as stiffness, slowness and tremor can be well controlled with medication. Symptoms like constipation, freezing and gait problem are quite troublesome.
Daily activities related:
Q: Should high protein food be avoided in PD?
A: Please follow the guidelines of healthy diet. Protein limitation or diet reconstitution is considered in some severe PD patients when the protein in diet jeopardizes the drug absorption. Dietitian should be consulted.
Q: Can PD patients drive?
A: There is no obligation for doctors to report the patients to Traffic Department. PD itself and medication may impair coordination, mental alertness and response in case of emergency. Therefore, patients should bear their own risks if they drive. Patients are advised to avoid driving for the maximum benefit of public and themselves.
Q: Can PD patients have a long haul flight, to USA for example?
A: Yes, it is possible for a stable patient. Please follow the routine drug regimen and keep moving in the flight.
Q: Any exercise recommended for PD patients?
A: Balance training exercise, Tai Chi or walking are good enough for PD patients.
Q: Any organization or self-help group of PD in Hong Kong?
A: Hong Kong Parkinson’s Disease Foundation /香港柏金遜症會 (http://www.hkpdf.org.hk/eng_profile.html) and Hong Kong Society for Rehabilitation /香港復康會 (http://www.rehabsociety.org.hk/465.html) are the two well-established organizations which provide constant support to PD patients and their families. Please visit their websites for details.