A Personal Perspective On Preventing The Progression Of Parkinson's Disease

I have had a very personal investment in understanding Parkinson's disease. When I was eight years old, my father struck an overhead steel cable with his head while he was driving a farm tractor. He spent several days in the hospital with a concussion, and when he returned home, he just wasn't the same person.

My super-dad became a scary dad. With a lot of patience and considerable professional intervention (the sort of thing that one just didn't talk about in the 1960's, going to see the psychiatrist), the family was able to adjust to his personality changes. What my father wasn't able to accommodate was early-onset Parkinson's disease that seems to have been triggered by the blow.

At first my dad had unusual mood swings and a slight, barely noticeable tremor in his left hand. It took over 30 years for the occasional tremor to become constant motion, and another 5 years for constant motion on the left side of his body to become constant motion of both sides of his body. The mood swings and personality changes got worse and worse until eventually he didn't remember anybody in the world, sometimes, except my nephew and me, but even on the last day of his life, 42 years after the initial injury, my father had moments of wit, and warmth, and humor.

In those 42 years, my father managed to run a farm, keep up with his buddies from his wartime days in the Pacific Theater in the Marine Corps and his college days playing football at Princeton and playing baseball at Southwestern. He had sufficient wits about him to get elected to a county-wide political office five times even though he was a member of one political party and, by his last term, over 90% of his constituents were members of the other, and make thousands of public appearances required by his job.

After my father's retirement at the age of 68, he managed to attend to the needs of my mother as she was dying of cancer and to maintain an active social life that included literally hundreds of people. Even at the age of 80 he was capable of performing daddy and grandpa duties.

My father's life was by any measure difficult, but he had one thing going for him that most people who have Parkinson's do not. He kept active even when activity was awkward, frustrating, and unsuccessful. He kept on trying even when he did not succeed. It turns out there is a neurological explanation of why a character trait of persistence helps Parkinson's patients hold on to their basic abilities.

Practice Makes Possible In Parkinson's Disease

You're probably familiar with the saying "Practice makes perfect." If you have Parkinson's disease, at least with regard to physical skills, all the practice in the world may not perfect your skills. But continuous practice of basic motor skills may make it possible to retain them. There is a neurological reason for this.

The brain changes in Parkinson's disease are most noticeable in an area known as the hippocampus. The hippocampus is at the base of the brain, in a group of structures known as the limbic system. Its job is to  assist in spatial navigation, either moving or staying still, and to convert short-term memories into long term memories. The hippocampus is so important that it operates on both sides of the brain, both left and right.

Left-Brain Parkison's Disease

Sometimes the brain changes that cause Parkinson's disease are more severe in the hippocampus on the left side of the brain. When this happens, the behavioral changes accompanying the disease tend to involve avoidance behaviors. Parkinson's makes the person withdrawn, less able to make decisions (losing "executive function" to make good decisions), and less social--not lacking "social skills," but avoiding any situations that require making social decisions.

Right-Brain Parkinson's Disease

Sometimes the brain changes that cause Parkinson's disease are more severe in the hippocampus on the right side of the brain. When this happens, the behaviroal changes accompanying the disease tend to involve the inability to recall "episodic memories." People who have Parkinson's disease on the right side of the brain have increasing difficult to recall a series of events and then do the things that they should do to take part of that series of events. They retain the ability to make "semantic memories," to understand the implications of events and how they feel about people and things.

Brain Training in Parkinson's Disease

Of course, most people who have Parkinson's disease suffer some degree of damage on both sides of the brain, but usually one side or the other is more damaged. The implication of this fact is that different kinds of activity help different Parkinson's sufferers in different ways.

• Sometimes someone who has Parkinson's disease who is beginning to "lose it," having trouble with decision-making, is helped by "sticking to" tasks that require fine motor skills. My dad, for instance, continued to do his own repair work on a 1980 Chevy until 2005. He might have to pick up a screw 10 times, it might take an hour to thread a bolt, but he would eventually make the "hunk of junk" run. This indirectly helped him retain his abilities to interact with people, making judgments about interactions, and make choices about his personal affairs. It's the persistence in doing the task that helps train this side of the brain.
• Sometimes someone who has Parkinson's disease who is beginning to have memory loss is helped by doing tasks that require hand-eye coordination, which is regulated on the same side of the brain. Doing things like knitting or tennis or ping pong as long as you can, and at some point just getting yourself in and out of your chair by yourself also helps you retain your ability to make episodic memories.

I can't prove to you by citing the scientific literature that any kind of persistent activity absolutely, positively always preserves abilities in the face of Parkinson's disease. I can just tell what I observed for 42 years in my own father and in several dozen other people who have had or now have Parkinson's. Staying engaged with life preserves basic brain function in Parkinson's disease. Intentional activity, even when frustrating, makes further activity possible. 

My father's legacy was that he cared enough about his family and his community to stay in engaged in life for over four decades. We all make decisions about how long we want to "hang in there," but it is often possible to remain active far longer than the experts predict.