Carolina Silva

According to the World Health Organization, Parkinson’s is the second most common neurodegenerative diseaseafter Alzheimer’s, affecting around 10 million people worldwide. In Portugal, it is estimated that this disease affects around 20,000 people and is more common among men. Key points of the article In this article, we explain the symptoms and how to diagnose them in a simple way Recommended therapies and daily care The disease in young people Adaptations at home Support services in Portugal What is Parkinson’s disease? This disease results from a reduction in the levels of dopamine, when there is this reduction the brain cells that produce it die. Dopamine is responsible for muscle activity in the brain and when it is reduced, body movements are affected. When symptoms appear, it usually means that between 60 and 80% of the dopamine-producing cells have already been lost. Who is most affected? It is more common after the age of 60 and slightly more common in men, but can appear at younger ages. Youth Pakinson When the diagnosis occurs before the age of 50, it is called juvenile Parkinsonism. It can have a slower progression, but a higher risk early on due to variations in the effectiveness of medication, involuntary body movements and specific challenges (work, family, long-term planning). Motor symptoms Bradykinesia: slower voluntary movements Resting tremor: involuntary movements, when at rest it can involve various parts of the body such as: hands, arms, legs or chin (not all patients have this symptom) Muscle stiffness: “stuck” limbs and trunk, lack of flexibility in both limbs and joints Changes in balance and gait (postural instability, short steps, “freezing“). Non-motor symptoms Decreased sense of smell Sleep disorders (including “acting out dreams”/RBD) Neuropsychiatric symptoms: depression, anxiety, apathy, hallucinations Autonomic dysfunctions: drop in blood pressure when getting up, urinary/sexual problems. These symptoms can have a greater impact on quality of life than motor symptoms and sometimes precede them by years. Disease progression The speed of progression varies greatly from person to person, as do the symptoms. Doctors often use the Hoehn and Yahr scale to measure the progression of the disease over time. State 1: Initial The symptoms are milder and don’t interfere with daily activities, the tremor is on only one side of the body. Those around the patient can recognize changes such as posture, loss of balance and facial expressions. Status 2: Bilateral Symptoms tend to worsen, affecting both sides of the body. There is a difficulty in walking, a worsening of posture, the patient remains independent but may find it more difficult to carry out daily tasks. State 3: Instability Moderate Postural This is the middle stage of the disease, causing loss of balance and slower movements. Falls become more common, the patient remains independent but the symptoms begin to affect everyday activities such as eating and dressing. There may be a “freezing” of the gait, difficulty walking in a straight line or even standing up. State 4: Instability Severe Postural Symptoms are severe and limit quality of life; standing may require support. The patient is unable to live alone and needs support to carry out daily activities. State 5: Locomotion Dependent This is the most debilitating condition, as the stiffness in the legs can make it impossible to walk. They may need a wheelchair or even be bedridden. The patient may suffer hallucinations and delusions. 24-hour monitoring required. Diagnosis and medical follow-up At an early stage, diagnosis can be more difficult, as the symptoms are more subtle. In older adults, it tends to be more complicated because the symptoms resemble symptoms of ageing, such as: slower movements, loss of balance, stooped posture and muscle stiffness Treatment and recommended therapies Depending on the patient’s clinical profile and the stage they are at, treatments and therapies can include: Specific medication Deep Brain Stimulation (DBS): surgical option in selected cases with motor fluctuations/resistant tremor, after specialized evaluation Structured physical exercise: about 150 min/week of moderate to vigorous activity (aerobic, strength, balance/agility, stretching) is recommended, preferably guided by physiotherapy. Exercise improves motor and non-motor symptoms Physiotherapy/occupational therapy: gait training, balance,freezingstrategies, energy in everyday life; follow European guidelines Speech therapy: LSVT LOUD (voice) and LSVT BIG (range of motion) programs have evidence of benefit Management of non-motor symptoms: sleep, mood, constipation, pain – combining drug adjustment, lifestyle measures and specific therapies. Daily care and quality of life Timely medication (use alarms/organizers) Predictable routine, with breaks and tasks in simple steps Sleep: sleep hygiene and safety if there are behaviors during sleep Nutrition: hydration, fiber for constipation; some patients benefit from avoiding proteins in the levodopa dose (medication that can be taken if recommended) Daily exercise (even short ones) and socialization Warning signs: falls, sudden confusion, marked hallucinations, choking/aspiration pneumonia – seek medical attention. How to adapt your home for Parkinson’s patients Remove loose carpets and cables, clear corridors, good lighting (night lights) Bathroom: grab rails, shower chair, non-slip mat Bedroom: bed at a safe height, easy access to light, clear path to the toilet Anti-falling/freezing strategies: marks on the floor and positioning furniture for wide strides Assessment by an occupational therapist/physiotherapist for personalized adaptations. Support services available There are various forms of support available, from associations to means of transportation and support networks.The important thing is that both the caregiver and the patient do not feel alone during this process. APDPk – Portuguese Association of Parkinson’s Disease: information, support groups, training for caregivers and rehabilitation services (neurophysiotherapy/speech therapy) Young Parkies: An association whose aim is to support people with juvenile Parkinson’s. Made up of doctors, researchers, carers, therapists and patients. Statute of the Informal Caregiver: rights, support measures and recognition (Segurança Social/Gov.pt) National Network of Integrated Continued Care (RNCCI): teams and units with physiotherapy/occupational therapy and long-term care (access by clinical referral) Non-urgent patient transportation (SNS): provided with a doctor’s prescription when clinically justified; there are exemption rules. Alternatively, you can use specialized private services, such as Ambula, which guarantees non-urgent patient transport with comfort, safety and professional accompaniment. SNS 24

Eczema and psoriasis are chronic skin diseases that may seem similar, both causing redness, itching and skin lesions, but they arise from different causes, require different treatments and affect specific areas of the body. It’s important to note that none of these diseases are contagious or develop due to poor hygiene. Throughout the article, we’ll help you understand the differences between these two conditions. Key points of the article Differences between eczema and psoriasis: causes, symptoms and affected areas Types of eczema and main aggravating factors How to identify and treat psoriasis Daily care and ways to prevent outbreaks Treatments available: from hydration to immune therapies Real testimonies from people living with these diseases When you should see a dermatologist. What is eczema? To put it in context, eczema (also known as atopic dermatitis) is an inflammation that causes dryness, irritation and a lot of itching, appearing in alternating periods of flare-ups and remissions. It is one of the most common skin conditions, especially in babies and children, but can appear in adulthood. There are two types of eczema: 1. Atopic Dermatitis Cause: genetic / immunological Usual age: childhood Location: folds, face, hands Duration: chronic Symptoms: itching, redness, dryness 2. Contact dermatitis Cause: external substance (allergen or irritant) Usual age: any age Location: direct contact area Duration: transitory (if the agent is avoided) Symptoms: redness, blisters, itching Causes of eczema These causes are not entirely known, but involve various genetic and immunological factors as well as certain environments. People with eczema have a more fragile skin barrier, which makes it easier for allergens to enter and there are some factors that facilitate its appearance. Common factors: Allergies (dust mites, pollen, food) Cold and dry weather Stress Synthetic clothes or aggressive detergents Genetics. Symptoms of eczema Redness and dryness of the skin Intense and persistent itching Cracks and scabs Injuries located in the folds of the body (elbows, knees, neck). Symptoms of eczema The most important step is to deeply moisturize your skin to reduce inflammation. However, in more serious cases, medication may be necessary. Examples of treatment: Emollients and moisturizing creams Topical corticosteroids Antihistamines (to relieve itching) Avoid triggering factors Prevention of eczema In order to prevent eczema outbreaks: Follow the treatment plan recommended by your dermatologist Avoid scratching the affected areas to avoid aggravating the lesions In colder weather, protect your hands with gloves Use gentle products and dry the skin with light touches, without rubbing Moisturize your skin several times a day (especially after showering) Prefer showers with lukewarm water Drink water throughout the day to keep your skin hydrated from the inside Wear clothes made of cotton or natural, breathable fabrics Avoid sudden changes in temperature and contact with irritating substances Reduce stress with activities such as walking, meditation or yoga. Testimonials from people living with eczema “We feel sorry for ourselves, it’s inevitable. Although, at the same time, we also feel particularly strong for being able to deal with something like this and overcome it every time.” – Ana Paula Correia Read the full article – taken from “Saberviver” “I don’t know what the future holds, but I have hope.” – Tânia Fernandes (about her 2-year-old son, Lucas) Read the full article – taken from “Activa” What is psoriasis? Psoriasis is an autoimmune and inflammatory disease in which the immune system accelerates the production of skin cells. This process causes the appearance of thick, reddish plaques covered in whitish scales. In Portugal, it is estimated that there are more than 200,000 people with psoriasis according to the Portuguese Psoriasis Association. Globally, the disease affects more than 125 million people, with around 14 million in Europe, according to international estimates. Causes of psoriasis The most likely cause of psoriasis is genetic and immunological factors. It is not contagious, but can be triggered or aggravated by external factors. Common factors: Physical or emotional stress Infections (e.g. tonsillitis) Certain medications (such as beta-blockers) Skin lesions (Koebner effect). Symptoms of psoriasis Red plates with white or silver scales Thick, well-defined lesions May affect nails (changes in color and texture) Joint pain or stiffness (in cases of arthritic psoriasis). Psoriasis treatment Psoriasis treatment aims to: reduce inflammation, slow down cell renewal and relieve symptoms. Common treatments: Creams with corticosteroids or calcipotriol Phototherapy (controlled UV light) Immunomodulatory drugs (in moderate to severe cases) Moisturizing and moderate sun exposure. Psoriasis treatment To prevent outbreaks of psoriasis, you should: Control stress Moisturize your skin daily Avoid skin lesions Moderate alcohol intake and don’t smoke Be careful with certain medications Controlled exposure to the sun Eat a balanced diet. Testimony from someone living with psoriasis “We go through various phases in terms of accepting the disease and I think I’ve been in the acceptance phase for a while now.” – Rita Felgueiras, 37 Read the full testimonial – “In your skin” “I don’t know if I’m bothered, if I’m sad… but I wish I wasn’t.” – Luís Carmo, 46 Find out more about her story – “In your skin” Eczema vs Psoriasis: What are the main differences? Although they share symptoms such as itching and redness, eczema and psoriasis have some differences: Appearance of the lesions: psoriasis has thick plaques with scales, while eczema presents as inflamed, dry and itchy skin Location: eczema tends to appear in the folds of the body, while psoriasis affects exposed areas such as the knees, elbows and scalp Origin: eczema is more associated with allergies and sensitivities; psoriasis is an autoimmune disease. Analyzing and being aware of these differences makes it easier to identify the problem and start the right treatment. When should you see a dermatologist? It’s best to see a dermatologist if you notice skin lesions that won’t go away, persistent itching or discomfort. Being followed up by a professional will help you to be diagnosed correctly and receive the most appropriate treatment. Seek medical help if: Symptoms interfere with your sleep or daily activities Lesions spread or worsen rapidly The usual treatments aren’t working You

It is one of the leading causes of death in Portugal. Stroke not only profoundly changes the lives of those who have suffered it, but also those of their families. Not all strokes are the same and the physical, emotional and social effects vary from person to person, but with adequate support, adaptation and follow-up, it is possible to recover quality of life. If you’re looking for information on this topic, this article is for you. Key points of the article What changes in the life of someone who has suffered a stroke Physical and emotional needs after stroke Adapting the home and routines for greater autonomy Stroke symptoms: the 5 F’s to remember Factors that can cause a stroke How to act in the event of a new stroke Types of stroke and their treatments Psychological support and the role of the family Real testimonies of overcoming. What changes in the life of someone who has suffered a stroke? Suffering a stroke is a big change. Day-to-day life becomes more challenging, either because people facing it may suffer some limitations in speech, movement, memory or vision. There are people whose changes are temporary and others whose changes can become permanent and require them to go through a learning process for tasks such as getting dressed, preparing meals or even communicating. These changes go beyond the body: family routine, social roles and even a person’s self-confidence can be profoundly affected. Physical and emotional needs after a stroke Suffering a stroke can represent a new beginning for many people. The impact is profound, especially as it can mean the loss of some independence, which generates frustration and uncertainty. That’s why it’s essential to ensure continuous support – not just physical, but also emotional. This support is essential for the person to adapt to the new reality and gradually recover their quality of life. Changes in mobility and communication As mentioned, many stroke survivors lose strength on one side of their body (hemiparesis) or have difficulty walking, talking or even eating. Physiotherapy, speech therapy and occupational therapy are essential to recover functions and promote autonomy. This rehabilitation should begin as soon as possible. Post-stroke fatigue, anxiety and depression A frequent complaint is the constant fatigue that arises after small tasks. In addition, the risk of anxiety and depression increases due to the loss of control over their lives. It is essential to provide psychological support and create an environment that fosters self-esteem and well-being. Adapting the home and routines for greater autonomy Adapting the home and daily routines is essential to facilitate the integration of people with strokes into their new reality. These changes make the environment safer and more functional, promoting comfort, autonomy and well-being on a daily basis. Useful equipment and aids (e.g. wheelchair) Features that can make all the difference in everyday life: Wheelchairs and walkers Support bars in the bathroom and shower Bath chairs and folding beds Adapted utensils for food and clothing Applications and devices to facilitate communication. Choosing the right equipment depends on each person’s limitations and should be done with the support of health professionals. Safety, hygiene and food care Prevention is better than cure. Especially when it comes to falls and infections. With regard to safety, some suggestions include: removing carpets, clearing corridors and reinforcing lighting. Personal hygiene may require some help, but the main thing is to respect the person’s privacy. When it comes to eating, it’s important to adapt the consistency of food or opt for specific diets to prevent further events. Symptoms of a stroke The 5 F’s are a simple and practical way of recognizing the main symptoms of a stroke. In Portuguese, they correspond to: F for Face: drooping face or asymmetrical smile F for Strength: weakness on one side of the body F for Speech: confused, slurred speech F for Severe headache: intense and sudden, with no apparent cause F for Lack of vision: in one or both eyes. If you notice any of these signs, call 112 immediately. Time is crucial to minimize brain damage. Factors that can cause a stroke There are several factors that can trigger a stroke, from controllable factors to others that may not be controllable. Controllable: Hypertension (main cause) Diabetes, high cholesterol Smoking, alcohol, sedentary lifestyle, obesity Poor diet, stress, heart disease Misuse of medication or drugs. Uncontrollable: Age: risk increases significantly after the age of 55 but 25% of cases occur in young people Family history of stroke or cardiovascular disease Sex: men have a higher risk, but women tend to have worse consequences Previous stroke or transient ischemic attack (TIA). How to act in the event of a new stroke: signs and first aid Being prepared and knowing how to identify the signs of a new stroke can save lives. The main symptoms include: Sudden weakness on one side of the body Difficulty speaking or understanding Changes in vision Dizziness, loss of balance Intense and sudden headache. In the event of suspicion, call 112 immediately. Time is of the essence: the sooner the person is assisted, the greater the chances of recovery. Types of stroke and treatments Being prepared and knowing how to identify the signs of a new stroke can save lives. The main symptoms include: Sudden weakness on one side of the body Difficulty speaking or understanding Changes in vision Dizziness, loss of balance Intense and sudden headache. In the event of suspicion, call 112 immediately. Time is of the essence: the sooner the person is assisted, the greater the chances of recovery. Ischemic stroke (obstruction of an artery – around 85% of cases) Emergency treatment: Emergency treatment: Intravenous thrombolysis with drugs (e.g. alteplase) to dissolve the clot Mechanical thrombectomy for endovascular clot removal (in specialized centers) Long-term treatment: Anticoagulant or antiplatelet drugs (to prevent new clots) Intensive rehabilitation: physiotherapy, speech therapy and occupational therapy Control of risk factors (blood pressure, diabetes, cholesterol). Psychological and social support: the role of family and community The involvement of family,

Com o passar dos anos torna-se uma queixa frequente e tendo um impacto significativo na mobilidade da terceira idade, a falta de força nas pernas, pode afetar a independência e a qualidade de vida. É importante compreender as principais causas deste problema, reconhecer os sintomas e agir a tempo para que complicações, quedas e fraturas sejam evitadas.   Ao longo do artigo vamos explorar as causas por trás da fraqueza muscular nas pernas dos idosos e possíveis soluções. Pontos-chave do artigo A perda de força nas pernas é comum na terceira idade e resulta, sobretudo, da redução natural da massa muscular (sarcopenia), de doenças crónicas e do sedentarismo Os principais sintomas incluem dificuldade em levantar-se, tonturas e fraqueza persistente Se não for tratada, pode levar a quedas, fraturas e perda de autonomia Exercício físico regular, adaptação do ambiente e acompanhamento médico são essenciais para recuperar e prevenir a fraqueza muscular. Porque é mais comum perder força nas pernas na terceira idade? De acordo com estudos recentes, a partir dos 50 anos, a nossa massa muscular começa a diminuir entre 1 a 2% por ano. Esta perda progressiva está associada ao envelhecimento natural do corpo e contribui para a fraqueza muscular. Estima-se que cerca de 25% das pessoas com menos de 70 anos e até 40% das que têm mais de 80 anos apresentem sinais de sarcopenia ou perda acentuada de força muscular.   Este problema tende a intensificar-se com a idade, atingindo valores ainda mais elevados a partir dos 80 anos. Fatores como doenças crónicas, alterações neurológicas e menor atividade física contribuem para a perda de força nas pernas e aumentam o risco de quedas. Principais causas da fraqueza nas pernas em idosos As causas desta fraqueza podem surgir por diversos motivos e apesar de ser uma situação comum é essencial conhecê-las. Sedentarismo e perda muscular (sarcopenia) Uma das principais causas da fraqueza muscular é a falta de atividade física. Sem os estímulos regulares, os músculos atrofiam, tornam-se rígidos e menos eficientes. A sarcopenia (perda progressiva de massa muscular) está relacionada com a idade, surge a partir dos 30 anos e acelera após os 60. Doenças neurológicas e articulares O Parkinson, AVC, esclerose múltipla, compromete a força nas pernas. Contudo, problemas articulares, como a artrose, limitam os movimentos e causam dor e limitam o uso dos músculos. Efeitos secundários de medicamentos Medicamentos utilizados para a pressão arterial, colesterol ou ansiedade, são comuns entre os idosos e podem causar efeitos secundários que afetam os sistemas neuromusculares, que provocam fraqueza, tonturas ou dificuldade em andar. Sinais de alerta e sintomas associados Dificuldade em levantar-se Um dos sinais de alerta que por norma aparece em primeiro lugar, é a dificuldade que o idoso pode ter ao levantar-se de uma cadeira ou cama sem auxílio. Este esforço demonstra que os músculos das pernas perderam a força e a resistência. Tonturas e falta de equilíbrio A instabilidade ao andar ou levantar por norma está associada à fraqueza nas pernas e pode provocar um desequilíbrio e consequentemente aumenta o risco de quedas. Dor e rigidez muscular O aparecimento de dores, rigidez ou sensação de fraqueza constante nos membros inferiores indica um problema que necessita de atenção. Consequências da fraqueza muscular não tratada A fraqueza muscular quando não é tratada aumenta o risco de quedas e de fraturas (especialmente na zona da anca). Esta fraqueza quando não é tratada leva a uma dependência de terceiros, isolamento e até a uma deterioração cognitiva. Isto pode piorar doenças existentes e reduzir qualidade de vida. O que fazer: estratégias para fortalecer as penas De modo a que esta força nas pernas seja fortalecida apresentamos um conjunto de estratégias que podem ajudar. Exercícios simples para idosos Incentivar a prática de exercícios na terceira idade, como caminhadas diárias, subir escadas, levantar e sentar de forma controlada e calma e aplicar exercícios de alongamento ajudam a manter e recuperar a força muscular. Existem programas de fisioterapia que são adaptados às necessidades de cada idoso.   Se estiver interessado estes exercícios podem ajudar.   Veja ainda cinco exercícios sentados, para idosos. Adaptação do ambiente para evitar quedas Adaptar o ambiente é imprescindível para que o idoso se sinta mais independente. Algumas alterações que se podem fazer passam por: instalar barras de apoio no WC, retirar tapetes, melhorar a iluminação e utilizar calçado antiderrapante. Estas dicas previnem quedas e devem ser consideradas. Quando procurar ajuda médica? É necessário um apoio médico quando existe perda de força muscular, seja progressiva ou súbita e que seja acompanhada de outros sintomas como dor persistente e intensa, inchaço ou alterações neurológicas. Este diagnóstico antecipado é essencial e permite um controlo ou um tratamento de forma a melhorar a mobilidade do idoso. Como prevenir a perda de força nas pernas Prevenir a fraqueza muscular, mantém um estilo de vida ativo e saudável.   Praticar exercício físico regular Ter uma alimentação rica em proteínas e vitamina D Controlar doenças crónicas Evitar longos períodos de imobilidade Realizar exames de rotina e avaliações de mobilidade.   Esta fraqueza nas pernas apesar de ser um problema comum e até inevitável, muitas vezes é negligenciado.   Veja o nosso artigo sobre alimentação para idosos. Links importantes sobre esta temática: MDS Manual – Distúrbios da marcha Vídeo Dr. Hiroki – Fraqueza nas pernas Guia de cuidados à pessoa idosa/BVSMS Testemunhos de pacientes – Dr. Leonardo Palmeira 6 causas e soluções para a fraqueza nas pernas – Dr. Flávio Lambo Os conteúdos deste blog são informativos. Não substituem diagnóstico ou tratamento médico. Consulte sempre um profissional de saúde. Partilhar: