Aging Well with Parkinson’s – Doctor’s Notes

Dr. Sughrue has very generously provided us with her own notes from our May meeting.  I transcribed but its possible to hear wrong or state incorrectly what is presented.  People with PD don’t always multi-task  very well.  So I encourage you, if anything sounds odd or contrary to what’s been told to you before, I strongly encourage you to double check with the Doctor’s Notes, reprinted below.


The Doctor’s Notes

We’re here to talk about normal aging which, for better or for worse, affects all of us eventually.  I think everyone here is touched in some way by Parkinson’s.  I won’t spend a lot of time on PD but we will talk a little about what PD brings over time, how it can be confused with age-related issues that have nothing to do with PD or maybe add on to some normal aging phenomenon.

PD has the motor stuff, of course, which is how most patients are first identified.  Then there are the non-motor symptoms that occur in many patients to a varying extent.  These can include constipation, low blood pressure, sweating, sexual dysfunction, sleep problems, psychiatric issues, fatigue, pain, problems with the sense of smell among others.  But wait?  There is nothing on that list that might not also be on a list for just aging except maybe the low blood pressure. Maybe you are more susceptible but all those things are symptoms I hear about in my pts without PD.

Your challenge seems to be figuring out what is coming from PD and what isn’t, what might be a side effect of one of your medications.  And what, if anything, you can do about it. For example, if you start a new medication and develop constipation, that’s seems like a clear correlation. There are longer-term side effects from your meds that might not be as obvious. For guidance on that you’re probably talking to your neurologist as well as your PCP, both will have helpful but different insights.

Aging well is a challenge for everyone but a bit more so for those with a chronic condition that can affect so many aspects of your life.  As a result a plan for maintaining good health is even more imperative for you than for someone without PD.
What do I mean by a plan for health?  This is the advice you probably give and have heard from doctors and lay people alike but it’s absolutely vital. I’ll just review the 5 components briefly.
Plan your food.  Most of it should be fruits and vegetables with a smattering of red meat if you eat it.  Better protein sources are legumes, fish and chicken.  Stay away from fast food, junk food, sodas (even diet) and make your portions reasonable.
Regular exercise, 30 minutes 5 days a week.  Interval training can be VERY short, like 2 minutes on and 2 minutes off repeated 4 times and you’re done.  Add in some attention to your balance and strength, again not a big time investment, and you will help reduce wear and tear as well as prevent falls going forward.
Sleep schedule should be as good as you can make it.
Stress reduction in any way possible.  Meditation or just breathing exercises are wonderful ways to avoid using medications in this setting.
Stay engaged like doing things like this!  All the evidence suggests that isolated individuals are at much higher risk for illness in general and memory or psychiatric ones in particular.

All that said I’ll just go through a few of the most common age-related complaints I hear.

Menopause:  Some of us sail through this, others really struggle.  In my years in medicine the pendulum has swung at least twice to the extremes of hormones for everyone, no hormones, supplements, no supplements.  At this point the buzz words are “window of opportunity.”  That means that there is a window of time basically from the onset of menopause (average age 51) and extending about 5-10 years when hormones might do more good than harm.  For every patient who feels she needs help, it is worth a special visit with your doctor to review the pros and cons for you taking into account your meds and other PD issues.  Symptoms of menopause include hot flashes, mental fogginess, sexual issues, insomnia, abnormal bleeding.  Some of those definitely overlap with PD so would require some sorting out.

Cataracts:  This has nothing to do with PD.  The lenses of our eyes can get cloudy with age.  Genetics accounts for about 35% of your risk and environmental factors 65%, i.e. Related to diet, smoking, lots of alcohol, sunlight exposure, poor lifestyle habits (like inactivity or poor nutrition), use of steroids and maybe statins which are used for cholesterol.  A word about steroids:  The occasional use for an acute asthma flare up or the like is not the issue.  Long term oral steroids or maybe even high-dose inhaled steroids like Flonase can be a problem.  The dietary pluses are best gained by eating the foods, not taking supplements which is pretty much true of all diet-related advantages.  So lots of Vitamin C is the big one for preventing cataracts, i.e. Fruits and vegetables – where have you heard that before?

Osteoporosis:  PD does not cause low bone density but you may be at higher risk due to the inactivity you might suffer because of motor issues.  It’s important because you might be at higher risk to fall.  The risk factors for osteoporosis overlap a lot with those for cataracts:  Smoking, inactivity, steroid use, high caffeine and/or alcohol use, thin, Caucasian.  Genetics also play a role.  The current guidelines don’t recommend a bone density test in the average woman until age 65.  Again it’s something to discuss with your doctor and do what you can with your risk factors.  Vitamin D is one supplement that it’s hard to get enough of given where we live and avoiding the sun as we do.  So a daily supplement of 800-1000 IU is recommended along with 1200-1500 mg daily of calcium.  The latter can be derived entirely from food or 1/2 and 1/2, it is worth looking at your diet and seeing what you might need to add in.

Before we move on to memory issues, I’d like to introduce something that’s had a few names during my years in medicine: Syndrome X was the first name, a little scary. Now we call it Metabolic Syndrome. This refers to a combination of medical conditions that conspire against our arteries in bad ways. Those conditions include HTN, DM, high cholesterol and overweight. The last problem, being overweight especially when combined with inactivity, is thought to be the main culprit in the changes that ensue leading to what we call small vessel disease and deposition of plaque in our brains, disrupting normal function. Memory problems are very much increased when you have 1, 2, 3 and 4 of those conditions and PD adds on to that. Please work with your PCP if you suffer from any of those conditions to minimize them as best you can. And it’s not just memory issues that result from metabolic syndrome, of course, there’s the usual heart disease, kidney disease, stroke among others.

Memory issues:  These occur to almost everyone with aging but there is no doubt PD confers a slightly higher risk.  Again it’s all the same stuff that helps prevent it that I started with – sleep, exercise, food, stress reduction and avoiding social isolation.  Managing your other medical conditions is key as I mentioned before. The kind of memory issues that normal aging causes can be disturbing but have no particular implications.

Energy levels:  Again it’s hard to sort out PD-related issues vs. aging.  There are often many contributing factors – chronic pain, chronic medical conditions, medications, stress, changing bodies, poor sleep.  Trying to identify what factors you can modify and those you can’t can help.

Arthritis/Pain:  This can be related to genetics plus wear-and-tear.  And that wear-and-tear can be specific to an abused joint, like a runner’s knees, or just generalized like in a person who does physical labor all his/her life and ends up with lots of joint-related issues.  Prevention is difficult when genetics are involved.  But minimizing its effects can really make a difference.  This is best accomplished by maintaining a healthy weight and staying physically active.  Many studies tell us that the more time those of us with arthritis spend being sedentary, the more likely we are to have increasing disability and we are more likely to develop other chronic health conditions.  And only 10% of us meet the current guidelines in terms of exercise recommendations.  So ANY increase in activity is good and that often means finding an activity that can accommodate the pain and disability.  Medications:  Nothing great unfortunately.  The NSAID’s and Tylenol are mainstays for pain.  There are many supplements out there, theories about antioxidants, etc.  Nothing really has been substantiated in placebo trials.  So try to keep it simple and stay active.

I have not talked about health maintenance items that crop up as we enter our 50’s and 60’s and on but would be happy to discuss recommendations about things like screening for breast, cervical and colon cancer since a lot has changed in the last 10 years for all of those. We could also talk about recommended immunizations and other screening blood tests if you want.

That’s it!


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