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PARKINSON EN EL ADULTO MAYOR

PARKINSON

Es una enfermedad del sistema nervioso central y se caracteriza por ser un padecimiento crónico degenerativo. A pesar de que aún no es posible la cura, en las últimas décadas se han hecho avances fundamentales en el esclarecimiento de las relaciones fisiopatológicas así como en la terapia de la enfermedad de Parkinson.
Anualmente se diagnostica la enfermedad de Parkinson a unos 50,000 norteamericanos, con más de medio millón de norteamericanos afectados en cualquier momento. Es casi imposible obtener un recuento exacto del número de casos porque muchas personas en las etapas iniciales de la enfermedad consideran que sus síntomas son el resultado del envejecimiento normal y no buscan ayuda de un médico.


SINTOMAS

adulto mayor

• Rigidez: que se debe a la contracción simultanea de músculos agonistas y antagonistas de cada articulación durante los movimientos, provocando una resistencia a los mismos. En el movimiento pasivo de la articulación se produce el fenómeno de la rueda dentada, al vencerse bruscamente la resistencia del músculo agonista y encontrarse con la del antagonista.
• Temblor: presente durante el reposo y la actividad con una frecuencia de entre 4 y 6 ciclos por segundo, generalmente de comienzo distal y que puede afectar los cuatro miembros y la cabeza. Cuando el paciente realiza movimientos voluntarios o cuando duerme, el temblor mejora o desaparece, empeorando con las emociones.
• Lentitud en los movimientos. El enfermo pierde los movimientos asociados automáticos para cada acto motor, por lo que debe ajustarlos voluntariamente y hacer gran esfuerzo para superar la rigidez muscular.
Estos tres síntomas provocan inexpresividad facial, dificultad para caminar (arrastrando los pies, inestabilidad y lentitud al iniciar la marcha), disfonías, trastornos en la escritura y dificultad para levantarse.
Además, los signos de afectación autonómica pueden ser importantes, como aumento de salivación, sofocos y aumento de la secreción sebácea.
 
La enfermedad es tanto crónica, lo que significa que persiste por un largo periodo de tiempo, como progresiva, que significa que sus síntomas empeoran con el tiempo. No es contagiosa ni usualmente se hereda - es decir, no pasa directamente de un miembro de la familia o de una generación a la siguiente.

¿Qué causa la enfermedad de Parkinson?

La enfermedad de Parkinson ocurre cuando algunas células nerviosas, o neuronas, en un área del cerebro conocida como sustancia nigra, mueren o sufren deterioro. Normalmente, estas neuronas producen un producto químico cerebral importante conocido como dopamina. La dopamina es un mensajero químico responsable de transmitir las señales entre la sustancia nigra y la siguiente "estación relevadora" del cerebro, el cuerpo estriado, para producir actividad muscular fluída y con un propósito.
La pérdida de dopamina hace que las células nerviosas del estriado actúen sin control, dejando al paciente incapaz de dirigir o controlar sus movimientos de forma normal. Los estudios han demostrado que los pacientes de Parkinson tienen una pérdida del 80% o más de las células productoras de dopamina en la sustancia nigra. La causa de esta muerte o deterioro celular se desconoce, pero resultados significativos obtenidos por científicos de investigación continúan produciendo pistas nuevas y sumamente interesantes de la enfermedad.
Algunos científicos han sugerido que la enfermedad de Parkinson puede ocurrir cuando una toxina externa o interna destruye selectivamente las neuronas dopaminérgicas. Un factor de riesgo ambiental tal como la exposición a pesticidas, o una toxina en el suministro de alimentos, es un ejemplo de la clase de desencadenante externo que pudiera hipotéticamente ocasionar la enfermedad de Parkinson. La teoría se basa en el hecho de que hay cierto número de toxinas, tales como 1-metil-4-fenil-1,2,3,6,-tetrahidropiridina (MPTP) y medicamentos neurolépticos, que se saben inducen síntomas de Parkinson en los seres humanos.
Sin embargo, hasta la fecha, ninguna investigación ha proporcionado prueba definitiva de que una toxina sea la causa de la enfermedad.

¿A quién afecta la enfermedad de Parkinson?

Parkinson

La enfermedad de Parkinson se manifiesta generalmente a partir de los 50 años de edad, aumentando el factor de riesgo a medida que avanza la edad. El riesgo aumenta en forma exponencial después de los 65 años , de manera que alrededor de un 3% de la población total y 3% de las personas mayores de 65 años sufren del síndrome de Parkinson idiopático. Se puede decir que afecta a ambos sexos por igual.

¿Cómo se trata la enfermedad de Parkinson?

En la actualidad, no hay cura para la enfermedad de Parkinson, la terapia de Parkinson es un tratamiento orientado a los síntomas, buscando en primer plano la sustitución de la falta estriatal de dopamina. En una fase inicial de la enfermedad se debe prestar especial atención en elegir una estrategia terapéutica neuroprotectora.

Sugerencias para la realización de la higiene diaria

1. Conviene tener una silla o taburete con asiento elevado para el aseo delante del lavabo, para mantener una buena postura.
2. Colocar una alfombra de caucho antideslizante en el suelo de la bañera y hacer instalar una barra de apoyo tanto en la ducha o bañera como en el WC que permita levantarse más fácilmente.
3. Puede instalarse una banqueta dentro de la bañera para que pueda sentarse y así facilitar el baño.
4. Es aconsejable la ducha o baño diario, inspeccionando la piel buscando áreas de roce como los codos, nalgas, talones y cabeza, sobre todo si tiene cierto grado de inmovilidad.
5. Secar bien y evitar la humedad de la piel especialmente en los pliegues (axilas, ingles.)
6. Proteger y cuidar la piel con crema hidratante extremando el cuidado en las zonas de prominencias óseas.
7. Para el afeitado, es mejor que utilice maquinilla eléctrica a no ser que sea portador de marcapasos.
8. Si el temblor dificulta el cepillarse los dientes, se puede utilizar un cepillo con el mango cubierto de goma espuma

Para vestirse puede ser de utilidad saber...

Parkinson
 
1. Es aconsejable esperar a vestirse cuando la primera dosis de la medicación del día, haya hecho efecto.
2. Debe vestirse, siempre que pueda, sin ayuda ya que constituye un ejercicio excelente.
3. Si tiene dificultad para ponerse la camisa, puede colocar la prenda enfrente, introducir los brazos en las mangas, levantar los dos brazos por encima de la cabeza y después pasar la cabeza por el cuello de la camisa o el jersey.
4. Es importante usar ropa cómoda. Se pueden utilizar jersey de cuello abierto y sin botones, faldas abiertas o con cintura elástica.
5. Los botones, cordones de zapatos etc. pueden crear dificultades. Es preferible utilizar cremalleras, cierres de velcro o botones a presión y zapatos tipo mocasín.
6. Para calzarse puede usar un calzador de mango largo y un banquillo para ponerse las medias o los calcetines.

¿COMO ACTUAR EN LA HORA DE LAS COMIDAS?

1. Se debe separar la hora de la toma de medicación de la hora de las comidas. Los platos ricos en proteínas animales deben tomarse a las horas en que la medicación esté más lejana, por ejemplo en la cena.
2. Se aconseja beber abundantemente tomando de 2 a 2,5 l. (entre 8 y 10 vasos) de líquido al día (agua, zumo, leche...).
3. Los alimentos con consistencia de papilla, son más fáciles de tragar que los alimentos cortados finos o picados.
4. Un sorbo de agua fría puede ayudar a tragar mejor, porque estimula el reflejo de la deglución.
5. Utilizar copas y platos con diseño que permitan sostenerlos firmemente.
6. Los cubiertos han de pesar poco ya que son más fáciles de manejar. Se pueden modificar los mangos introduciéndoles en un cojín de espuma tubular. A veces es más fácil utilizar la cuchara que el tenedor.
7. Si hay dificultad para llevarse el vaso a la boca, utilice una paja flexible.
8. Al comer debe sentarse correctamente, de manera que el cuerpo quede perfectamente alineado.
9. Para mejorar la dificultad a la hora de comer:
a. Mantener los labios cerrados y los dientes juntos, poner la comida en la lengua, levantar la lengua hacia arriba, luego hacia atrás y tragar.
b. El problema de la acumulación de alimentos, puede prevenirse comiendo lentamente y tomando pequeñas porciones cada vez. Tragar sólo pequeños bocados y bien masticados.
c. Cuando mastique, debe hacerlo con fuerza y mover la comida con la lengua. Masticar primero por un lado y luego por el otro.
d. No poner comida adicional en la boca, antes de haber tragado el bocado anterior.
10. Acumulación de saliva:
a. Hacer un esfuerzo consciente para tragar la saliva a menudo. Cerrar los labios firmemente. Derivar la saliva hacia la parte posterior de la garganta y tragar.
b. Intentar poner la cabeza en posición alta, así se facilita que la colección de saliva, se trague automáticamente.
c. Tragar un posible exceso de saliva, antes de intentar hablar.

Estreñimiento

1. Es un problema común en muchos pacientes con Parkinson. A veces debido a que comen poco y beben poca agua. También es fruto de la medicación.
2. No es necesario defecar diariamente y es suficiente hacerlo cada dos o tres días.
3. Se pueden tomar varias medidas:
a. Beber al menos dos litros de agua al día.
b. Añadir salvado a la dieta así como fruta y vegetales.
c. Sentarse cómodamente en el WC, con las rodillas encogidas para favorecer la contracción de los músculos abdominales.
4. Evitar en lo posible laxantes o bien utilizar laxantes suaves como la leche de magnesio.
5. Evitar el uso frecuente de enemas. Los supositorios de glicerina o los pequeños enemas comercializados, pueden ser de gran ayuda.
6. Procurar tener un momento del día en el que disponga del tiempo necesario para sus necesidades.
7. Procure tomar en ayunas kiwis o ciruelas pasas con agua

Dificultad para caminar

adulto mayor


1. Para superar el bloqueo, el paciente debe pararse, apoyar los talones sin inclinarse hacia atrás y comenzar a balancearse sin moverse de sitio, hasta que esté listo para continuar.
2. El uso del bastón invertido, puede ser de gran utilidad para superar los bloqueos. Consiste en añadir un apéndice de plástico rígido, mejor de color llamativo, en la base del bastón (suele encontrarse en la mayoría de las ferreterías). Forma de uso: cuando presente el bloqueo, debe tratar de dar un paso por encima del apéndice y después de éste, los pasos subsiguientes.
3. Surge efecto también ante el bloqueo, el incitarle a que responda a un paso militar (un, dos, un, dos...), o que intente saltar por encima de un pie de su acompañante, o un palo en el suelo...
4. Para evitar la festinación (pasos cortos, rápidos y confusos):
a. Debe dejar de andar cuando arrastre los pies. Con los talones firmes en el suelo, separar los pies entre sí unos 20 cm. para mejorar la estabilidad, y cuando dé un paso, apoyar primero el talón al suelo y luego los dedos.
b. Si va con acompañante, caminar al lado, y no delante ni detrás, ya que podría perder el equilibrio.
c. Es conveniente entrenarse en subir y bajar escaleras.
d. Para girar: no girar nunca sobre un pie o cruzar las piernas. Caminar describiendo un semicírculo con los pies ligeramente separados entre sí.
5. Se debe dar importancia al equilibrio y coordinación de movimientos: Se pueden efectuar marchas combinando marcha-equilibrio, marchas alternas (adelante, atrás, de lado). Es interesante incorporar el baile (vals) siguiendo el ritmo con cambios de direcciones.
6. Para ejercitar la marcha puede ser útil marcar una distancia de 6 a 10m. lineales, señalando las líneas de salida y llegada. Contar el nº de pasos que debe hacer del principio al final. Contar en voz alta: Grandes pasos:
a. Mejorar la estabilidad, aumentando la base de sustentación y apoyando primero el talón: Intentar andar la misma distancia con menos pasos y más largos.
b. El movimiento del brazo tiene que ser opuesto al de la pierna: el brazo derecho, se mueve con la pierna izquierda y viceversa: Balanceo de los brazos: balancear libremente los brazos al caminar.
c. Puede ejercitarse mediante la colocación de obstáculos: Elevación de la rodilla.
d. Durante la marcha, el peso del cuerpo debe pasar de una pierna a la otra., ejercitando marchas a 4 tiempos asociando los movimientos de brazos y piernas.: Distribución del peso del cuerpo.

(Las personas que no puedan hacer estos ejercicios de pie, lo harán sentados en un taburete. Incluso en las fases más avanzadas, siempre podrán beneficiarse de los ejercicios, aunque sea de manera pasiva)

Dificultad ante otros movimientos

ANTE EL TEMBLOR
1. Apretar el codo de la extremidad afectada contra el lado para estabilizar la parte superior del brazo.
2. Efectuar el movimiento lo más rápidamente posible con la mano.

MOVERSE EN LA CAMA

1. Para girarse mejor en la cama:
• a) Doblar las rodillas y apoyar los pies en la cama. Ladear las rodillas hacia la derecha.
• b) Entrelazar las manos y levantarlas estirando los codos.
• c) Girar la cabeza y los brazos hacia la derecha. Agarrar las manos al colchón para ajustar la posición hasta estar cómodo.

2. Para levantarse:
• a) Estirarse boca arriba y colocar los brazos al lado del cuerpo.
• b) Levantar la cabeza de la almohada dirigiendo la barbilla hacia el pecho y sentarse apoyándose sobre los codos.
• c) Mantener la cabeza en la posición anterior e incorporarse progresivamente hasta llegar a sentarse apoyándose con los brazos situados por detrás del cuerpo.
• d) Ir moviendo las piernas hacia el borde de la cama hasta sentarse.

3. Para acostarse:
• a) Sentarse al borde de la cama, cerca de la almohada.
• b) Estirarse de manera que la cabeza quede sobre la almohada en posición correcta.
• c) Levantar las piernas sobre la cama.

Mejorar la comunicación verbal
1. Tener presente que hablar claramente requiere una atención y esfuerzo deliberados.
2. Expresar las ideas de forma escueta, utilizando frases concisas.
3. Tomarse el tiempo necesario para organizar los pensamientos y plantear lo que se va a decir.
4. Respirar antes de empezar a hablar, haciendo pausas frecuentes.
5. Mirar al interlocutor, será mucho más fácil la comunicación para los dos.
6. Exagerar la pronunciación de las palabras. Comportarse como si el interlocutor fuese sordo y tuviera que leer en los labios

CON FAMILIARES Y AMIGOS

Parkinson
1. Dar al paciente la más completa atención.
2. Si tienen problemas para empezar a hablar, dele tiempo para que empiece sin interrumpir su concentración. Sitúese enfrente de él.
3. Animar al paciente que diga frase por frase y palabra por palabra. Repetir cada palabra o frase después de él.
4. Decirle que exagere la pronunciación de las palabras.
5. Dar al paciente señales afirmativas, como hacer que sí con la cabeza, indicando que se entiende lo que está diciendo.
6. Animar al paciente a utilizar frases cortas, a veces de tipo telegráfico.
7. Incitar a que le hable en voz alta y que se imagine que habla desde otra habitación.

¿DE QUÉ MANERA SE SUGIERE MANTENER ORGANIZACION EN LA CASA?
1. Debe estar organizada de manera que no existan posibles peligros, como por ejemplo; suelos pulidos, esteras o alfombras no fijadas, cables eléctricos que cuelguen o desorden general.
2. Los muebles han de situarse de manera que la persona, no pueda tropezar.
3. Las escaleras, no suelen dar muchos problemas, pero puede ser necesario la colocación de un pasa manos.
4. Es conveniente tener en lugar de un sillón que puede resultar difícil levantarse, una silla estable con respaldo alto.
5. Si le resulta difícil ponerse de pie, puede diseñarse una silla expulsora. En ocasiones, una silla de oficina giratoria con ruedas, puede ser de utilidad para girarse o desplazarse.
6. Existen teléfonos especiales con botones con memoria para marcar los teléfonos más frecuentes y también amplificadores para hablar.

DORMITORIO
1. Conviene que la cama tenga una altura adecuada. Si es demasiado alta, se pueden cortar las patas, o bien, añadir un suplemento si es demasiado baja.
2. Si existe dificultad para dar la vuelta en la cama, se pueden utilizar unos escarpines que permiten a los pies agarrarse a la cama y girar mejor.
3. Las sábanas y pijamas de satén pueden facilitar la movilización.
4. Se puede reducir el peso de las mantas usando un edredón ligero o bien elevando la ropa de la cama colocando al pie una caja de cartón.
5. Para resolver el problema de ir al lavabo por la noche, puede ser conveniente un orinal o botella en el dormitorio.

COCINA
1. No debe haber ningún obstáculo en el suelo.
2. Los utensilios deben estar en sitio fácilmente accesible.
3. Se deben modificar las alturas de las estanterías para que estén más a mano.
4. Para preparar la comida hay que estar en buenas condiciones. Conviene tener en casa una reserva de alimentos envasados.
5. En la cocina serán muy útiles los objetos que no se rompen.

Documento avalado por: Dr. Gustavo Castillo R. Ced. Prof. 1256736

doctor

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