DEAR READER: Essential tremor can be caused by several conditions, including anxiety and stress. It is often confused with Parkinson’s disease, and affects almost 15 percent of people over the age of 65.

The Xanax you have been prescribed is in a group of drugs called benzodiazepines. I can only assume your physician prescribed it because he or she believes the tremor is caused by anxiety. Other prescription drugs that have shown promise include beta blockers commonly used for hypertension, some epilepsy drugs and Botox. Without knowing you personally, I cannot say whether the medication is doing you any harm; but should you choose a trial of alternatives, you might consider avoiding caffeine, excessive amounts of alcohol and stress. Hypnosis, massage, acupuncture, physical therapy or biofeedback might be of assistance.

DEAR READER: Parkinson’s is a neurological disorder with a myriad of symptoms, including fatigue, malaise, depression, memory loss, cramped handwriting, tremor, rigidity, gait abnormalities, lack of facial expression and sense of smell, and more. Postural instability develops as the disease progresses. Excess saliva is uncommon, but each person experiences different symptoms, so I won’t unequivocally dismiss any involvement with your diagnosis.

Current research indicates that symptoms of Parkinson’s disease are related to depletion or low levels of dopamine in the brain. Ropinirole is a central-nervous-system agent with some of the same effects as dopamine. Carbidopa and levodopa work in combination. Carbidopa helps to prevent the breakdown of levodopa before it reaches the brain. Then the levodopa kicks in and converts to dopamine once it gets there.

You may have been placed on the ropinirole in addition to your carbidopa/levodopa because the combination drug alone did not control your Parkinson’s symptoms satisfactorily. I urge you to discuss any concerns or questions you may have regarding your treatment with the prescribing physician. You should also be under the care of a neurologist familiar with treating Parkinson’s disease.

After the neurologists’ diagnosis, I did research on the internet and found that my husband has every symptom, both physical and mental. His falls started several years ago. His movements are now painfully slow, his thinking is impaired, he has trouble swallowing, spills foods, requires help getting up and down, has great trouble walking even with a walker, has lost weight, is very weak, spends 15+ hours in bed a day, has a blank stare and reduced eye movement (says he can’t see).

He has not accepted that there is no cure and asked that I write for your opinion on the best place to seek help.

DEAR READER:
I believe you may have misunderstood the diagnosis since Vascular Parkinsonism and Progressive Supranuclear Palsy are two separate, yet similar, disorders.

Vascular Parkinsonism (VP) is caused by small strokes within either or both of the basal ganglia portions of the brain. Symptoms include resting tremor, rigidity, slowness of movement and difficulty walking. Some patients may experience sudden onset of symptoms as well as a stroke-like event, others may be completely unaware of the strokes and develop gradual worsening of symptoms.

Diagnosis can be difficult since it closely resembles typical Parkinson’s disease and is often misdiagnosed as such in the early stages. Brain scans will show evidence of strokes. Treatment is primarily aimed at eliminating future strokes.

Progressive Supranuclear Palsy (PSP) is also a Parkinson-like disorder but differs in several small ways. Like VP, it is often misdiagnosed as Parkinson’s disease in the early stages. The symptoms are caused by deterioration of nerve cells in several tiny areas of the brainstem, including an area commonly affected in typical Parkinson’s disease.

Symptoms include loss of balance while walking, stiffness, unexplained falls (usually backward), awkward gait, irritability, forgetfulness, loss of interest, impaired thinking, sudden laughing or crying, apathy, problems controlling eye movement, blurred vision, inability to maintain eye contact during conversation, slurred speech, trouble swallowing solids or liquids, and more.

Based on the symptoms of each disorder, your husband appears to match closely those of PSP, rather than Vascular Parkinson’s.

Treatment for Progressive Supranuclear Palsy can be difficult as there are no truly effective medications or therapies. Medications which increase levels of dopamine can be successfully used in about 30% of those diagnosed with PSP but effectiveness is limited to about two years. Antidepressants such as Prozac appear to improve symptoms for some but it is not clear why.

Botox injections into specific muscles around the eyes may block chemical signals which cause involuntary eyelid spasms or eye movement. Bifocal or prism glasses may aid problems with looking downward. Speech and swallowing therapy may help individuals regain or improve function. Balance therapy and aids such as walkers, railings and others can prevent falls or reduce damage caused by falls by slowing the individual down.

I urge both of you to return to his neurologist to discuss possible treatment options.

To give you related information, I am sending you a copy of my Health Report “Parkinson’s Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER:
First, I will briefly discuss hydrocephalus.

The body produces about eight ounces of cerebrospinal fluid (CSF) each day. Almost all of that fluid is reabsorbed into the bloodstream. When this fails to occur, as with head injury, stroke, meningitis or when a tumor develops, an imbalance occurs. This problem is known as hydrocephalus. There are two known forms, congenital and acquired. Congenital hydrocephalus generally occurs at birth. The acquired form (NPH) most frequently occurs in individuals over the age of 60.

Now, the problem. Symptoms include gait abnormalities, difficulty walking up and down stairs, confusion, urinary frequency and urgency, and short term memory loss. As you pointed out, these are also symptoms tied to Parkinson’s and also to Alzheimer’s.

Normal pressure hydrocephalus differs from congenital hydrocephalus in that pressure in the head may have fluctuations of CSF from high to low or even normal. Some cases are linked to bleeding in the brain or result from a blockage in the flow of CSF through and around the brain and spinal cord.

Diagnosis is made through computed tomography, magnetic resonance imaging, lumbar puncture, gait analysis, NPH protocol and more. The protocol involves a series of screening procedures to assist a physician with proper diagnosis. Part of that screening may be removal of CSF through a catheter over a 36 hour period.

Treatment of choice by a surgeon may be through an implantable shunt. The purpose of the shunt is to drain excess fluid away from the brain and spinal cord. Once the fluid is removed, symptoms can be partially or completely reversed.

Parkinson’s disease, on the other hand, occurs when nerve cells in a part of the brain die or become impaired. These cells produce a chemical known as dopamine in healthy individuals. The dopamine provides a coordinated function of the body’s muscles. When about 80% of the cells are damaged, symptoms of Parkinson’s appear. An individual may be depressed, handwriting may become cramped and illegible, a tremor may be present, there may be gait and postural abnormalities, the sense of smell may be diminished, there may be a loss of facial expression; memory and slow thinking can occur; sleep patterns, and urinary incontinence or constipation can be present.

Evaluation is generally completed by a neurologist who specializes in the disease. There are no x-rays or blood tests to confirm the diagnosis. It is chronic and progressive but affects each individual differently. Some patients may have a noticeable tremor; others may have extremely mild symptoms that don’t progress rapidly.

Medication is available and may be prescribed in conjunction with medications that act like dopamine. Studies are ongoing in treating this difficult disease.

Alzheimer’s disease is a disorder that results from the gradual loss of brain cells. Two brain abnormalities associated with Alzheimer’s include clumps of protein fragments that accumulate on the outside of cells and clumps of altered protein that accumulate within the cells.

Age is the greatest risk for developing Alzheimer’s. Statistics reveal that up to 10% of all people 65 and older and up to 50% of those 85 and older are affected.

Symptoms include memory loss, disorientation as to time and place, difficulty speaking or finding specific words, personality changes, misplacing items around a house, difficulty performing routine tasks, dressing inappropriately for the season, and more. An individual may forget a dentist appointment, not remember how to dial a phone, forget how a radio or television is turned on, or have a dramatic personality change. He or she may become fearful over simple issues and will likely become more dependent on family members or caregivers.

There is no single test to confirm diagnosis. A medical history, status of mental health, gait testing, laboratory testing and more may be required. If memory loss is tied to a drug interaction, vitamin deficiency, thyroid abnormalities and a host of other conditions, reversal of symptoms is possible. For example, vitamin E has been recommended for mild to moderate dementia. Testing is ongoing to determine if folic acid supplements that lower homocysteine levels can treat or prevent the disease. Long-term nursing home care may be needed as a patient’s symptoms progress.

Medical advances are ongoing and extremely promising, and support groups are available for both the patient and families.

To give you related information, I am sending you copies of my Health Reports “Alzheimer’s Disease” and “Parkinson’s Disease”. Other readers who would like copies should send a self-addressed, stamped, number 10 envelope and $2 for each report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the titles.

The last sentence of your response, however, referred to B-50. Could you clear this up for us, please? My brother is in the early stages of Parkinson’s or something like it and has the shakes. We attempted to locate B-5Q with no success, but B-50 is available.

Thank you. We appreciate your help.

DEAR READER:
As I am sure you are aware, Parkinson’s is a progressive neurological disorder that is both chronic and progressive. It is not contagious, nor is it generally inherited.

Early symptoms may be subtle and occur slowly. Key signs can include postural abnormalities, a shuffling gait, tremor, dementia, a blank stare and lack of facial expression, and more. The sense of smell may be affected and individuals with what may have been a voracious appetite may not appear hungry or express any interest in food. Pill rolling, the rhythmic back and forth motion of the thumb and forefinger, is common to those watching, but the Parkinson’s patient may be unaware of the action.

Parkinsonism is the term given to a group of combined symptoms. If Parkinson’s is the result of specific drugs taken for psychiatric, hypertensive and stomach disorders, the condition can be reversed by either discontinuing the medication or by reducing the doses taken. Other forms of the disease are not reversible.

Now, on to your letter that obviously caused some confusion. A typographical or typesetting error was made by your local newspaper when my column on the subject was entered. The product I referred to was not B5Q, but B50. According to a number of my readers, two vitamins, 100 mg of grape seed extract and vitamin B-50, have been used effectively and without side effects for control of the tremor associated with Parkinson’s.

I don’t believe that over-the-counter drugs will do your brother any harm, but he should be seen by his primary care physician and referred to a neurologist for diagnosis. Tremor doesn’t have to be the result of Parkinson’s, but can be from other causes. Once the neurologist makes a diagnosis by connecting the symptoms, he may choose to prescribe Eldepryl or another medication for control.

To give you related information, I am sending you a copy of my Health Report “Parkinson’s Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Because I can never talk to my doctor (only his assistants) I was hoping you could tell me what this means.

DEAR READER:
The Circle of Willis is an area at the base of the brain where several arteries join together. While all brain aneurysms are potentially dangerous, one situated in the Circle of Willis is especially so because the interior carotid arteries branch off from this area and supply about 80% of the brain’s blood.

Encephalomalacia is an abnormal softening of part of the brain, usually because of a restricted blood supply (ischemia) or death of the tissue (infarction, often due to loss of the blood supply).

The right temporal lobe is responsible for the memory of shapes and sounds. Damage to this area can cause loss of that type of memory and occasionally can cause personality changes such as loss of libido, humorlessness, extreme religiosity and others.

From your brief letter I cannot determine if you had the aneurysm surgically repaired or if it has remained untouched. In either case, the aneurysm may be directly related to your brain softening because the right temporal lobe is in close proximity to the right side of the Circle of Willis.

You need to have a follow-up examination so I urge you to see a neurologist for further testing. He or she can explain in better detail what symptoms may be caused by the abnormality and if there are any possible treatment options. The specialist can also give an accurate outlook about how this may affect you in the future and if it will require any special considerations as you age.

I would like to add that I am disappointed at the hospital doctors and your personal physician for not providing you the diagnosis, prognosis and other vital information. If your doctor cannot be bothered to speak with you about your situation, it is time to find a new physician who will be more caring and attentive. Because of your age, you may find that a gerontologist (practitioner who deals with senior citizens only) is an appropriate choice. These specialists are specially trained to recognize and care for maladies of the elderly. They also serve as general practitioners for normal routine check-ups and more.

To give you related information, I am sending you copies of my Health Reports “Alzheimer’s Disease” and “Parkinson’s Disease”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

My father suffered from some of these symptoms, particularly increasing rigidity. He was later diagnosed at autopsy with Lewy body dementia. He, too, was on Aricept for several years with little or no difference in the condition.

DEAR READER:
Lewy body dementia is a relatively common form of dementia. It is characterized by the loss of the ability to think, reason and remember. This is due to the development of abnormal round structures (Lewy bodies) in the areas of the brain that control thinking and movement. It is unknown why these anomalies develop in the first place.

Symptoms are similar to both Parkinson’s disease and Alzheimer’s disease. A distinctive symptom is hallucinations that can appear very realistic. These can include sounds, shadows, colors, shapes, animals, people and more. Hallucinations are often the first sign of Lewy body dementia. Like Parkinson’s, it can also cause a shuffling gait, slowed movement, tremors and rigid muscles. Like Alzheimer’s, symptoms can include depression, memory loss, confusion, decreased cognition, and delusions.

Unlike other forms of dementia, sufferers of Lewy body dementia can experience large fluctuations in symptoms. They may awaken in the morning and be completely lucid and by late morning be inattentive or unable to stay awake. Symptoms can also worsen based on medication. If initial symptoms present as Parkinson’s disease and medicines designed to treat that condition are given, confusion, delusions, and hallucinations may worsen.

Lewy body dementia primarily affects individuals between the ages of 50 and 85 with a predominance toward men. You are at higher risk of developing this condition if you have a family member who had it. (Diagnosis can only be confirmed at autopsy.)

Unfortunately, there is no cure; however, treatments are available. Alzheimer’s medications seem to have the best results, but for some, like your father, do little good. Using memory aids and providing well structured environments often improve symptoms. Physical therapy, massage and even aromatherapy may also help. Reducing stress and situations that cause agitation, anger and fear are important and it is equally important to provide stimulating activities such as playing games that encourage memory, walking or another physical activity. Anyone with impaired memory needs to be closely monitored during outside activities to ensure they do not wander off and get lost or injured.

Most sufferers of dementia, regardless of the cause, have less drastic changes in mood, behavior and symptoms if given proper care. In the same way you care for a child, such as with bedtime rituals, proper communication, and more, so you should with the sufferer. In essence, rather than growing up, dementia causes people to “grow down”, reverting to childhood, toddler-hood and eventually infancy. It is a devastating process, but until more research is done and causes are found, we can only do our best to provide care, safety and most importantly, love.

Thank you for writing to remind me and my readers of this disorder.

Anyone who is interested in learning more about this form of dementia can go online to www.MayoClinic.com/health/lewy-body-dementia/DS00795. The Alzheimer’s Association also has information on several forms of dementia and can be found at www.Alz.org.

To give you related information, I am sending you a copy of my Health Report “Alzheimer’s Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER:
Let’s consider the big picture here. You are on a host of medications and supplements for your Parkinson’s, hypothyroidism, depression, anxiety, hypercholesterolemia, and osteoporosis.

I would like to clarify the dosage of Levoxyl you are taking for hypothyroidism. While I left out the dosages of the medications you are on, you stated you take 50 mg daily. This amount is beyond comprehension. Could you have meant to say 50 micrograms (mcg)? Levoxyl should be taken in the morning on an empty stomach and at least four hours apart from other drugs taken that are known to interfere with its absorption. At what time of day are you taking this drug and how often do you follow-up with your other medications?

Side effects include anxiety, nervousness, insomnia, weight loss, heat intolerance, headache, hyperactivity, diarrhea, hair loss, and more. A consequence of over-or-under treatment for women with long-term use includes a decrease in bone mineral density. You don’t indicate whether you are male or female. Could your insomnia and osteoporosis be a consequence of the Levoxyl?

How often do you have blood drawn to test for your hypothyroidism? One consideration you should speak with your physician about is that drugs that have worked well for years can become ineffective for no apparent reason. We anticipate things will not change. Unfortunately, our bodies respond in different ways and what worked in the past simply might not work that way permanently.

Now on to your question of insomnia. Serotonin and melatonin are essentially the same. Serotonin kicks in when light is present and is a naturally-occurring chemical found in the brain and intestines that controls wakefulness and mood. It converts to melatonin when darkness occurs and is a hormone released into the bloodstream by the pineal gland in the brain. Many individuals with depression have low serotonin levels, leading to low melatonin levels and an inability to sleep. In many instances, light is present in the room a person sleeps in — either from a night light or television.

Synthetic melatonin is often used as a sleep aid. It is available in most pharmacies and is one of the safest options offered. Before you consider trying it for your insomnia, ask your physician if one of your medications might be the culprit. Perhaps we can get you sleeping and stop any advancement of the osteoporosis, simply by keeping tighter control on your hypothyroidism.

To give you related information, I am sending you copies of my Health Reports “Parkinson’s Disease” and “Sleep/Wake Disorders”. Other readers who would like copies should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

I see a primary care physician at a VA clinic, a local internist, urologist, cardiologist, and a neurologist. I have type 2 diabetes and have had episodes of atrial fibrillation in the past. My medications include Metformin, simvastatin, warfarin, flecainide, a daily multi-vitamin, and monthly B12 injections. Further, I had partially successful atrial ablation in 2006 and cryotherapy for prostate cancer in 2007. My blood pressure readings and lab testing for diabetes are always great.

After an MRI I was told I do not have Parkinson’s disease, but Parkinsonism symptoms. Two trials of carbidopa/levodopa gave initial improvement that faded after several days — even with dose increases.

Do you have any thoughts on why my legs have become progressively weak? Any ideas would be appreciated.

DEAR READER:
You appear to be plugged in to the appropriate specialists to handle the plethora of medical issues with which you have had to deal. In spite of this, I will attempt to cover one issue at a time, so bear with me.

Your type 2 diabetes is stable on the Metformin dosage prescribed. The atrial fibrillation is held in check with the Warfarin and Flecainide. You don’t indicate you have high cholesterol readings. I must interpret, therefore, that the Simvastatin was prescribed for both your cardiac condition and diabetes. The B12 injections and multi-vitamins are for fatigue and as a boost for what might be lacking in your diet.

Now on to the biggest issue. Symptoms of Parkinson’s include tremor, rigidity, stooped posture, shuffling gait, fatigue, lack of facial expression, and more. General weakness is relatively common with this neurodegenerative disorder.

You appear to have several symptoms associated with Parkinson’s disease but were not given a diagnosis as such. This leads me to believe that you may have some other condition causing them.

Parkinsonism’s symptoms can be caused by many conditions other than Parkinson’s disease including, drug-induced Parkinson’s, normal pressure hydrocephalus, vitamin deficiency, arteriosclerosis, and more.

You need to have a full neurological work-up including blood testing and a review of your current medications. To the best of my knowledge, there is no test to diagnose Parkinson’s disease but there are tests for other disorders which can be performed to rule out other causes.

Given the fact that you have symptoms of Parkinson’s disease and responded to dopamine therapy (even if for a brief time), I believe you may truly have the disorder despite the fact that your MRI said otherwise. (Again, I don’t believe that an MRI can confirm or rule out Parkinson’s, rather it is based on symptoms, etc.)

I recommend you get a second opinion from another neurologist who may be able to help you more than your current specialist. Let me know what happens.

To give you related information, I am sending you a copy of my Health Report “Parkinson’s Disease”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER:
As I am sure you are aware, Parkinson’s disease is a progressive neurological disorder that occurs when nerve cells in a part of the brain die or become impaired.

Early symptoms are extremely subtle and vary. Some individuals might have difficulty getting out of a chair, handwriting might appear cramped, the sense of smell or memory might be affected, and irritability and depression might be observed. More obvious symptoms include tremor of the hand or mouth, muscle rigidity, slowed movement, gait abnormality, and urinary incontinence or constipation. Postural instability and other features may come in to play as the disease progresses.

You don’t indicate why your doctor has diagnosed you with Parkinson’s, but you must be exhibiting some symptoms for him to have come to that conclusion. Therefore, I suggest you make an appointment with a neurologist to discuss the matter. This type of specialist can confirm your diagnosis if you truly have Parkinson’s. If not, he or she can order testing and then provide you with a new diagnosis. Keep in mind that some Parkinson’s sufferers only have mild cases that may take years to worsen if at all. The other end of the spectrum is severe symptoms that may go from mild to severe and eventually lead to death in only a matter of months or a few years.

To give you related information, I am sending you a copy of my Health Report “Parkinson’s Disease”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.