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[back] Awareness is crucial Anthony Thanasayan (The Star) - 26 November 2009

Awareness is crucial

Thursday November 26, 2009 - WHEEL POWER, The Star Newspaper

The lack of understanding of the implications of Parkinson's disease is alarming.

Parkinson's disease is the second commonest late life neurodegenerative disease after Alzheimer's disease. It is prevalent throughout the world and predominantly affects patients above 60 years of age. It is caused by progressive degeneration of dopamine containing cells (neurons) within the deep structures of the brain called the basal ganglia and substantia nigra. Both motor and non-motor symptoms exist in PD, although the cardinal features and the diagnosis of PD is based purely on the presence of motor symptoms.

PARKINSON's disease (PD) is a condition of the nervous system which causes the muscles to become stiff and the body to shake. It gets worse as a person ages. As alarming as the disease may sound, one medical expert is concerned that the condition is not getting the attention it deserves.

"PD needs to be recognised in its entirety," says Assoc Prof Dr Norlinah Mohamed Ibrahim, Head of the Neurology Unit at Universiti Kebangsaan Malaysia Medical Centre (PPUKM) in Cheras, Kuala Lumpur.

The consultant neurologist who specialises in PD and movement disorders points out that an insidious disease like Parkinson's can leave its victims with shattered hopes.

"Just last week, I saw two more patients who were referred to me for the possible diagnosis of PD," explains Dr Norlinah who is also Deputy Head of the Department of Medicine at PPUKM.

"Not a week goes by when I don't see at least one patient in my clinic who has been referred for PD. Most patients are unaware of PD but what is more alarming is the lack of understanding of the possible implications of their condition."

File Pic from MPDA: Assoc. Prof. Dr. Norlina is also the medical advisor for Malaysian Parkinson's Disease Association

Dr Norlinah, who is also a researcher on the disease, says that although many patients with Parkinson's are obvious to medical experts at first glance, the situation is not the same for the patients themselves or their families who are caregivers. This results in a critical delay in treatment for their condition.

"PD symptoms slowly creep up in patients, mostly over the age of 60, and this is often misinterpreted as part of normal ageing."

Dr Norlinah is also a medical adviser of the Malaysian Parkinson's Disease Association in Kuala Lumpur. NGOs like hers, together with the help of medical professionals, have been raising awareness on the implications of being diagnosed with PD.

Although PD is generally a disease of the elderly, 10% of patients have a family history of the condition and are diagnosed at a younger age.

"I'm seeing more patients being diagnosed before the age of 45. It is estimated that more than 10,000 people in Malaysia are afflicted with PD, and the number appears to be increasing," says Dr Norlinah.

The initial symptoms of PD are non-specific: patients usually complain of muscle cramps, fatigue, sleep disturbances and constipation - years before their movements become affected.

These symptoms, referred to as non-motor symptoms, may precede the movement problems by years. For example, it is common for patients with PD to turn up at orthopaedic clinics with a "frozen shoulder" for months or years before PD is finally diagnosed.

"Since the early symptoms of PD often mimic the normal ageing process and are non-specific, the diagnosis is sometimes missed even by healthcare professionals who are not familiar with the disease," explains Dr Norlinah.

"I came across a patient who had severe slowness of movement affecting only one side of the body. The difference between the affected and the non-affected side was so marked, that the slowness was misinterpreted as 'weakness' and the patient was diagnosed with a stroke for a few years, before the actual diagnosis of PD was made.

"In this particular case, the right diagnosis was crucial. After the correct medication was given, he was able to function normally."

Dr Norlinah says that by the time patients are referred to neurologists, they already have the cardinal motor signs of PD known as the triad of tremor, bradykinesia (slowness of movement) and rigidity.

"Making a diagnosis and treating the motor problems at this point is not difficult, What's more challenging is to identify and treat the non-motor symptoms such as depression, dementia, sleep disturbances, constipation and pain," she explains. Patients who are unaware that these symptoms are part of PD may not reveal them to their doctors.

Dr Norlinah points out that the lack of awareness of the non-motor symptoms, diagnostic difficulties and the rising cost of medication, have made the treatment of PD a challenging issue for patients and doctors.

"With better awareness of the disease on the part of healthcare professionals, government authorities and the public, more effective treatment strategies can be implemented to improve patient care," adds Dr Norlinah.