As temperatures rise, risks climb for people with Parkinson’s
Neurologists warn of complications due to limited heat tolerance
People with neurodegenerative diseases like Parkinson’s disease or dementia are more vulnerable to heat-related complications than those without these conditions, according to a commentary by two neurologists.
Medical providers should be trained to understand how heat waves can affect these people, the viewpoint advised. It was co-written by Indu Subramanian, MD, a neurologist and movement disorders researcher at the University of California, Los Angeles (UCLA), and Ali Saad, a neurologist with expertise in climate change at the University of Colorado.
The scientists also noted that higher temperatures, which contribute to heat-related stress, are becoming more common.
They urged doctors to set in place practices like remote video checkups during heat waves, and to provide patients with the information and resources needed to protect them in the context of worsening and more frequent heat waves.
The commentary, “Heatwaves and Neurodegenerative Disease,” was published as a viewpoint in JAMA Neurology.
A medical need to be ‘proactive’ during heat waves
“The number of people affected by heat waves increased by around 125 million between 2000 and 2016, and global ambient temperature is expected to increase 0.9 °F (0.5 °C) per year over the next 30 years,” the scientists wrote.
“People with Parkinson’s disease and dementias are at risk for dying in heat waves and we can be proactive about preventing this,” Subramanian said in a UCLA Health news story.
Various symptoms of Parkinson’s disease are due to problems with the workings of the autonomic system, a part of the nervous system responsible for controlling involuntary bodily functions such as breathing and digestion. Considered nonmotor disease symptoms, they can include difficulties sleeping, excessive sweating and drooling, issues with regulating blood pressure, and gastrointestinal problems.
Heat has been shown to worsen a person’s autonomic function, increasing the risk of dehydration, heat stroke, and fainting. A questionnaire asking Parkinson’s patients of their responses to “feeling hot,” as opposed to responses during a defined heat wave, found “74% and 82% reported a worsening of nonmotor and motor symptoms, respectively, as well an impairment in their ability to perform household activities,” the commentary noted.
Heat stroke is an emergency condition caused by the body’s inability to regulate its core temperature as a consequence of exposure to high temperatures. It is characterized by headache, dizziness, nausea, confusion, body temperatures above 103 F (about 39.4 C), a fast heart rate, and a loss of consciousness.
Increase in hospitalizations seen among patients as temperatures rise
Some Parkinson’s treatments, such as anticholinergic medications that block the activity of acetylcholine, a brain chemical messenger, and tricyclic antidepressants, can reduce sweating and blood flow to the skin. As such, they can contribute to increasing the body’s temperature.
The commentary also made note of a previous studies reporting “statistically significant increases of more than 10%” in hospitalizations and death among Parkinson’s patients with “just” a one-degree temperature rise once temperatures reach 93 F (34 C). The scientists also noted, however, that those with Parkinson’s in these retrospective studies tended to be at older ages, and age is a factor in heat sensitivity.
Older adults have a higher incidence of neurodegenerative disease and more difficulty regulating their body temperature. They also can be isolated socially, putting them at risk of delayed detection of heat-related problems.
“I was surprised how many patients view us docs or health care providers as their only touch point with the world outside their house,” Subramanian said.
Healthcare professionals should seek to reduce heat-related risks by establishing best-practice guidelines, and regularly checking for social isolation among at-risk patients.
Community efforts to address heat-related risks for people with Parkinson’s and other neurodegenerative diseases should focus on two primary aspects. One, it is important to identify isolated individuals and connect them to resources that can help mitigate heat-related concerns. Two, using both telemedicine and in-person visits to screen for potential heat-related complications, better ensuring comprehensive care and attention.
Family members also should be informed about the importance of monitoring loved ones during heat waves and ensuring appropriate cooling and mitigation strategies, like turning on air conditioners, taking a cold shower, staying hydrated, and traveling to cooler locations. Setting up weather alerts on a patient’s smartphone can help in maintaining their independence.
“It is crucial to raise awareness and implement proactive measures to mitigate heat-related complications in people living with neurodegenerative diseases. By doing so, we can prevent unnecessary suffering and mortality in this vulnerable population,” the commentary concluded.
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