by Sally Colby
Dr. Tara Haskins, Total Farmer Health director for AgriSafe, gave some statistics for Parkinson’s disease: It affects one million people in the U.S., and every year, about 60,000 new cases are diagnosed. The occurrence of Parkinson’s is about 1.5 times greater in men, and the majority of cases are diagnosed in individuals over age 55.
Haskins described the cause of Parkinson’s as the loss of the dopaminergic neurons in the brain. “Dopamine is a neurochemical that’s important in various activities for daily living and mood,” she said. “It affects movement and the reward/motivation part of the brain. It’s highly implicated in major depressive disorders, but it’s also important to understand these neurochemicals do not work in isolation.”
By the time someone presents with physical symptoms of Parkinson’s, Haskins said they have already lost about 80% of dopaminergic producing neurons. By the time symptoms present in a 60-year-old, the process has been in effect for years.
While Parkinson’s disease includes both motor and non-motor symptoms, the most commonly recognized are motor symptoms because they’re the most visible. Parkinson’s results in stiff, rigid extremities, slow movements and resting tremors. Tremors often subside as movement is initiated. Also typical in Parkinson’s are gait abnormalities such as short steps and shuffling when initiating movement. In some cases, once movement is initiated, it can be rapid and difficult to control.
Some Parkinson’s patients experience “freezing,” which Haskins described as feet stuck on the floor. The freezing phenomenon can occur when someone attempts to move through a doorway or navigate through a close space such as in a restaurant. “It’s almost like the brain misinterprets the environment and miscommunicates with the muscles and movement,” said Haskins.
Non-motor, early symptoms of Parkinson’s include constipation, loss of smell and sleep disturbance, especially in REM cycles. These early signs can occur five to 10 years before motor symptoms are obvious. Haskins pointed out that Parkinson’s doesn’t look the same for everyone, and that severity, symptoms and manifestations vary. “We need to ask good questions about what people are experiencing because it isn’t a cookie-cutter disease,” she said.
For many, one aspect of Parkinson’s is the loss of fine motor skills such as handwriting. “Handwriting over time can become very short and sometimes super-slanted and difficult to read,” said Haskins. “I’ve heard some individuals say they look back over time at handwriting and see changes.” Haskins suggested strategies such as practicing handwriting, using lined paper and sitting down at a hard surface to write. Those who must do a lot of legible handwriting often do this and other fine-motor tasks when medications are working at peak. Some medications for Parkinson’s are short acting, so it’s important to time those to be taken prior to work that requires more coordination.
Movement is a major part of working in agriculture, from getting up and down from tractors and other equipment to working around large animals and navigating in the shop. Balance and core strength are critical, but both tend to decline over time with Parkinson’s. “Staying active safely is important,” said Haskins. “Agricultural work is physically demanding but a regular exercise program can help decrease some declines.” Difficulty in movement can be highly individual, but exaggerating the movement, such as purposely extending the gait when walking, can help. Haskins added that music can be beneficial in helping to connect the brain with muscle movement.
Parkinson’s can result in mental health challenges. The neurochemicals in the brain that help modulate mood and stave off depression are compromised. Other issues can complicate the disease, including the stigma of Parkinson’s. When compounded with possible decline in function, the burdens on business and a shift in responsibilities among others on the farm, there’s potential for anxiety, uncertainty, stress and worry. Although delayed speech along with slow and deliberate movements may make the person with Parkinson’s appear to have lost intellectual capacity, that isn’t typically the case.
In managing Parkinson’s, remember that navigating terrain can be difficult. A good exercise program and fall prevention are important. Some patients benefit from speech therapy. Provide good seating with seats and arms that make it easier to get in and out of the chair. It’s also important to address sleep management. “Farmers are already at a sleep deficit,” said Haskins. “When there’s a disorder that affects sleep negatively, that can be a challenge.”
Farmers diagnosed with Parkinson’s may need to take extra safety precautions to avoid falls and other injuries. Make sure the person always has a cell phone and check in with them frequently. If balance is a problem, ensure walking surfaces are even and free from obstructions. Be aware of potential delayed reaction time and operate machinery and power tools at a slower speed. Take frequent breaks and recognize the need for rest.
When Parkinson’s disease is identified and managed, most patients can continue with regular daily activities, including manageable farm tasks. Physical and/or occupational therapy, and counseling when appropriate, can help patients remain active and productive.