Unsteady gait in the elderly

It should be noted that it is not possible to remove the calcifications in the brain. The treatment of Fahr's disease is therefore symptomatic.

Parkinson's disease in the elderly: stages and nursing features

Parkinson's disease is caused by abnormalities in the CNS and a lack of production of the hormone dopamine. As a result, impulses from the brain are not transmitted to other organs. The result is tremors in the hands, slowed movements and limited activity.

The disease increases the risk of stroke, thrombosis and heart attack. In later stages, Parkinson's patients have difficulty swallowing. In older people, the disease develops without any obvious symptoms, but these become noticeable when up to 70 % of the neurons are affected.

Parkinson's disease in the elderly

On the side of older people are characterized by symptoms such as:

• Stiff, clumsy movements. The disease often starts in the right arm, then spreads to the right side and eventually affects the whole body.
• The muscles are tense and in a state of increased tension. This is accompanied by a flexing and bending of the joints of the legs and arms.
• The gait may change, the sufferer may shuffle or shuffle their feet. The first step is particularly difficult and can be painful. The patient may have balance problems and lose their center of gravity.
• Trembling of the hands and chin when at rest.
• Frequent blinking, with facial rigidity.
• Drooling, loss of clarity of speech.

Parkinsonism is also associated with slowed thinking and reduced attention span. However, in the early stages of Parkinson's disease, memory and intelligence are not impaired. In some people, developing the syndrome leads to decreased motivation and depression. Accompanying disorders can also occur: oily skin, hair, reduced sense of smell, urinary problems. These symptoms can appear in the early stages of Parkinson's disease.

How is my gait changing?

changes in gait begins with a shortening of the stride. The elderly person walks slowly, looks under the feet and controls each step. There follows a… semi-fixed gear…The older person then begins a contracted gait where the feet do not leave the ground. A stooped posture. It is becoming difficult to combine movement and communication. Speech is sluggish and the patient uses simple sentences or phrases. As the disease progresses, the elderly find it difficult to take the first step from a seated position, although leg movements in bed are not a problem.

Over time, the gait becomes unsteady, the balance is disturbed and dizziness occurs. In the final stages of the disease, the ability to walk is lost. The patient lies in bed in a position with flexion, characteristic of cerebral paraplegia contracture.

Altered gait as a result of brain disease is usually associated with impairment of memory, intellectual ability, and cognitive function. Psychiatric (apathy, personality changes, delirium) and neurological (incontinence) symptoms may also occur.

Causes of gait changes

Pathological gait changes are caused by neurological disorders characteristic of advancing age. Early detection of the pathology prevents the progression of the disease and preserves an active life for many years.

Causes of gait disorders:

• atherosclerosis of cerebral vessels;
• conditions before and after a stroke;
• Parkinson's disease (also accompanied by hand tremors);
• senile dementiamainly caused byAlzheimer's disease;
• brain tumors
• drug poisoning;
• Taking medication in inappropriate doses.

Age-related changes in gait Age-related gait changes must be distinguished from pathological movement disorders. A correct diagnosis enables effective therapy and prevents the development of complications.

Why is the gait stiff?

Parkinson's disease

The patient has four major movement disorders: tremor, asymmetric muscle rigidity, hypokinesia (slowing and limitation of movements, decreased speed and amplitude), and postural abnormalities. Stiffness occurs on average five years after disease onset and is more common in older patients.

The frequency and duration of episodes of gait increases with the progression of Parkinson's disease. There is no clear association with the severity of other movement disorders, but there is an association with the severity of speech, anxiety, and depressive disorders. In severe cases, the patient can no longer move without help.

Secondary Parkinsonism

A polyetiological disorder that differs from Parkinson's disease in the rapid onset of symptoms and symmetrical movement disorders. The clinical picture is very variable and does not necessarily include all the symptoms characteristic of Parkinson's disease. A combination with other cerebral manifestations may occur: ataxic gait, cerebellar syndrome, early intellectual decline. Stiffness when walking and other symptoms of secondary parkinsonism are caused by the following abnormalities:

• Traumatic brain injury: Single severe (compression or contusion of the brain) and repeated mild (multiple concussions) trauma.
• infectious diseases: Encephalitis, Herpes, Measles, Mumps, HIV.
• Toxic Effects.Methanol, hydrocyanic acid, carbon monoxide, heavy metal poisoning, manganese poisoning from synthetic drugs.
• Degenerative diseases of the CNS.Multiple sclerosis, progressive supranuclear palsy, dementia with Lewy bodies, Wilson's disease.
• cerebral hypoxia.After suffocation, clinical death, severe acute respiratory distress caused by illness or injury.

diagnosis

The neurologist is responsible for determining the cause of the gait stiffness. It is important to recognize Parkinson's disease and to distinguish it from the different variants of secondary Parkinsonism according to established criteria (asymmetry of symptoms, resting tremor, progressive course, high efficacy of levodopa treatment). To definitively distinguish the type of disease and determine the etiology of secondary parkinsonism, the following diagnostic procedures are recommended:

• Electroencephalography. This is carried out to assess the functional status of the brain after strokes, brain injuries, chronic circulatory disorders, toxic influences and other factors that can cause secondary parkinsonism.
• rheoencephalography. Indicated in vascular disorders: dyskinetic encephalopathies, atherosclerosis, hypertension, chronic cerebral circulatory insufficiency, post-CMT conditions and stroke.
• Computed tomography of the brain. Recommended for confirmation of hydrocephalus, stroke, atherosclerosis, differential diagnosis of Parkinson's disease with Alzheimer's disease.
• Magnetic resonance imaging of the brain. The most informative method for detecting foci of degeneration, differentiating volumetric processes, detecting ventricular dilatation in hydrocephalus, determining the extent and location of the lesion area in stroke.
• Consultation of specialists. Patients are referred to an ophthalmologist to confirm the fundic changes characteristic of hydrocephalus and the Kayser-Fleischer rings in Wilson's disease. In the case of psychiatric disorders, consultation with a psychiatrist is indicated.

Assessment of the gait

The doctor will try to identify as many potential factors contributing to the gait disorder as possible.

Gait observation with or without an aid such as a cane or walker (if safe to do so)

Assessment of all gait parameters (start of gait, normal length and height of right and left foot, symmetry)

The doctor performs a physical exam and asks open-ended questions about difficulties with walking, balance, or both, including a history of falls (or fear of falling). The doctor will also ask about specific skills, such as B. whether the patient is able to climb and descend stairs, sit and get up from a chair, shower or bathe, shop and prepare food if necessary, and perform other household tasks. He or she will assess the patient's muscular strength, particularly in the lower legs and thighs.

Sometimes your doctor will recommend tests, including a computed tomography (CT) scan. In a computed tomography (CT), formerly called axial computed tomography (CAT), an X-ray source and an X-ray detector rotate around the patient. In today's. Read more ) or magnetic resonance imaging (MRI) Magnetic resonance imaging (MRI) uses a strong magnetic field and very high frequency radio waves to produce high-resolution images. MRI does not. Read more ) to determine whether a gait disturbance is due to a disorder of the brain, spinal cord, or another part of the body.

Prevention of gait disorders

A high level of physical activity helps seniors maintain their mobility even if they have a medical condition. Regular walking or an active lifestyle are key to maintaining a normal gait. The adverse effects of sedentary lifestyle should not be underestimated. Regular walking for 30 minutes a day is the best physical activity to maintain mobility; however, walking does not increase strength in frail patients. Walking with crampons on elevated terrain can help maintain leg strength. The use of white canes or adjustable walking sticks can give older people a sense of security and security.

Gait impairment does not always need to be treated or adjusted. Abnormally slow gait can help older people walk safely unaided. However, a doctor may suggest treatment for the walking disability to improve the quality of life. Treatment includes exercise, balance training, and the use of assistive devices.

Treatment

The conservative treatment of unsteady gait includes various measures. Based on the basic diagnosis, patients are prescribed antibiotics, NSAIDs, muscle relaxants, anticonvulsants, agents for normalizing microcirculation and improving nerve impulse conduction.

An integral part of the comprehensive conservative treatment of gait and coordination disorders is physiotherapy, which includes classical methods, mechanotherapy and exercises on special devices. The movement therapy is supplemented by massages, reflex zone massage and various manual therapy methods as well as physical therapy methods such as mud treatments, heat treatments and electrostimulation.

Surgical treatment is carried out only in the case of serious indications. In the case of extensive pathological processes, tumors are excised, abscesses are opened and hematomas are treated.

In the case of circulatory disorders, aneurysms are closed or embolized, arteries are reconstructed and artificial anastomoses are created.

Decompression trepanation and spinal stabilization surgery are indicated for trauma.

In some cases, patients require orthopedic surgery to correct secondary musculoskeletal disorders.

The prognosis varies

Since the disease is rare and little research has been done on it, the prognosis for Fahr's disease is very uncertain.

Limescale deposits grow very slowly, over decades. In addition, the disease is almost never diagnosed in the early stages, and the size of the lesion sites can be at odds with the external symptoms.

The problem is the lack of sufficient information and the inability to establish specific treatment. The more information material is collected and the more methods for early detection are developed, the easier it is to avoid the irreversible consequences of the disease.

Diagnosis of Parkinson's disease

Parkinsonism is one of the diseases that can be diagnosed remotely, especially during the course of the disease. However, it is difficult to diagnose Parkinson's disease at an early stage. Early and accurate diagnosis of the disease is very important to develop the best treatment strategies and maintain a high quality of life for as long as possible. In practice, it is possible to underestimate or overestimate Parkinson's disease. A neurologist who specializes in movement disorders is able to make the most accurate diagnosis possible. The initial assessment is based on a medical history, a neurological examination, and specific tests to assess the symptoms of the disease. The neurological examination includes an assessment of coordination, gait, and fine motor skills, as well as an assessment of neuropsychological status.

Obtaining a second opinion depends largely on the patient's personal decision. However, it is important to remember that Parkinson's disease is often difficult to diagnose accurately, especially when symptoms are mild. There is no simple diagnostic test, and about 25 % of Parkinson's diagnoses are wrong. Parkinson's disease begins with few visible symptoms, leaving many physicians untrained in the field of movement disorders unable to make an accurate diagnosis. Even the best neurologists can make mistakes. If your doctor doesn't have much experience in this area, you should see a movement disorders specialist. A good neurologist will understand your desire to confirm the diagnosis. A second opinion can help you to make the right decisions about diagnosis and therapy in good time.

Treatment of Parkinson's disease

Although there is no cure for Parkinson's disease, there are a number of methods that can enable you to live a full and productive life for many years. Many symptoms can be relieved with medications, but these become less effective over time and can cause unwanted side effects (such as involuntary movements known as dyskinesia).

There are several treatments that delay the onset of motor symptoms and improve motor function. All of these treatments aim to increase the amount of dopamine in the brain, either by replacing dopamine or by prolonging the effects of dopamine by inhibiting its breakdown. Studies have shown that early therapy can delay the development of motor symptoms and thus improve quality of life. [5]

Many factors influence the type and effectiveness of treatment:

1. The severity of the functional deficit;
2. the age of the patient;
3. Cognitive and other non-motor impairments;
4. the individual sensitivity to drugs;
5. pharmacoeconomic considerations.

The goal of therapy for Parkinson's disease is to restore impaired motor function and maintain optimal motor function for as long as possible, while minimizing the risk of adverse drug reactions. [1]

There are also surgical procedures such as deep brain stimulation, which involves implanting electrodes into the brain. Because of the risks associated with this type of treatment, most patients avoid this treatment modality until the medications they are taking no longer provide significant relief. This treatment is typically used in patients with an illness of four years or more who are working on the medication but who have motor complications such as significant 'blackouts' (periods when the medication is not working well and symptoms return) and/ or have dyskinesia (uncontrolled, involuntary movements). Deep brain stimulation works best for symptoms such as stiffness, slowness, and tremor, but not for stability, stiffness with walking, and non-motor symptoms. This treatment can even worsen memory problems, which is why it is not recommended for people with cognitive impairments. [6]

Dizziness in acute peripheral vestibulopathy

Vestibular neuronitis is a condition characterized by sudden dizziness. Symptoms also include nausea and vomiting with no apparent hearing loss. Unfortunately, the exact cause of the condition is not known at this time, although it is believed to be caused by a viral infection that selectively attacks the vestibular nerves.

Dizziness can vary in intensity and duration, although most are brief attacks that are manageable to some extent. Symptoms can increase with changes in posture, but if you remain still and try to focus your gaze on an object, the condition can improve significantly.

Vestibular neuritis is treated with symptomatic medications to relieve dizziness. Balance exercises are recommended during patient recovery. All drugs are selected strictly individually, taking into account the patient's age and the presence of comorbid chronic diseases in the patient's anamnesis.

Slight positional dizziness and effective medication

If the symptoms, especially dizziness and involuntary rhythmic eye movements, occur in a certain head position, it is referred to as positional vertigo. Sometimes the problem occurs after head trauma, viral infection, or ear surgery, but more often than not, the origin and cause of the condition is unknown. Dizziness usually resolves spontaneously within 1-4 weeks after the first attack. The complaints are not accompanied by severe pain in any part of the body or head, nor is there congestion in the ears, for example.

Bed rest and the use of vestibulolytics are recommended for acute attacks of dizziness, and therapy for other attacks. A course with balance exercises leads to good therapeutic results. The Brandt-Daroff method is one of the most appropriate home care exercises. The exercises allow the sufferer to reduce discomfort, reduce the likelihood of falls, and adapt to changes in posture.

Before performing gymnastic exercises, a recommendation should be obtained from a doctor. It is important that the specialist chooses an individual therapy program that takes into account the general health of the patient.

At first glance, all exercises related to vestibular gymnastics are simple and straightforward. However, it is important to know that they can be dangerous for the elderly because of the risk of losing consciousness. Therefore, do not do the exercises alone. If you feel discomfort or pain during the exercises, you should stop doing the exercises.

Shuffling walk

A shuffling gait can be caused by many different factors - heavy, improper footwear, habits or illness. As for the medical issue, the most common cause of shuffling gait is limited mobility of the foot, where it is difficult to lift the toes. To compensate for the lack of mobility, patients raise their knees slightly higher than is required for a normal, healthy gait. Such a gait may be related to changes in the foot nerve.

The appearance of a shuffling gait in the elderly requires special attention. Dementia is associated with impaired brain function, affecting clarity of thought and the ability to care for oneself, as well as motor activity. Notably, changes in gait occur long before the onset of memory loss. If you intervene early enough, you can influence and significantly delay the onset of dementia.

Walk like a duck

Only ducks, penguins and pregnant females move from side to side in a cute and fascinating way. Shifting the center of gravity, the precious 'weight' beneath the heart, is one of the reasons for this gait. Otherwise, the development of this duct can indicate a pinched nerve in the lumbar spine. The pinched nerve cannot fulfill its task of transmitting signals. When the muscles involved in gait receive an 'incomplete' signal, the gait changes and the body begins to roll from side to side.

When a disease develops, even in its early stages, the body sends signals. However, these often go unnoticed and are ignored because they seem insignificant. It is important to learn to read the changes, listen to the signals and take the necessary steps to eliminate them in time.

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