The situation of an ageing society and the challenge of Parkinson's disease in Thailand

At present Thailand has entered an ageing society completely, since the population aged more than 60 years counts as 20 per cent of the whole population, and it is predicted that in the year 2582 BE the number of elderly people will reach 28 per cent of the whole population. Parkinson's disease (Parkinson's disease) is a disease of degeneration of the nervous system, found in more than 5 million people, or 0.3 per cent of the population throughout the world, and found in 1-2 per cent of the population aged more than 60 years. Its cause arises from the degeneration of the cells that produce the substance dopamine in the part of the brain called the Substantia nigra. The main symptoms consist of slow movement, tremor, stiffness and spasm, and abnormal walking/balance. The group of Parkinsonian symptoms (Parkinsonism) means the main symptoms mentioned above, which arise from other diseases besides Parkinson's disease, found in 14-55 per cent of patients.

Parkinson's disease usually has a problem of abnormal walking (Gait disorder), arising from a momentary disturbance of the circuit of movement (Locomotor circuitry) in the brain, which makes the patient's speed in walking decrease and the length of the step decrease, so that there is a limitation in movement and an increased risk of falling.

Freezing of Gait

Freezing of Gait is a symptom met often in this group of patients. The patient will feel as though glue is holding the feet, so that the leg cannot step out, being unable to begin to step the foot, getting stuck while turning around, or walking with short quick steps. These symptoms arise temporarily, and usually occur when walking in a narrow place, or when there is an obstacle in the way.

As for advice to increase the ability to walk and reduce freezing of gait

  1. Walk with a long step, lift the leg high, and swing the arms more
  2. It is advised to practise walking about 30-60 minutes after taking medicines in the group that increases the action of the substance dopamine in the brain
  3. If you want to turn around, it is advised to walk in a U-turn, such as walking around a chair, and to lift the foot off the ground rather than pivoting the foot, because that increases the risk of falling
  4. Before beginning to walk, it is advised to practise standing and stepping with a transfer of weight (Weight shifting), which can be done by standing with the legs apart at the width of the shoulders, transferring the weight onto one leg, and with the other stepping forward or backward, or stepping out to the side and then returning to the same place
  5. Use cues (Cueing) to help in movement, namely using a visual cue, such as sticking brightly coloured tape on the floor and having the patient step according to the spacing of that tape, with a spacing of about 45-60 centimetres advised; using a laser walking stick and having the patient step along the band of laser light; or using an auditory cue, such as having the patient walk to the rhythm of a song, to a count of the beat, or to the sound of a metronome (Metronome)
  6. Arrange the environment, remove obstacles, and let the patient walk in a wide space
  7. If the patient has severe symptoms, or has had them for some time, it is advised to arrange the environment so that the patient has concentration in walking, preventing disturbance from outside
  8. Exercise regularly, namely aerobic exercise, training balance, and increasing the strength of the muscles and the flexibility of the body

Source

  • The Centre of Excellence in Medicine for Parkinson's Disease and the Group of Movement Disorders
  • Report on the situation of Thai elderly people, 2564 BE