1. Sarah Ehlers & Brendan Valentine Parkinson’s Disease

2. Description A progressive disorder of the nervous system Symptoms: Tremors Slowed Movement (bradykinesia) Rigid Muscles Impaired Posture and Balance Loss of Automatic Movements Speech Changes Writing Changes (1)

3. Stages Stage 1 - one side of the body is affected Stage 2- both sides of the body affected; balance intact Stage 3- balance impaired, but not independent functioning Stage 4- walking or standing difficult with out assistance Stage 5- bedridden or wheel chair bound with out assistance

4. Examples

5. Risk Factors Age. Young adults rarely experience Parkinson's disease. It ordinarily begins in middle or late life, and the risk continues to increase with age. Heredity. Having a close relative with Parkinson's disease increases the chances that you'll also develop the disease. However, your risks are still small unless you have many relatives in your family with Parkinson's disease. Sex. Men are more likely to develop Parkinson's disease than are women. Exposure to toxins. Ongoing exposure to herbicides and pesticides may put you at a slightly increased risk of Parkinson's disease.

6. Etiology Specific etiology is unknown (6) Related to loss of brain chemicals Cells in the substantia nigra part of the brain degenerate these cells make dopamine Decreased dopamine lead to increased muscle tension and tremor (3,4)

7. Diagnosis Medical History and Clinical Examination Motor Symptoms Bradykinesia (slow voluntary movements Tremors (involuntary movements) Rigidity Posture Olfactory Dysfunction Sleep behavior Depression Cognitive Decline Diagnosis can only be certain post mortem (2)

8. Statistics Each year, approximately 60,000 Americans are diagnosed with Parkinson's disease. Prevalence Rate: approx 1 in 272 or 0.37% or 1 million people in USA It appears to affect whites more than African Americans or Asians. Not even 10% of cases are diagnosed in adults under age 40. Most of the fresh diagnoses are in those above age 60. Men are one and a half times more likely to have Parkinson's than women. Medication costs for an individual person with PD average $2,500 a year, and therapeutic surgery can cost up to $100,000 dollars per patient. (5)

9. PD and Nutrition IncreaseDecrease Magnesium- deficiency symptoms similar to PD symptoms and sleep support Vitamin D- enhances brain- derived neurotropic factor (basically growth hormone for neurons) & anti- inflammatory Omega-3’s-Mood-boosting & anti-inflammatory Homocystein- toxic if elevated & found at high levels in people with PD folic acid, vitamins B12 and B6, zinc and tri- methyl-glycine (some co- factors dopamine production) (7)

10. Affects on Nutrition Unintentional Weight LossLong Term Increased EE: Tremors, Dyskinesia, Rigidity Reduced Intake: Olfactory changes Dysphasia Reduced peripheral ability Medicinal Complications (7) Increased Hospital Stays Decreased bone density Increased chances of fractures Depression Loss of muscle mass Introduction of new chronic disease Death (7)

11. Treatment Levodopa with dopadecarboxylase inhibitor The most effective treatment available for Parkinson’s Dopamine and Serotonin Inhibitor Eventually a wearing off effect will occur Results in dyskinesia (involuntary movements, tics) Debate over when to start treatment in patients under 50 (8)

12. Surgical Treatment Option Deep Brain Stimulation (DBS) Surgically places electrode in the brain Does not damage healthy brain tissue Blocks electrical signals from targeted areas in the brain. Helps treat tremor, slowness, rigidness (10)

13. Role of the Dietitian Team Approach Registered dietitian must work with the primary care physician, a neurologist and, the SLP when dysphasia is present Develop a menu meeting the needs for: Folic acid Vitamins B12 and B6 Zinc Magnesium Vitamin D Omega 3’s Work with the SLP on how the diet must be administered (7)

14. Case Study Patient 72 year old female Stage 4 Nursing home resident Severe tremors Holding silverware is difficult Dysphasia present Experiencing unintentional weight loss

15. Treatment Options Levodopa medication Adaptive eating utensils Pureed diet high in magnesium, vitamin D, and omega 3’s Weight training, tai chi, yoga exercises (if cleared by doctor) with assistance Swallowing techniques, exercises, rehab with SLP Monitor and watch for signs and symptoms of weight loss, malnutrition, and act with the SLP to change diet accordingly

16. References 1. Mayo Clinic. Parkinson's Disease. http://www.mayoclinic.com/health/parkinsons- disease/DS00295 (accessed April 14, 2013). 2. Lingor, P., Liman, J., Kallenberg, K., Sahlmann, C., Bahr, M.. Diagnosis and Differential Diagnosis of. Intech.2011;1(1):1-19 3. http://www.palmbeachneurological.com/news/non-motor-symptoms-of-parkinsons-disease/ 4. http://students.cis.uab.edu/kelseycp/Parkinson%27s.html 5. http://www.pdf.org/en/parkinson_statistics 6. Gaenslen A, Gasser T, Berg D. Nutrition and the risk for Parkinson's disease: review of the literature. Journal Of Neural Transmission (Vienna, Austria: 1996) [serial on the Internet]. (2008, May), [cited April 15, 2013]; 115(5): 703-713. Available from: MEDLINE with Full Text. 7. http://www.foodforthebrain.org/nutrition-solutions/parkinsons-disease/about-parkinsons- disease.aspx 8. Holden, K.E.. Unintentional Weight Loss and Its Management. Nutrition in Clinical Care.2001;4(3):131-139 9. Worth, P.F.. How to treat Parkinson's disease in 2013. Clinical Medicine.2013;13(1):93-96 10. http://www.parkinson.org/Parkinson-s-Disease/Treatment/Surgical-Treatment-Options/Deep- Brain-Stimulation