Leczenie żywieniowe w neurologii — stanowisko interdyscyplinarnej grupy ekspertów. Część II. Rola żywienia w chorobie Parkinsona
Streszczenie
Choroba Parkinsona (PD, Parkinson’s disease) to schorzenie neurozwyrodnieniowe z osiowymi objawami, takimi jak bradykinezja, sztywność, drżenie i zaburzenia odruchów postawnych. Prawidłowe odżywianie oraz dostosowanie diety do przyjmowanych leków ma istotne znaczenie na każdym etapie choroby. U niektórych pacjentów w zaawansowanym stadium PD obserwuje się chudnięcie (niekorzystny wskaźnik przebiegu choroby). Terapie w zaawansowanym okresie także wpływają na zmianę masy ciała — dochodzi do jej zwiększenia po zabiegach głębokiej stymulacji mózgu czy chudnięcia po założeniu systemu Duodopa. Metabolizm lewodopy sprzyja powstawaniu homocysteiny, co prawdopodobnie może mieć związek z powstawaniem obwodowych neuropatii, nasileniem osteoporozy (ryzyko złamań) oraz pogorszeniem funkcji poznawczych i wymaga suplementowania kwasu foliowego oraz witaminy B12 w celu ich uniknięcia. Dieta zaburza również wchłanianie lewodopy i wymaga odpowiedniego dostosowania, aby utrzymać skuteczność terapii. Od wczesnych stadiów choroby dokuczliwe są zaparcia (modyfikacja diety) oraz dysfagia z ryzykiem poważnych powikłań (zachłyśnięcie) lub po prostu nieprzewidywalnym działaniem leków doustnych. Hipotonia ortostatyczna wymaga odpowiedniej podaży płynów i unikania obfitych posiłków. Wszystkie te problemy mogą znacznie pogarszać jakość życia chorego i wymagają skutecznych interwencji w celu zapobiegania powikłaniom. Rekomendacje grupy ekspertów w zakresie odżywiania mają pomóc w codziennej opiece nad chorymi z PD.
Słowa kluczowe: choroba Parkinsonaniedożywieniedystrybucja białkadysfagia
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