Managing Parkinson's Disease: Addressing Anxiety and Daily Challenges

Parkinson's disease

Dear Dr.
Jiang,
My mother was diagnosed with Parkinson's disease last August at the age of 66.
She has had long-standing insomnia issues and has a naturally introverted and anxious personality.
It wasn't until last year that she experienced weakness in her left lower limb and began dragging her feet while walking, leading to her diagnosis.
Currently, she is taking levodopa and anti-anxiety medication, but her anxiety has not improved.
She often expresses a lack of motivation to do household chores and has difficulty holding dishes (her hands feel weak).
She has also fallen while riding her electric scooter; therefore, my father does not allow her to do housework or ride a scooter, which makes her feel even more useless.
She frequently asks if this illness will ever get better, believing she is diligently taking her medication and exercising.
She usually walks for 1-2 hours daily.
I would like to take her for heavy metal testing, as she has lived in the countryside and worked in agriculture and hotel housekeeping for 25 years.
If it turns out that she has been exposed to excessive levels of heavy metals and treatment could alleviate her symptoms, it might also improve her mood.
I would like to know your opinion on this matter.
How can we help her, especially regarding her emotional state? Family encouragement and persuasion have not been effective.
Thank you!

Ms. Chen, 40~49 year old female. Ask Date: 2022/11/18

Dr. Jiang Junyi reply Neurology

Hello Ms.
Chen,
You mentioned, "Heavy metal testing, due to living in the countryside and working in hotel housekeeping for 25 years.
If there has indeed been excessive exposure and treatment, would it improve symptoms, and would her mood improve?" For atypical Parkinson's disease, it is indeed important to consider testing for toxic metals in the blood, as well as making adjustments for environmental factors.
Typical Parkinson's disease presents with three main symptoms: tremors (shaking of the hands), rigidity of the limbs, and bradykinesia (slowness of movement).
Depressive symptoms in Parkinson's disease can occur throughout the course of the illness, with an incidence ranging from 40-60%.
Approximately 30% of Parkinson's disease patients may also develop dementia.

If depressive symptoms persist, it is recommended to seek treatment for depression: consult a psychosomatic medicine specialist to confirm the diagnosis.
Continue taking antidepressant medications to maintain a stable concentration of the drug in the body.
Change the way you speak to yourself.
Seek out supportive individuals who can accompany you through difficult times.
Set simple daily goals for yourself to achieve.
Engage in some light exercise.
Find a supportive group that understands your situation.

I suggest discussing testing and treatment options with your attending physician.
Thank you for your inquiry, and feel free to discuss any related questions further! Wishing you good health, peace, and joy.
Dr.
Jiang Junyi, Taoyuan Medical Center, cares about you.

Reply Date: 2022/11/18

More Info

Managing Parkinson's Disease, especially when compounded by anxiety and emotional distress, can be a complex challenge for both patients and their families. Your mother’s situation, as you described, involves not only the physical symptoms of Parkinson's disease but also significant psychological components that can exacerbate her overall condition.
Parkinson's disease is a neurodegenerative disorder characterized by the loss of dopamine-producing neurons in the brain, leading to symptoms such as tremors, rigidity, bradykinesia (slowness of movement), and postural instability. However, it is also well-documented that many patients experience psychological issues, including anxiety and depression. These emotional challenges can significantly impact a patient's quality of life and their ability to engage in daily activities.

Your mother’s feelings of inadequacy and frustration about her limitations are common among Parkinson's patients. The fact that she feels she cannot contribute to household tasks or ride her electric scooter without fear of falling can lead to a sense of loss of independence, which can further exacerbate feelings of anxiety and depression. It is crucial to address these emotional aspects alongside the physical symptoms.

Here are several strategies that may help improve your mother’s situation:
1. Psychological Support: It may be beneficial for your mother to see a psychologist or psychiatrist who specializes in chronic illness or neurodegenerative diseases. Cognitive-behavioral therapy (CBT) can be particularly effective in helping patients manage anxiety and depression. This type of therapy focuses on changing negative thought patterns and behaviors, which can help her develop a more positive outlook.

2. Medication Review: Since your mother is already on medication for anxiety, it might be worth discussing with her healthcare provider whether her current regimen is adequate. Sometimes, adjustments in medication or the addition of an antidepressant can significantly improve mood and anxiety levels.
3. Physical Therapy and Occupational Therapy: Engaging in physical therapy can help improve her mobility and strength, which may reduce her fear of falling and increase her confidence in performing daily activities. Occupational therapy can also provide strategies for safely engaging in household tasks, which might help her feel more useful and involved.

4. Support Groups: Connecting with others who are experiencing similar challenges can be incredibly beneficial. Support groups provide a space for sharing experiences, coping strategies, and emotional support. This can help your mother feel less isolated in her struggles.

5. Family Involvement: Continue to encourage her, but also ensure that you are validating her feelings. Sometimes, simply acknowledging her frustrations and fears can help her feel understood. Encourage her to express her feelings openly, and reassure her that it’s okay to feel overwhelmed.

6. Lifestyle Modifications: Encourage her to maintain her exercise routine, as physical activity has been shown to improve mood and overall well-being. Additionally, consider exploring relaxation techniques such as mindfulness, meditation, or yoga, which can help reduce anxiety.

7. Nutritional Considerations: While you mentioned the idea of heavy metal testing due to her past occupations, it’s essential to approach this with caution. Nutritional support, including a balanced diet rich in antioxidants and omega-3 fatty acids, may help support brain health. Consulting with a nutritionist familiar with Parkinson's disease could provide tailored dietary advice.

8. Regular Follow-ups: Ensure that she has regular follow-ups with her neurologist to monitor her Parkinson's disease progression and adjust treatment as necessary.
In conclusion, managing Parkinson's disease involves a holistic approach that addresses both physical and psychological health. By integrating psychological support, physical rehabilitation, and family involvement, you can help your mother navigate her challenges more effectively. It’s essential to remain patient and supportive as she adjusts to her diagnosis and treatment.

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