The symptoms of Parkinson's disease are so unpredictable, they can vary from day to day, or even hour to hour, making the condition very difficult to live with, a nurse specialist working in this area has said.

Parkinson's is a progressive neurological disease, the symptoms of which include tremors, stiffness and slow movement. An estimated six to seven thousand people in Ireland are affected and there is no cure.

According to Margaret Richardson, a clinical nurse specialist in Parkinson's disease at the Mid Western Regional Hospital in Limerick, the condition is caused by the degeneration of dopamine-producing nerve cells in the area of the brain most associated with movement.

Dopamine is a chemical messenger or ‘neurotransmitter', which is used by the brain to control movement.

She noted that by the time Parkinson's symptoms become evident, ‘up to 80% of dopamine may already have been lost from nerve cells in this part of the brain'.

The exact cause of the disease is unclear although experts believe it is probably caused by a combination of genetic and environmental factors.

While early diagnosis is essential, it ‘can be difficult', Ms Richarson pointed out.

"There are no consistently reliable laboratory tests or easily available imaging tests that can distinguish Parkinson's disease from other conditions that have similar clinical presentations," she noted.

She explained that where the disease is suspected, a patient should be referred to a neurologist or geriatrician with a special interest in Parkinson's. According to best practice, this referral should occur within six weeks.

The diagnosis will largely be based on the history and examination of the patient. Those affected usually present with four specific motor symptoms:
-Rest tremor
-Bradykinesia (slowness of movement)
-Muscle rigidity (stiffness)
Postural instability.

Medication is usually the first line of treatment and neurosurgery may be recommended in certain cases. Other treatments may also help with symptoms, such as speech and language therapy and physiotherapy.

According to Ms Richardson, Parkinson's disease is ‘an individual and fluctuating condition'.

"A person's symptoms can vary and change at any time, resulting in good and bad days. Symptoms can vary from day to day or even from hour to hour," she said.

This unpredictability makes it very hard to live with, both for the affected person and for their carer, she said.

"People with Parkinson's disease need extra time and understanding so that they can maintain their independence and maximize their quality of life," Ms Richardson added.

She made her comments in the World of Irish Nursing & Midwifery, the Journal of the Irish Nurses and Midwives Organisation.