Should you just lie down when you have Parkinson's? Elderly Parkinson's patients should "move up"

Aunt Liu, 66 years old this year, has always been in good health, but she began to have an unstable gait three years ago. She walked in a "flustered" manner, as if someone was chasing her from behind. She also had many symptoms such as slow movements, postural balance disorders, hyposmia, hyperhidrosis and paranoia. She had visited doctors in many hospitals and was diagnosed with Parkinson's disease. The old lady's early oral anti-Parkinson's drugs had a good effect, but now her condition is getting worse. Her arms are shaking so badly that she can't even hold a teacup or a bowl. Her family was afraid that she would fall and get injured when walking back and forth, so they simply let her sit on the bed all day. Last month, the old lady, whose condition was getting worse, was sent to the fourth ward of the Department of Neurosurgery of the First Affiliated Hospital of Harbin Medical University. After repeated demonstration and evaluation, the attending doctor Professor Xie Chuncheng and the members of the expert group finally performed deep brain stimulation on her. After the operation, the old lady's condition improved greatly and she was able to wash her face, brush her teeth and drink water from a cup by herself.

When Aunt Liu was discharged from the hospital after recovery, Professor Xie repeatedly reminded the elderly woman to take her medicine on time and go to the hospital for regular check-ups. He also suggested that, under the premise of avoiding excessive fatigue, she should exercise with the company of her family and choose some appropriate sports, such as walking, jogging, and marching on the spot, and not be afraid of daily activities.

Parkinson's disease is most common in the elderly. In 2021, the Parkinson's Disease and Movement Disorders Group of the Neurology Branch of the Chinese Medical Association and the Parkinson's Disease and Movement Disorders Group of the Neurology Branch of the Chinese Medical Association jointly released the latest "Guidelines for the Treatment of Parkinson's Disease in China (Fourth Edition)". The "Guidelines" introduce that Parkinson's disease is a common degenerative disease of the nervous system in middle-aged and elderly people. The prevalence rate of people over 65 years old in my country is 1.7%, which is similar to that in Europe and the United States. As the most populous country in the world, the number of Parkinson's disease patients in my country will increase from 1.99 million in 2005 to 5 million in 2030, accounting for almost half of the number of Parkinson's disease patients in the world.

On the eve of World Parkinson's Day on April 11 this year, in an interview with media reporters, Professor Xie Chuncheng, chairman of the Vertigo Disease Professional Committee of the Heilongjiang Association of Traditional Chinese and Western Medicine and master's supervisor of the Fourth Ward of Neurosurgery of the First Affiliated Hospital of Harbin Medical University, commented that with the gradual progression of the disease, the motor and non-motor symptoms of Parkinson's disease will also show a trend of gradual worsening, which will seriously damage the patient's daily activities on the one hand, and bring huge economic and medical burdens on the other hand. Therefore, it is necessary to arouse the whole society to care, pay attention to and care for Parkinson's patients, and hope that they can get rid of the torture of the disease as soon as possible and return to a healthy life.

Professor Xie Chuncheng introduced that Parkinson's disease is a common neurodegenerative disease with unknown etiology. It is more common in the elderly, with an average age of onset of 60 years old. It is more common in people over 65 years old. It is rare for people under 40 years old to have onset. Most of them are sporadic cases, and only less than 10% of people have a family history. In fact, people are not unfamiliar with the "bad reputation" of Parkinson's disease. Many celebrities have also suffered from it, such as the boxing champion Ali, the famous actress Katharine Hepburn, the World War II general MacArthur, the artist Dali, and the celebrities in my country's cultural and mathematical circles, Ba Jin and Chen Jingrun, all of whom died of Parkinson's disease.

As early as more than 200 years ago, the medical community had a deep understanding and insight into Parkinson's disease. In 1817, Dr. James Parkinson, a British physician, gave a detailed description of patients with this disease: resting tremor, bradykinesia, muscle rigidity, posture and gait disorders, some accompanied by depression, cognitive and mental disorders, sleep disorders, olfactory disorders, autonomic dysfunction and other non-motor symptoms. Studies have shown that the main pathological change of Parkinson's disease is the degeneration and death of dopaminergic neurons in the substantia nigra in the human brain, which causes a significant decrease in dopamine content in the striatum and causes the disease. However, the mystery of Parkinson's disease has not been solved so far. It is speculated that it is closely related to factors such as genetics, environment, aging and oxidative stress.

Movement difficulties are the biggest challenge. Professor Xie Chuncheng further introduced that the specific movement symptoms of Parkinson's disease are as follows: First, limb tremor. Patients often complain of limb shaking and rhythmic static tremor, which often starts from one limb and gradually develops to the opposite side. Second, bradykinesia and increased muscle tension are manifested as reduced movement and smaller movement amplitude. When the disease first occurs, there are obstacles to fine activities such as lacing and buttoning. The handwriting becomes smaller and smaller, and the facial expression becomes dull and single, becoming a "mask face"; standing up, turning around, and walking are all very strenuous, especially starting to walk and unable to stop. As the disease progresses, turning over, walking, and eating are all beyond one's ability, and eventually become disabled and bedridden. The third is balance disorder. Patients cannot maintain body balance when standing and walking, and have abnormal postures, such as leaning forward, slightly bent knees, and inability to swing both upper limbs; when changing postures quickly, they cannot adjust the body amplitude in time.

At present, the diagnosis of Parkinson's disease mainly relies on medical history, clinical symptoms and signs, and general auxiliary examinations often show no abnormal changes. As for the treatment of Parkinson's disease, Professor Xie Chuncheng admitted that, strictly speaking, humans still lack a "golden key" to unlock the huge problem of neurodegenerative changes. Whether it is physical means or the use of compound levodopa, dopamine receptor agonists, anticholinergic drugs, etc., although they are in a state of treating the symptoms but not the root cause, and will not slow down the course of the disease and clinical cure, they can enhance the activity level of dopaminergic neurons from different angles, improve symptoms, improve the quality of life, and prolong the life of patients. Therefore, it is necessary to intervene early to "put on the brakes" to slow down the progress of Parkinson's disease.

At the same time, for those who do not respond well to medication, surgical nerve nucleus destruction and deep brain electrical stimulation can be considered. The former is to reduce the activity of acetylcholinergic neurons by destroying brain nuclei, while the latter is to enhance the activity of dopaminergic neurons by electrical stimulation. The former is gradually neglected or abandoned due to its destructiveness, irreversibility, and recurrence, while the latter is gradually emerging due to its non-destructiveness, reversibility, and sustainability, as well as the significant reduction in the cost of using domestic equipment. Professor Xie Chuncheng explained that the so-called deep brain electrical stimulation is what people often call a brain pacemaker. Its principle is to implant stimulating electrodes in brain nuclei or specific brain areas, and regulate the functions of related nuclei or brain areas through pulsed electrical stimulation to achieve the purpose of improving the condition.

For Parkinson's patients, if exercise therapy is added early while actively carrying out surgery and rehabilitation treatment, it will not only help slow down the progression of the disease, but also help sleep, stabilize emotions, and have a positive impact on the psychological state. Professor Xie pointed out that as one of the intractable diseases of motor function, Parkinson's patients, in addition to the well-known "hand tremor", that is, static tremor, will also fall into difficulties such as muscle and joint stiffness, difficulty getting up or starting, dragging feet on the ground and walking in small steps, and poor body balance. A certain intensity of exercise is expected to improve the stability and coordination of gait, increase muscle strength, improve balance, prevent falls, and avoid various complications caused by long-term bed rest, such as lung infection and respiratory failure.

It should be emphasized that the first thing to keep in mind when exercising is safety. For Parkinson's patients, in order to persist for a long time, they need to focus on choosing the types of exercise that are suitable for their own activity conditions. If necessary, they can consult a professional doctor before exercising to avoid sports injuries. At the same time, if the symptoms are mild and the ability allows, the intensity of exercise can be appropriately increased, and sports such as running, cycling, and playing ball can be chosen. If the symptoms worsen, you can choose to do some activities that require effort, such as brisk walking for 20 minutes, doing yoga, dancing, and Tai Chi. If the symptoms are severe and complicated, it is recommended to focus on some daily activities that are difficult, such as practicing standing up from a chair, or shaking your hands and lifting your feet in bed; in the late stage of the disease, family members and caregivers should also assist patients in turning over, patting their backs, and massaging.

Here, Xie Chuncheng reminds the public that Parkinson's disease is a seemingly simple but actually quite complex disease that requires a long period of struggle and battle. At present, Parkinson's disease cannot be completely cured. Some false advertisements in the market claim that certain folk remedies and health products can cure Parkinson's disease, which is absolutely unreliable. Patients should believe in science and professional doctors, take medication under the guidance of experts, or choose appropriate surgical procedures or rehabilitation therapies.

At the same time, you should not be afraid to go out and participate in activities, and reject all kinds of exercise; you should not regard yourself as a useless person just because you have Parkinson's disease, and you should not ask others to feed you. Generally speaking, as long as you can eat by yourself, try not to let others feed you, and if you can dress yourself, you should do so, because dressing and undressing can also exercise your muscles well. Professor Xie also suggested that you should chew your three meals a day slowly, eat more fresh fruits and vegetables, and eat less animal fat; at the same time, you should supplement with milk and beans in moderation to prevent osteoporosis and fractures.

Doctor Profile

Dr. Xie Chuncheng

Doctor, Master's supervisor, and associate chief physician in the Fourth Ward of Neurosurgery, the First Affiliated Hospital of Harbin Medical University.

Academic status: Member of the Vertigo Professional Committee of the Chinese Society of Integrated Traditional Chinese and Western Medicine, Chairman of the Vertigo Professional Committee of the Heilongjiang Society of Integrated Traditional Chinese and Western Medicine, Vice Chairman of the Professional Committee of the Heilongjiang Research Medical Association, Vice Chairman of the Spinal Cord and Spine Professional Committee of the Heilongjiang Research Hospital Association, Vice Chairman of the Oculomotor Disorder Rehabilitation Professional Committee of the Heilongjiang Rehabilitation Medicine Association, Vice Chairman of the EEG and Epilepsy Branch of the Heilongjiang Anti-Epilepsy Association, Standing Member of the Neurosurgery Professional Committee of the Heilongjiang Geriatric Medicine Research Association, Standing Member of the Children's Hydrocephalus Prevention and Treatment Professional Committee of the Heilongjiang Preventive Medicine Association, Member of the Chinese Anti-Epilepsy Association, Member of the Hydrocephalus Professional Committee of the Chinese Microcirculation Society, Director of the Heilongjiang Anti-Epilepsy Association, Member of the Neurosurgery Professional Committee of the Heilongjiang Medical Promotion Association, and Member of the Heilongjiang EEG Specialty Alliance.

Expertise: Microvascular decompression and percutaneous trigeminal nerve semilunar balloon compression for trigeminal neuralgia, microvascular decompression for hemifacial spasm, minimally invasive surgery for acoustic neuroma, meningioma, glioma, schwannoma and other central nervous system tumors, minimally invasive neuroendoscopic treatment of pituitary tumors and craniopharyngioma, minimally invasive surgery for aneurysms and cerebrovascular malformations, intracranial and extracranial bypass for moyamoya disease, deep brain stimulation for Parkinson's disease, Meijer syndrome, spastic torsion, spasmodic torticollis, chorea, etc., spinal cord stimulation to promote vegetative awakening and treat intractable pain, diabetic nephropathy peripheral neuropathy, etc., carotid sympathetic nerve network stripping for spastic cerebral palsy, facial nerve canal decompression for facial paralysis, neuroadjustment for motion sickness, vertigo, migraine, ventriculoperitoneal shunt and neuroendoscopic third ventriculostomy for hydrocephalus, SEEG monitoring and precise resection of epileptogenic focus for intractable epilepsy.