I live on a family-owned farm. I have a brother, named Frank, who mainly takes care of our farm. Recently some issues have erupted with my brother and his behavior has been strange. We were at the breakfast table this morning and out of the corner of my eye I saw Frank’s hand tremble as he held something. His other hand lay perfectly still on the table. This was not the first unusual thing that has happened with him the past week. I have noticed that his whole demeanor has changed such as his walking. His posture has become a bit stooped, and now walks without the swinging movement of his arms. He has told me previously that sometimes his legs become stiff when he stands as if it his leg has become so heavy that he isn’t able to move. Not only did he have trouble with movement but his handwriting has decreased in size significantly when he wrote. He has mentioned having issues with his sleep before but I never really thought much of it. But now all of these things have occurred and I found it necessary to get a doctor’s opinion on this situation. We visited the doctor today who sent us to a neurologist at the hospital. The neurologist performed a series of tests on him such as a blood test, and imaging such as MRI and CT to rule out other possible diagnoses. He then told us that it was possible that Frank has Parkinson’s disease after he heard of all the symptoms I had noticed the past few weeks, especially the fact that he had a tremor on only one side of his body. But to know for sure he sent Frank home with carbidopa-levodopa, a medication for Parkinson’s. He told us to come back a few weeks for a check-up and that’s exactly what we did. At home I noticed he seemed to be improving. When we returned to the doctor finally diagnosed him with Parkinson’s due to the fact that the medication helped.April, 1985It has been 7 years (hasn’t it been 4 years not 7??)since Frank has been diagnosed. It is noticeable that the symptoms worsen in between doses. He continues to have difficulties with his movement, I hear his feet shuffle whenever he walks by my door. He has problems with balance and coordination and has become quite clumsy as he slowly moves around the house. There have been instances in which I hear him yell out for me somewhere in the house and I’d rush over and he’d say “I can’t move my feet! My leg won’t move!” The doctor warned me of all these movement symptoms that occur as time progresses so I try to be close by in case he falls. During our talks it is sometimes hard to understand while his voice trails off so soft that it is inaudible and turns into mumbling. He has had trouble swallowing food so I have made sure his meals are cut up into smaller biteable pieces for him. Taking care of him has become my full-time job, I have laid off farming for awhile but I don’t mind. I help him button his shirt The doctor explained to me in detail what was happening to Frank’s brain. He said that Parkinson’s is a disorder that impacts complex bundles of nerve cells called the basal ganglia and the substantia nigra located deep in the brain. Normally, body movement is controlled by the ganglia. Information is passed from the striatum in the center of the brain which collaborates with the substantia nigra to pass along impulses back and forth from the brain to the spine. Usually these impulses are sent by a chain of neurons from the brain to the spinal cord and to the muscles to create movement. Nerve cells produce a neurotransmitter called dopamine in the substantia nigra which relays messages to control movement of the body. A normal neuron cell will fire an action potential which is an electric signal that goes down from the cell body to the axon to the synapses to release neurotransmitters to the target neuron. The electric signal must be strong enough to surpass the threshold or else the neuron won’t fire. In people with Parkinson’s the nerve cells that produce dopamine begin to die and the symptoms of tremors, slow movement, and stiffness occur when 80% of the dopamine is lost. There just isn’t enough dopamine for nerve cells to fire and send messages which cause tremors and stiffness. Since there is a depletion in dopamine, the levels of other neurotransmitters, such as glutamate, try to compensate for it but it never replaces the role of dopamine. December, 1995Dear Diary,It has been 17 years (14 years??) since the diagnosis of my brother. His symptoms have been increasingly worse and has reached the advanced stage. Frank is limited to using a wheelchair and being in bed. He isn’t able to walk on his own like he used to. We have created a bedroom for him with a bathroom on the first floor so there is no need to use the stairs. The doctor told us that he isn’t able to live on his own so I have invested the past few years since the diagnosis to helping him full time. I usually stack his pillows repeatedly throughout the day to help make his posture comfortable in his bed. He is unable to stand on his own without tipping and falling over. He has developed a common side-effect of Parkinson’s which is dementia. He has had trouble with short-term memory. He has trouble keeping track of valuables that he puts down, many times he will ask me to go looking for it throughout the entire house. There is now a communication barrier between himself and the outside world with his limited ability to think or reason to carry on with daily life.