Parkinson’s Disease and Parkinsonism
Parkinson’s disease and many diseases that have almost the same symptoms but develop due to different causes are grouped under the title of “Parkinsonism”. Generally, an experienced neurologist can distinguish between Parkinson’s disease and Parkinsonism based on the detailed disease history and examination findings given by the patient and his/her relatives. However, the diseases in this group are so similar to Parkinson’s disease that it is sometimes difficult for even the specialist physician to make a decision based on examination findings alone. In such cases, some laboratory or X-ray examinations may be required. When we look at foreign sources, it is seen that the diagnosis of Parkinson’s disease is not correct in approximately 20% of the patients in the brain autopsies performed after the death of patients diagnosed with Parkinson’s disease and there are findings of other Parkinsonisms.
WHAT IS PARKINSONISM?
The word Parkinsonism evokes many diseases that are recognized by a series of symptoms that occur due to different causes, rather than a specific disease. In these, the symptoms seen in Parkinson’s disease draw attention. However, the basis of Parkinsonism is movement impoverishment, there are numerous additional symptoms besides trembling of limbs, slowness of body movements, rigidity of muscles, forward-leaning posture, walking with small strides and shuffling, fast and monotonous speech, and so on, often other parts of the brain are also affected. . Therefore, when a patient with Parkinsonism is seen, it is important to investigate the root cause and make a definitive diagnosis.
WHO HAS PARKINSON’S DISEASE?
Parkinson’s disease was first described by British Physician James Parkinson in 1817, as “Shaking Palsy”. It occurs as a result of the deterioration of the cells that produce the substance in the brain called dopamine, which enables brain cells to communicate with each other. The disease begins between the ages of 40-75, often over the age of 60. Only 5 to 10% of all Parkinson’s patients have the age of disease onset between 20 and 40 years. The disease usually starts insidiously and its symptoms progress very slowly but gradually over years. In most patients, symptoms tend to occur in one half of the body, but over time they also manifest in the opposite half. The rate of progression of the disease and the type and severity of symptoms vary from patient to patient. Parkinson’s disease is slightly more common in men than women. It is accepted that one out of every 100 people over the age of 65 in the society has Parkinson’s disease.
SYMPTOMS OF PARKINSON’S DISEASE
The most common symptom of Parkinson’s disease is tremor. Shaking of the hand at rest is a very obvious indicator. Slowing of movements is one of the first symptoms of Parkinson’s disease. In addition, Parkinson’s has symptoms such as speech change, posture balance disorder, writing change, constipation, posture and balance problems, muscle stiffness, loss of automatic movement, sleep problems.
TREATMENT OF PARKINSON’S DISEASE
Unfortunately, there is no treatment that completely stops or prevents the disease. Although Parkinson’s disease cannot be prevented, early recognition of symptoms and initiation of treatment are very important. Because if dopamine deficiency is not noticed and replaced early, the brain tries to correct this deficiency by developing compensation mechanisms, and these mechanisms may unfortunately cause other dysfunctions. Therefore, early diagnosis and treatment provides a better course of the disease. The aim of the treatment of Parkinson’s disease is to replace the missing dopamine. For this reason, drugs that increase the release of dopamine and dopamine itself are used. The choice of these drugs should be made by a specialist neurologist.
Aging with its Social and Psychological Aspects
In many countries in the world, the increase in the elderly population has accelerated. It is seen that this general education in the world population takes place faster in developed countries. If the declining trend in the birth rate of the countries continues, the proportion of the elderly population will rise much higher. On the other hand, decreases in birth and death rates increase the life expectancy of the world population. Significant increases in life expectancy have been recorded in the twentieth century. As the last century ends, the average life expectancy has increased from forty-nine years to seventy-five years. This number is 79.2 for women, 73 for men in Iceland, a northern European country, 75 for women and 72.7 for men in Scandinavian and Western European countries. In general, it is estimated that it can reach 80 years for men and 90 years for women. On the other hand, the lowest averages where life expectancy does not exceed 40-45 years are found in African countries. In these countries, female life expectancy is higher than that of males. In developing countries, the number and proportion of the elderly are increasing in the total population. Data show that the world population is aging. However, there are also those who find it untrue that the world population is aging at an increasing rate. In their view, a hundred years ago, 20-year-olds expected to reach old age in 30 or 40 years; Today, 50.60 years must pass before young people can truly admit that they are getting old. Aging has been a slow process, not a faster 1982). Medicine today; strives to prolong human life and delay old age. In recent years, studies in Europe have brought up the idea that aging itself is a disease, so old age can be treated, there is no reason why human life cannot be extended. The field of the general science of aging has expanded. The science of gerontology, which studies the biology, biochemistry, and molecular biology of aging, has emerged, and aesthetic medicine has addressed this issue. On the other hand, demographic characteristics are changing in cities around the world. Although urbanization is a universal process, the rate of urbanization is not the same in all parts of the world. Although it is estimated that the population growth between 1950-1975 and the population increase between 1975-2000 in cities in highly developed regions will be at the same rate, urban population in developing countries is growing faster than the general population.
There are differences between rural and urban in terms of age and gender distribution due to migration from rural to urban areas. In almost every region of the world, it is seen that the elderly in the cities, especially the female elderly, are more common than the male elderly. The elderly who migrate from the countryside to the city change their status, and the technology, social structure, diversity of cultural values and mobility in the city make the elderly outdated and obsolete. Demographic expectations are that the population considered to be elderly will reach 15.9 percent of the total population in developed countries in 2000. In the mentioned countries, the elderly face problems in income security, employment, retirement, health, housing, education, lifestyle and other issues. Acceleration of industrialization and urbanization process and related social; economic processes will bring the developing countries face to face with the problem of old age in the near future. The population phenomenon, which has become a source of concern especially for developed western countries, has social and economic consequences for societies and especially for the elderly.
Developing countries, on the one hand, try to change the rapid increase in the population, which they see as an obstacle to development, on the other hand, they try to determine and implement social welfare policies in the face of the newly emerging needs of the elderly. In summary, countries that differ from each other in social, cultural and political terms have been affected by the transformation that started with the industrial revolution in the West and has become increasingly widespread, and they faced the problems created by the change. Turkey has been experiencing a rapid modernization process since the beginning of the Republican era and is witnessing a radical social structure change. The transition from rural structure to urban structure has created social categories that are affected differently by this transformation. Structural change causes social problems arising from the basic structural features of our society. Delays in the formation of new institutions required by change in some sections cause the emergence of cultural lag, in other words, problems. Due to the demographic and social structure characteristics of Turkey, old age has not yet reached the level of a widespread social problem in our country. However, especially in our big cities, people tend to The need for services tends to be a problem. Social security programs and institutional care (nursing homes) within the framework of social service programs take the first place among the services for the elderly in Turkey. In Turkey, old age is an under-treated subject in all aspects. In this study, within the framework of general information about the elderly and old age, the relationship between social adjustment and social adjustment of the elderly people who are taken care of and attend the old people’s home during the day and some qualities of the elderly are examined. In the research, it was aimed to provide information that can help in the development of institutional care services and other services for the elderly.
Overview of aging
Aging is an inevitable and irreversible process. All living things grow old towards the end of their lives and complete their lives. Aging is not just a human phenomenon. Aging, which is seen as a part of the life process of our age, includes time-dependent changes in the human species. It is a universal phenomenon of nature that the life cycle of the human organism, like any other organism, begins with birth and ends with death. However, the life span of individuals is a variable ‘conditioned’ by the information resources and values of the society. The life cycle traditionally covers four periods. These are childhood, youth, adulthood and old age. The first two periods are considered preparation for adulthood. This process, which lasts from the formation of life to the end of life, also indicates aging (Blau, 1973). The duration, meaning and content of the stages in the human life cycle are determined not only by biological processes, but also by social values and defects. The word old age describes the continuation of development in the late period of life and its changes in the individual. Old age is a period of loss and collapse in life. It is also a result of cultural, environmental and economic factors.
Aging is divided into two as chronological and biological. Chronological aging describes the aging depending on the years that pass from the birth of a person to the time he is in. Biological aging is the aging of appearance determined according to heredity, health and work force. Biological age occurs under the influence of natural hereditary factors as well as chemical, psychological and environmental factors and lifestyle. It differs from person to person by chronological age. When determining the biological age, which does not always coincide with the calendar age, experts take into account the functional criteria of all organs and the changes in all metabolisms. Aging is a biological event and the old person’s organism shows some characteristics. Aging changes the individual’s relationship with time, that is, his relationship with the world and his own history (De Beauvoir, 1970). These two aging processes do not progress in a balanced way; In some people, chronological aging takes precedence, while in others, biological aging takes the lead. Moreover, the aging of organs in the human organism does not proceed together. They have a separate chronology of aging and wear according to their personal use and structure. Aging is a relative concept. Every elder has a biological history, work experiences and emotional life. In addition, aging differs from one society to another and according to the age. Social and cultural factors play an important role in every person’s struggle between aging and dying. Aging is the physical and mental regression of a person as an individual change. Although aging is individual, societies also determine the value and place given to the elderly and old age in line with social values and other factors. For this reason, old age is not only a biological event, but also a social and cultural event. In other words, old age is a phenomenon with complex aspects. Some perceive old age as a problem, some adopt positive attitudes towards old age. Cato, who has a negative attitude towards old age, says, ‘In my opinion, I prefer to complete my time before I am old.’ Joseph Choate, who perceives old age as a golden age, sees the age between 70-80 as a period of real happiness, “it should get there as soon as possible.” asserts. Democritus, who made one of the definitions of old age in ancient thought, perceives old age as neediness. “Old age means cutting off the organs of the body without any loss; everything is there, they are all in need.” Democtritos makes a meaningful comparison between youth and old age. “Strength and beauty are the goods of youth, temperance is the flower of old age”. Democtritos approaches the subject very calculatedly in his evaluation of old age. “The old has passed through youth. It is not clear that the young can reach old age. Now the unfinished property outweighs the future and the doubtful. Democtritos young, old Emphasizes education and creation in the comparison. “The young are wise, the old are foolish; it is not time that teaches thoughtfulness, but the education and creation of its time.” Magenta focuses on changes in old age. Fear old age, because it does not come alone.” Of course, old age does not come alone, old people are a collection of changes. Heraclitus of Ephesus, one of the last and great thinkers of Ionia, emphasizes the continuity of life and compares youth and old age: “Youth and old age, life and death, all these differences are the same. They are things and they are separate and separate aspects of one.” Because when these change, the living, the dead, the young and the old are the same thing. As you can see, Heraclitus constantly emphasizes change. In Taoist philosophy, which is the continuation of ancient Chinese cults, immortality and long life are thought to be. East; the founder of rubai type in literature. The numbers highlight the emotions that are the main fabric of Ömer Khayyam’s view on old age. Oh, spring is gone, winter is now, Youth was a cheerful bird, but alas, It has come, landed, sang and flew away.”
Our very valuable poet Behçet Necatigil presents the drama of the elderly in his poem “Grandmaids”, which he wrote when he was only thirty years old. / He hasn’t lived his world / He goes to your son / He has not fulfilled his will / He goes to your offspring. You had a happy home / You had a valiant husband / This and this one’s hands / You will be despised. It goes to your pain / Most of you should have a stroke. Either your eyes are blind / You are hard of hearing Grandmothers, shame on you / Your son, your daughter / You have been left behind. The role of an old person, played with skill, is indicated by calm, reason, freedom, dignity and sense of humor. Almost everyone wants to play the old man like this, but few dare (Skinner, Vaughan, 1984).
When does old age begin?
It is not correct to answer the problems of “who is the elderly” and “when does old age begin” with a single definition. Statistical methods are used to determine old age in pension, insurance and planning issues. In demographic studies and analysis; Although statistical information is necessary in social policy, it is insufficient to explain the situation of a single elderly person. Because the speed and time of physical aging and mental and spiritual aging are quite different. The experience of everyone who knows older people shows that there are actually two kinds of aging. Scientific studies in many countries reinforce this judgment. In other words, some parts of the brain do not undergo the aging process, while some parts of the brain definitely begin to age at the age of thirty. In many studies on aging, the definition of elderly is made chronologically. The retirement age of 65, which is the retirement age in a significant part of developed countries, is used as the beginning of old age in studies. In the reports published by the United Nations on aging, the ages are chronologically started from the age of 60. (U.N. 1980). In the seminar organized by the World Health Organization in 1963 on the health problems of the elderly, aging was divided into three chronologically (Hobson, 1970): -Middle-aged (40+59 years) -Old people (60-74 years) -Old people (75+years) As can be seen Those over the age of 60 are considered old. However, the debate on when aging begins still continues today. Aging, which lasts until the end of life in the formation of living things, is divided into sections. Accordingly, aging is divided into five parts. -Molecular Aging -Cellular Aging -Tissue and Organ Aging -Personal Aging -Social Aging
Aging is a phenomenon that occurs from the beginning of development.
On the other hand, dividing the population into 0-14, 15-64 and 65+ age groups facilitates the studies in examining the aging phenomenon and related social and economic issues. However, the structure and quality of the population in terms of age groups are used in social, economic, demographic analysis and comparisons. Age is also a grouping criterion (Guvenc, 1972). Age classes are formed by clustering the members of this community according to their age. The fact that some of the members are considered old in all societies is due to the fact that they have different status and behaviors from other age groups in the society. The basis of attaining this status is the measure of time, the chronological age of life, or being at the same age with contemporaries who consider themselves ‘old’ with age, weakening in physical strength, etc. topics are included. However, those who are considered to be old differ greatly from one society to the next. Although there are great differences between societies in the interpretation of their special roles for the elderly, it is generally seen that there is a change in the direction of decrease in mobility in old age, need for more counseling and supervision, mental effort rather than physical effort, and economic power. There are increasing tendencies to demand care from the group to which one belongs rather than from production (Cowgill, 1972). Healthy and long life is valuable in all societies. There are themes related to longevity in myths and other folklore products about the human body. For example, in theory, there are practices that include diet, gymnastics and breathing exercises, and sexual disciplines to achieve immortality in philosophy and practice (Simmons, 1961). Although studies have been carried out to stop and prevent aging throughout the history of humanity, it has not been possible to reverse this biological process. Since aging is considered a function of living beings, stopping aging and maintaining eternal youth means the abolition of life (Kayahan, 1966). In summary, no matter what ways are tried to explain aging, it is not possible to stop or reverse aging. Today, studies are carried out to slow down aging. Experts who closely follow the developments related to aging say that the most interesting subject is treatment and drugs used. Treatment is possible in old age, which is considered a disease. However, it is suggested that it is necessary to cooperate with various doctors and continue the treatment with care. Issues that need to be considered in particular; general aging, brain aging and memory, sexual aging, skin aging, healthy life. The problem of aging is primarily of a medical and social nature. In order to overcome the existing difficulties in this regard, more attention should be paid to preventive medicine related to aging. One of the main problems of gerontology is how to distinguish between changes caused by aging and changes in sources from disease. In order to overcome the difficulties in this regard, more attention should be paid to preventive medicine related to aging.
ALZHEIMER AND ITS SYMPTOMS
Describing changes in the brain tissue of a woman thought to have died of an unusual mental illness in 1906, Alzheimer’s disease is named after Dr. Alois comes from Alzheimer’s. The most common symptoms of Alzheimer’s disease are memory loss and forgetfulness. This disease is medically caused by the death of brain cells. Brain cells can die depending on age, or they can be affected by other environmental factors or genetic factors. Alzheimer’s disease affects the thinking, memory, and language parts of the brain. The onset of the disease is insidious and destruction is usually slow. Today, the cause of the disease is unknown and there is no cure. Alzheimer’s disease affects all groups of society and is not related to social class, gender, ethnic group or geographic region. In addition, Alzheimer’s disease is more common among the elderly, although younger people can also be affected by this disease.
WHAT ARE THE SYMPTOMS OF ALZHEIMER’S DISEASE?
Not everyone with Alzheimer’s disease has all these symptoms, and these symptoms vary from person to person and affect each person differently. Its effect is largely related to how the person was before the illness. For example; such as personality, physical condition and lifestyle. The signs (symptoms) of the disease are as follows;
1. Short-Term Memory Loss
One of the most common early symptoms of Alzheimer’s is forgetting new information. While it is normal to occasionally forget names or appointments, forgetting important matters and constantly asking for the same information are also common symptoms in the early stages of Alzheimer’s.
2. Having Difficulty Doing Familiar Jobs
One of the most common early symptoms of Alzheimer’s is forgetting new information. While it is normal to occasionally forget names or appointments, forgetting important matters and constantly asking for the same information are also common symptoms in the early stages of Alzheimer’s.
3. Problems in Writing and Speaking
One of the most common early symptoms of Alzheimer’s is forgetting new information. While it is normal to occasionally forget names or appointments, forgetting important matters and constantly asking for the same information are also common symptoms in the early stages of Alzheimer’s.
4. Time and Place Confusion
Alzheimer’s patients may get lost in their neighborhood, forget where they are and how they got there, and may not know how to get home.
5. Wrong and Poor Decisions
Alzheimer’s patients may wear layers in nice weather or dress very lightly in cold weather.
6. Problems with Abstract Thinking
Someone with Alzheimer’s may have unusual difficulty performing complex mental functions, such as what numbers are and what they are used for.
7. Putting Things In The Wrong Place and Failure to Follow the Steps
Someone with Alzheimer’s can put things in awkward places.
8. Changes in Mood and Behaviors
A person with Alzheimer’s can experience rapid changes in their mood. Such as suddenly bursting into tears when calm, getting angry or aggressive. They may be extremely confused, anxious, suspicious, or dependent on a family member.
9. Difficulty Understanding Visual Images and Spatial Relationships
For some, a change in visual processing may be among the early signs of Alzheimer’s. These people may have difficulty in reading, they may not be able to make out the distance, they may not be able to determine the color or contrast.
10. Withdrawal from Social Activities
A person with Alzheimer’s symptoms may avoid being social because of the changes they have experienced. These people may stay away from sports, social activities and hobbies. They may sit passively in front of the TV for hours, sleep more than usual, or not want to do their daily activities.
DEMENTATION
Dementia disease (dementia), which usually occurs later in the elderly and the patient’s daily It is a brain disease that greatly affects the ability to perform activities A person’s attention to those around him
starts to lose. Learning and remembering new information, correct words while speaking The slowdown in finding and solving the problems of daily life becomes evident over time. Memory weakening
First of all, it is the inability to fully remember phone numbers, names, and daily events. Attention is easily distracted. Relationships with the environment begin to be limited. As social inadequacy becomes evident loneliness deepens. The person is restless and sad. He may be more fragile, angry, or suspicious. in time to the past Memories may also begin to be erased. It is possible to stop or slow the progression of dementia, but It is not possible to completely destroy it. Most of the diseases that cause dementia do not have a definitive treatment and the drugs used are generally for symptomatic treatment. Dementia Vascular
Diseases, Alzheimer’s Disease, Chronic Alcohol Use, Continuation of Psychoactive Substance Addiction, Brain Tumors can occur for many different reasons depending on Systemic Physical Diseases. dementia and It is a very challenging disease for both the person and their relatives. Since dementia affects the whole family, Psychotherapy and The aim of drug treatments is to support the patient’s and family’s quality of life while maintaining it.
PERSONALITY CHANGE AND ATTENTION
Over the years, people become irritable and change in character with advancing age. Over time, performance loss may occur in areas such as memory, attention, and concentration. A thorough assessment of the problem encountered and
A decrease in the ability to produce solutions becomes evident. It becomes difficult to interpret the behavior of the other person, wrong interpretations begin to be made frequently. Control over behaviors that are not approved by the environment and therefore controlled may decrease. Emotional reactions such as anger, sadness and joy are experienced more strongly. Sometimes there may be sexually inappropriate conversations, jokes, and behavior.
Responsiveness can be accepted as a natural behavior pattern up to a certain point. In advanced ages, both social and physical losses make the person more sensitive and fragile. However, susceptibility, which is the behavior pattern of many mental disorders, is one of the main difficulties that disrupts harmony with the environment.
LOSS OF PERFORMANCE
Age-related structural changes occur in the nervous system and brain. Decreased attention, slowing down in verbalizing the names of objects, difficulties in learning new information and remembering previously learned ones occur in advanced ages. Decrease in physical endurance, slowing of reflexes and loss of body functions in varying degrees are added to social skills.
deficiencies occur. It becomes difficult to find solutions to problems and adapt to new environments. Loss of performance, which can spread to all areas of life, can cause feelings of inadequacy and other mental problems.
ANXIETY (ANXIETY)
Anxiety is a normal psychological response that people have when faced with stress or danger. It is a picture of intense uneasiness that occurs with the feeling of palpitation, shortness of breath, chest tightness, headache, burning-soreness in the stomach, which is experienced in the face of anxiety. Anxiety observed in advanced ages may also occur due to another physical or mental disorder that the person is experiencing.
Depression due to aging, needing the help of the environment, having to live more isolated by limiting social position, emergence of diseases that do not respond to treatment, loss of a loved one or the threat of loss cause anxiety. Due to the distress and uneasiness experienced, the person cannot stay in the place where he/she sits or lies for a long time and feels the desire to wander around. Anxiety, which dominates his daily life, reduces the quality of life of the person.
DEPRESSION
In addition to being a mental disorder that can be seen at any age, depressive disorders that are more common in older ages, not being able to age well, psychology of feeling inadequate, physical and mental diseases (heart disease, cancer, stroke, hypertension, dementia) onset of depression, forgetfulness), loss of spouse, economic difficulties, loss of relatives or the existence of this possibility facilitate the emergence of depression. The person is reluctant to talk to his environment and is sluggish. Sleep disorder begins to spend more time lying down. Sometimes extremely restless, “as if something is going to happen at any moment”, agitated and is troublesome. The thoughts of hopelessness and inadequacy about the future are evident. Angry behaviors, sometimes inappropriate drug and alcohol use, and thoughts of death may occur by not enjoying life. Depression is a disorder that can be corrected with psychiatric help. There are effective drugs used in the treatment of depression. However, it should not be forgotten that a period of 3-4 weeks is required for the effects of the drugs to become evident. Although the recovery does not start quickly, the treatment results of the disease are satisfactory. Since the risk of suicide is high if left untreated, it can be used as a preventive medicine in a sense.
Recognition and appropriate treatment of depression is very important. Time should not be lost to start the treatment process.
DIFFICULTY TO LEARN AND MEMORY
Memory, which carries out learning and remembering functions, is a very complex system.
Aging affects some parts of this complex system more. While the person can easily remember what he learned and experienced in childhood, he has difficulty remembering what he experienced a few days ago.
Forgetfulness, Memory Difficulty; Depression is one of the most important symptoms of mental illnesses such as dementia. Forgotten “things” (such as names, phones, things to do, places to put things) cause intense distress and difficulties in adapting to the environment. Sometimes excuses or other imaginary things are made up for the forgotten “thing”. Timely medical assistance by identifying the causes of learning and remembering difficulties prevents these complaints from becoming established.