(10) Parkinson's disease
Parkinson's disease is a progressive neurological disorder
affecting learned voluntary movements such as walking, writing, swallowing
and talking. The main symptoms are tremor, rigidity and slowness of movement.
In the United Kingdom, Parkinson's disease affects one in 500 people,
with a prevalence of one in 100 in people over 60 and one in 50 in people
over 80. The main treatment is drug therapy and there is little evidence
that any specific mineral, vitamin or other nutrient can prevent or treat
the disease. However, nutritional advice can help to improve the patient's
quality of life.
- Eating a healthy diet with regular meals is important for patients
with Parkinson's disease because it helps digestion and the absorption
of medication. A normal, balanced diet should therefore be encouraged.
- Many patients with Parkinson's disease suffer from constipation, which
may be caused by their drug therapy. A high fibre diet, containing plenty
of wholemeal bread, cereals, vegetables (especially peas and beans)
and fresh and dried fruit should be encouraged.
- Many patients have problems with a dry mouth (often caused by medication)
and swallowing difficulties. For these patients, food consistency is
an important consideration. Soft, moist food such as custard, sauces,
soup and yoghurt tend to be easier to swallow, but it is important to
try to exercise the jaw too, so soft food should not be eaten to the
exclusion of everything else.
- Foods that stick to the roof of the mouth, such as fresh bread, dry
mashed potato and tomato, may be a problem for some patients.
- Some patients may have difficulty in handling cutlery and cutting
up their food. Special cutlery can be obtained, and food can be cut
into small pieces for the patient, but other measures, such as eating
peas or rice with a spoon, can be helpful.
- If the patient eats slowly, family and friends should be encouraged
to continue conversation at mealtimes to allow the patient to finish
their food.
- Some patients have difficulty consuming sufficient calories to maintain
their body weight. Additional calories can be obtained by eating fatty
and sugary food or by adding, for example, cream to soup, butter or
margarine to vegetables, or grated cheese to soup.
- Food supplements such as Complan, Ensure and other "milk shake"-type
drinks, and blancmange-type puddings such as Formance and Fortipudding
are helpful for patients who require more calories.
- If tremor is severe, a sip feed with a straw may be the easiest type
of food to handle.
- The use of vitamin supplements remains controversial, but a multivitamin
supplement may be helpful for a patient who is not eating well.
- In some studies, vitamin E, vitamin C and selenium have been shown
to slow the progress of Parkinson's disease, but further research is
required.
- Supplements containing vitamin B6 should be avoided by patients taking
levodopa. However, levodopa is now rarely used on its own and this advice
does not apply to patients taking levodopa combinations such as co-beneldopa
and co-careldopa.
- Protein can interfere with the absorption of levodopa (including that
from combination preparations), and restriction of protein intake may
help to maximise the effect of levodopa. However, a dietitian should
advise on the reduction of protein and how protein intake should be
spread throughout the day. If this intervention works, and a suitable
pattern of meals and drug administration is established, variation in
eating habits should then be avoided as this may reduce the effect of
levodopa and lead to clinical deterioration.
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