Today (April 11) is World Parkinson's Day, and this year's theme is - epidemic prevention and anti-Pascal, full management.
Parkinson's disease is a chronic, progressive disease. As the disease progresses, the patient's condition worsens and often requires increasing doses. However, when the dose of antiparkinsonian drugs is increased, the risk of side effects also increases. So, in addition to increasing the dosage, what ways can improve the efficacy?
Through clinical research and practice, it has been found that diet therapy, exercise therapy, psychological therapy, rehabilitation therapy and other methods can help to improve the efficacy, thereby avoiding excessive increase in drug dosage and reducing the risk of treatment.
"Eating right" helps the drug to work better
Diet can seriously affect the efficacy of drugs, especially compound dopas. Many patients take a lot of drugs, but the effect is not good, it is due to improper diet. Therefore, adjusting the diet and taking the drug, without affecting the nutritional supplement, can better play the efficacy of the drug.
The following points should be noted in terms of diet:
1. Take the compound dopa 60 minutes before meals. Patients taking the drug after eating a full meal will lead to a significant decrease in the absorption rate of levodopa, resulting in a significant decrease in efficacy.
2. For the elderly, the recommended reasonable protein intake is about 1.5 g/kg bw/day. A high-protein diet reduces the duration of levodopa's efficacy. A low-protein diet will make the compound Dopa have a faster onset of action, maintain the efficacy for a longer time, and significantly reduce the fluctuation of motor symptoms. Some patients who do not respond to levodopa have regained their drug sensitivity after adopting a low-protein diet. Protein intake has a significant effect on codopa, mainly at breakfast and lunch, so protein intake can be transferred to dinner to avoid low-protein diets leading to weight loss and malnutrition in patients with Parkinson's disease, while maintaining the therapeutic effect of codopa.
3. Foods rich in vitamin C can improve the efficacy of the drug. Vitamin C reduces the oxidation reaction of levodopa and reduces the occurrence of side effects. In addition, vitamin C can also significantly improve the bioavailability of levodopa, the direct effect is to allow patients to take compound dopa drugs, the onset of action is faster, the effect is more significant, and the efficacy is maintained for a longer time. Vitamin C in combination with levodopa is a good way to improve the treatment of Parkinson's disease.
4. Excessive intake of iron is an important risk factor for the onset and exacerbation of Parkinson's disease. Studies have found that ferrous sulfate can significantly reduce the efficacy of levodopa, mainly due to the maximum reduction of efficacy and the shortening of the maintenance time of efficacy. For patients with Parkinson's disease, moderate restriction of consumption of iron-rich foods can be moderate. If there are patients with Parkinson's disease, because of the need for appropriate iron supplementation such as anemia, the time of taking levodopa and iron should be more than 2 hours apart.
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Three exercises help improve cognitive function in patients
Medical experts have been studying whether exercise patterns can benefit People with Parkinson's disease. Recently, the internationally renowned Academic Journal of Parkinson's Disease, journal of movement disorders, published a research article written by a Canadian scholar. The study found that after aerobic exercise in patients with Parkinson's disease, the metabolic activity of the striatum in the brain was enhanced, and the release of dopamine from the caudate nucleus was enhanced. This study shows that moderate aerobic exercise is expected to regulate the neuroplasticity of the striatum and promote the release of dopamine from the striatum, which will have a therapeutic effect.
Common forms of exercise suitable for people with Parkinson's disease include aerobic exercise, strength training, and flexibility exercise. Aerobic exercise is mainly to improve and enhance the body's aerobic activity ability, such sports include walking, jogging, cycling, doing aerobics and so on. Strength training is a strength-enhancing, bodybuilding-based exercise, such as the use of dumbbells, elastic bands and other weight-bearing methods or impedance methods for strength exercises. Flexibility exercises are mainly exercises that stretch muscles and ligaments, accompanied by exercises that adjust breathing rhythms, such as yoga, tai chi, and health exercises. The study found that patients with early and mid-stage Parkinson's disease underwent a 16-week multimodal exercise program, including twice a week for 30 to 60 minutes of exercise and fitness training, mainly to train agility, balance and coordination, and the results showed that these Parkinson's disease patients had improved motor ability, cognitive function and mood.
The condition of Patients with Parkinson's disease varies widely, so their exercise needs to be individualized analysis, and according to the patient's condition, age, health, past exercise ability and other factors to comprehensively judge, decide how to carry out reasonable exercise and rehabilitation. Patients should avoid exercise that is too overloaded and too long during exercise, and pay attention to controlling the heart rate, strengthening protection during exercise, and avoiding the risk of trauma such as falls. At the same time, patients should fully warm up before exercise, and perform moderate massage to recover after exercise.
Patients with Parkinson's are more likely to experience stress responses
Many people with Parkinson's disease experience a sudden exacerbation of their condition after encountering external stress, stimulation and tension, anxiety, depression, and painful negative events. People's reactions after encountering external stress, external stimuli, and various negative events are called stress or stress responses. The study found that after encountering similar external pressures, external stimuli or negative events in life, Parkinson's disease patients are more likely than healthy people to feel severe stress and have severe and excessive stress responses.
The factors that cause the stress response are called stressors and include the following categories:
● External environment: including natural and man-made factors. The natural environment changes are cold, hot, humid, strong light, lightning, air pressure and so on. Human factors include air, water, food, radiation, noise and other pollution.
● The internal environment of the individual: including various diseases and discomfort symptoms, pain, nutritional deficiencies, etc. These can be either stressors or part of the stress response.
● Psychosocial environment: various stressful and negative events in life and work, unpleasant, painful, sad, anxious, depressive events, etc.
Patients with Parkinson's disease may experience both acute and chronic stress responses after encountering the above stressors. Acute stress can induce rapid exacerbation of motor symptoms, such as tremor, gait freezing, and dyskinesia, and can also reduce the effectiveness or even failure of dopaminergic drugs. Chronic stress, sustained stress responses can induce or exacerbate depression and anxiety. In the blood of patients with Parkinson's disease, the level of cortisol, a marker of stress, is significantly increased, indicating that patients with Parkinson's disease are susceptible to stress and have a severe stress response.
For patients with a pronounced stress response, family members and surrounding healthy people should be cared for, treated if necessary by a psychologist, and taken on the necessary medications on the advice of a specialist.
Rehabilitation therapy has a special effect
Rehabilitation therapy has a definite effect on Parkinson's disease. Patients may undergo some special forms of rehabilitation, such as water rehabilitation.
Aquatic rehabilitation is suitable for patients with limb movement disorders, joint atrophy, and increased muscle tone. With the help of the buoyancy, pressure, resistance and fluidity of water, patients can perform active exercise in the water, as well as passive movement of limbs and joints and massage in the water under the guidance and help of medical staff.
Various rehabilitation exercises in the water, compared with the traditional water rehabilitation treatment in the shower, soaking method, the effect is more obvious, help to increase limb strength, improve motor coordination, alleviate muscle tonic spasm, effectively promote the rehabilitation process. For patients with Parkinson's disease, water movement rehabilitation therapy is superior to rehabilitation therapy on land in terms of gait, balance, and motor capacity.
Patients should perform water rehabilitation exercises slowly and under the guidance of a professional rehabilitator.
Expert tip: Helicobacter pylori infection seriously affects the efficacy of co-dopa drugs
Multiple studies have shown that Helicobacter pylori infection has a serious impact on the efficacy of compound dopas. Treating patients with Helicobacter pylori infection by a reasonable approach can significantly improve efficacy and improve symptoms in patients with Parkinson's disease without increasing the dose of compound Dopa.
Patients with Parkinson's disease should be screened and radicalized for Helicobacter pylori infection, especially those with reduced efficacy in levodopa therapy. Patients should make individualized choices about their treatment options by weighing efficacy, drug resistance, potential adverse effects, and drug availability.
Author | Feng Tao, Director of the Department of Motion Disorders at Beijing Tiantan Hospital affiliated to Capital Medical University
Audit | Expert of the National Health Science Popularization Expert Database
Chen Haibo, director of the Department of Neurology of Beijing Hospital
Planning | Fang Tong Tan Jia
Edit | Mu Salary