Joe Biden, 81, has announced that he will not be seeking a second term as President of the United States, although he intends to stay in his role until the election later this year.
Many people have speculated that he may be suffering from age-related cognitive decline, although he has not said that this is the case.
Others are convinced that he show the typical signs of Parkinson’s disease, which affect around 153,000 people in the UK, according to the charity, Parkinson’s UK. This too has been denied by the White House.
But what are the typical features of the progressive disorder that affects the nervous system causing in many cases, difficulty with gaur and speech, as well as causing people to ‘freeze’ and lose awareness of their surroundings?
Dr Fayyaz Ahmed, a Consultant Neurologist and Honorary Senior Lecturer at Hull University Teaching Hospitals NHS Trust, said. ‘People with Parkinson’s often have a characteristic gait when they take small steps and don’t swing their arms, as well as a fixed expression.’
Parkinson’s is caused by low levels of L-DOPA in the brain, which is converted to dopamine by the aromatic amino-acid decarboxylase enzyme in the blood. Dopamine has many functions including helping to initiate and co-ordinate different motor activities and control muscle movements.
There are two distinct types of freezing syndrome in Parkinson’s, he explains. ’If there is a lack of LDOPA in the brain, it is difficult to co-ordinate different motor activities hence it seems as if the person is frozen – a similar thing can happen as there is slowing down on initiation on any motor movement. This can also affect speech and some call it speech arrest and tends to last a few seconds. The lack of co-ordination between different muscles involved in speech can cause
mumbling and monotonous speech.
Another type of freezing is seen in advanced Parkinson when people just can’t move at all. ‘This is not momentary but happens for few minutes to hours and often relieved by taking anti-Parkinson’s medications.’
Professor Roger Barker, a consultant neurologist the University of Cambridge says that freezing episodes can come out of the blue. ‘They can come on very suddenly and lead to falling over in some cases. They are typically short-lived but can recur frequently. It is not due to changes in muscle tone due to age, Instead, for some reason we can’t quite explain, their feet get ‘stuck’ to the floor and they can’t move.’
Professor Barker says that freezing episodes tend to recur more frequently as the disease progresses. ‘Exactly why this happens is not known, but people with Parkinson’s may find they freeze in narrow cluttered spaces and doorways. One theory is that there may be some damage in areas within the brainstem, at the base of the brain, including a structure called the pedunculopontine nucleus.’ The pedunculopontine nucleus (PPN) forms part of the rostral locomotor region of the brainstem and is thought to play a central role in the initiation and maintenance of gait.
How do patients get out of freezing? According to Professor Barker; ‘There are tricks that people can use to overcome these ‘freezes’ including stepping over a line on the floor, or listening to sounds with a rhythmic quality, such as the beats of a metronome, used to beat out
time in music practice. In some people, dopamine drugs can help, but not in most cases, Some also respond to another class of drugs known as cholinesterase inhibitors.’ These prevent the breakdown of the neurotransmitter acetylcholine which helps to send messages to the brain.
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