Tài liệu PARKINSON’S DISEASE pptx

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N   R. This book is not meant to substitute for medical care of
people with Parkinson’s disease, and treatment should not be based solely on its
contents. Instead, treatment must be developed in a dialogue between the indi-
vidual and his or her physician. Our book has been written to help that dialogue.
© 2001 The Johns Hopkins University Press
All rights reserved. First edition 2001
Large print edition 2002
Printed in the United States of America on acid-free paper
9 8 7 6 5 4 3 2 1
The Johns Hopkins University Press
2715 North Charles Street
Baltimore, Maryland 21218-4363
www.press.jhu.edu
Library of Congress Cataloging-in-Publication Data
Weiner, William J.
Parkinson’s disease / William J. Weiner, Lisa M. Shulman,
Anthony E. Lang. — Large print ed.
p. cm.
ISBN 0-8018-6880-7 (lg. print)
1. Parkinson’s disease — Popular works. 2. Large type books.
I. Shulman, Lisa M. II. Lang, Anthony E. III. Title.
RC382. W45 2002
616.8Ј33—dc21
2001038915
A catalog record for this book is available from the British Library.
Illustrations on pages 7, 9, 38, 187, 189, 194, 234, and 292 by Jacqueline
Schaffer.
To Monica and Miriam Weiner. May you continue to
pursue your dreams and goals.
WJW
To Joshua and Corey Shulman. We continue to learn
together.
LMS
To Matthew, Stephen, and Kathryn Lang. Your happiness
and joy in life are always in my thoughts and prayers.
And in memory of the remarkable inspiration and love of
their grandfather Thomas Lang.
AEL

Contents
Preface ix
Acknowledgments xiii
PART I Introduction
1. What Is Parkinson’s Disease? 3
2. Who Gets Parkinson’s Disease? 25
PART II Signs and Symptoms of Parkinson’s
Disease
3. Early Symptoms 43
4. Moderate Parkinson’s Disease 59
5. Advanced Parkinson’s Disease 82
6. Behavioral Changes and Psychiatric Symptoms 104
7. Young-Onset Parkinson’s Disease 121
PART III Diagnosing Parkinson’s Disease
8. How a Diagnosis Is Made 135
9. Types of Parkinsonism 152
10. Diagnosing Other Neurologic Problems 165
PART IV Treatment of Parkinson’s Disease
11. How the Brain Works and How Treatment Works 185
12. Choosing the Correct Medications 202
13. Drug Therapies 221
14. Diet, Exercise, and Complementary and Alternative
Therapies 266
15. Surgical Treatments 282
PART V Other Issues
16. Illness, Hospitalization, and Parkinson’s Disease 305
17. Parkinson’s Disease Research 313
18. Questions and Answers 328
Resources 349
Index 355
viii / CONTENTS
Preface
This book has been in the planning stage for a consider-
able period of time. Each of us has been involved in the
care of patients with Parkinson’s disease for many years,
and we have become keenly aware of the need for a book
that will help patients and their families develop a fuller
understanding of what living with Parkinson’s is like.
When people first learn of the diagnosis of Parkinson’s
disease, they generally know very little about this illness.
Understandably, a myriad of questions arise. Many pa-
tients and families become alarmed as they translate
their limited experience and knowledge to themselves.
The fact is that the effect of Parkinson’s disease on peo-
ple’s lives has been fundamentally altered in recent years,
as new and better treatments have become available.
Indeed, in the last few decades, Parkinson’s disease has
become a disorder that does not prevent people from liv-
ing productive and satisfying lives for many years. Un-
derstanding the symptoms of Parkinson’s disease and
the management of the disease is the key to each person’s
ability to preserve his or her sense of stability and con-
trol. There are many examples of medical conditions
that are chronic illnesses, including arthritis, asthma, di-
abetes, and Parkinson’s disease. In every one of these ex-
amples, the recipe for living well with the disorder in-
volves having a clear understanding of both the medical
condition and the pivotal role that a prepared individual
can assume in the management of his or her own health.
For example, in making clinical decisions, a physician re-
lies on the history and feedback that the patient and
caregivers provide. There is no one formula for the suc-
cessful management of Parkinson’s disease. Instead, suc-
cess relies upon an individualized and comprehensive
plan of care based on shared decision-making between
the experienced physician and the prepared patient.
We have written a book that explores Parkinson’s dis-
ease in straightforward and honest terms. We have ex-
plained what goes wrong in the brain which leads to the
disorder, and we have also explained how a physician
goes about making the diagnosis of Parkinson’s disease.
We have discussed the subtleties involved in diagnosis,
so people with Parkinson’s disease and their families un-
derstand the challenges that sometimes arise in arriving
at a correct diagnosis.
Parkinson’s disease is a progressive problem, which
gradually worsens with time. In separate chapters we
have delineated the common problems associated with
the early, middle, and advanced stages of Parkinson’s
disease. We not only discuss these problems in consider-
able detail but also offer numerous suggestions based on
our experiences regarding how to better live with these
problems.
Most people think that the major problems of Parkin-
son’s disease relate to problems with movement, includ-
ing tremor and walking. However, patients with many
x/PREFACE
years of experience with Parkinson’s are also familiar
with a variety of nonmotor symptoms. Therefore, we
have extensively reviewed the many common nonmotor
symptoms that may occur, including depression, apathy,
anxiety, sweating, sexual dysfunction, memory prob-
lems, sleep disturbance, bladder problems, and consti-
pation.
The role of drug therapy in the treatment of Parkin-
son’s disease is thoroughly discussed in this book. In the
last thirty years, impressive advances in the therapy of
Parkinson’s disease have been made. We outline how
Parkinson’s drugs work, why they are helpful, the side ef-
fects associated with them, and what patients can realis-
tically expect of each of them. How to use medications
safely and effectively, and the various drug combina-
tions, are also thoroughly reviewed, as is drug therapy
for the various non-motor symptoms.
The role of surgery in the treatment of Parkinson’s
disease is rapidly evolving. We review the different types
of surgery that can be of value in Parkinson’s disease.
Importantly, we present the key questions that patients
and families should ask themselves and their physician
before considering surgery as a therapeutic option.
The book closes with a long chapter of commonly
asked questions and clear and concise answers to these
many difficult questions that often arise during an office
visit. (The subject of each question and answer is cov-
ered in much greater detail in the many chapters within
the book.)
Our experience with taking care of patients with Par-
PREFACE /xi
kinson’s disease teaches us that well-informed, knowl-
edgeable patients do better over time. Our goal in writing
this book is to contribute to a foundation of knowledge
for persons who are living with Parkinson’s disease in
order to help them make healthy adjustments to these
changes, to develop competency in self-monitoring and
self-management, and to become effective partners in
shared decision-making with their physician. The chap-
ters of the book can be read in sequence but they can
also be read separately. To permit this approach we have
incorporated a certain amount of duplication in the
information provided. For those reading chapters in se-
quence this can serve to reinforce the important issues
covered.
xii / PREFACE
Acknowledgments
We w ish to thank all the patients and families whom we
have taken care of over the years, for sharing with us
their insights and responses to Parkinson’s disease. The
spirit that the Parkinson’s community exhibits is an en-
during inspiration. We hope that we successfully com-
municate the world conveyed by our patients to the
larger community of persons and families affected by
Parkinson’s disease.
We thank Maria Macias, who has diligently supported
us with fine administrative assistant skills during the
preparation of this book. We thank our editors at the
Johns Hopkins University Press, Jacqueline Wehmueller,
Alice Lium, and Linda Strange, who helped us transform
our initial text into an easily readable and patient-
friendly format. We also thank special benefactors who
have generously supported our research on this project
as well as many other Parkinson’s disease related proj-
ects: Rosalyn Newman, Morton Shulman, and Jack and
Mary Clark.