Sustained improvement in a patient with young onset Parkinson’sdisease after the arrival of a pet dog Received: 14 January 2010 / Revised: 11 February 2010 / Accepted: 17 February 2010 / Published online: 16 March 2010Ó Springer-Verlag 2010 III: 8/108). However, despite domperidone, she experi-enced continuous nausea, anorexia and fatigue, which Much research has been carried out into pharmacological aggravated her existing depression. Deep brain stimulation treatments for Parkinson’s disease (PD); by comparison the role of lifestyle interventions in PD has remained relatively In 2003, 6 months after commencing apomorphine, a unexplored. We describe a young onset PD patient in friend gave her a puppy (a highland terrier). The respon- whom major symptomatic benefits and reduction in treat- sibility of having to walk, feed and look after the dog ment were observed after receiving a pet dog.
motivated her to exercise regularly. Although she remained In March 2000 a 28 year old lady was diagnosed with depressed the companionship provided a much needed PD, having presented with constipation, depression, fatigue distraction. Remarkably sustained functional benefits also and reduced dexterity. She developed marked tremor, occurred with improvement in her walking and non-motor bradykinesia and rigidity. A DaTSCAN demonstrated symptoms including appetite, sleep and bowel function, as reduced putaminal tracer uptake. Subsequently, her mother well as socialization. She discontinued apomorphine and developed iPD but no genetic cause was identified.
by mid-2004 her anti-PD medication had reduced slightly The illness had a significant impact on her life and she (by co-careldopa 25/100 mg and entacapone 200 mg/day).
retired as a bank clerk on medical grounds. She suffered from The positive effects of the dog have persisted (for 6 years) an apathetic form of depression in spite of anti-parkinsonian with no subsequent adjustment to her anti-parkinsonian and anti-depressant treatment (mirtazepine 45 mg/day from treatment (current ‘on-state’ UPDRS part III: 19/108), March 2002, having been on 3 antidepressants previously).
although she remained on mirtazepine 30 mg/day (to July She was intolerant of dopamine agonist drugs (which caused 2008) and then venlafaxine 150 mg o.d. for depression.
nausea, drowsiness and fatigue). Her condition deteriorated Exercise has been shown to improve physical function, (‘off-state’ UPDRS part III score was 55/108) so that 3 years health related quality of life, leg strength, balance and gait after diagnosis she was on Sinemet CRÒ (co-careldopa 50/ speed in PD, and is possibly mediated through increased 200 mg) b.d., co-careldopa 25/100 mg 5 times/day, entaca- pone 200 mg 5 times/day and mirtazepine 45 mg/day.
remaining dopaminergic nigrostriatal cells Our As a result of intrusive dyskinesia, painful dystonia and patient’s symptomatic improvement may have resulted refractory tremor, not adequately controlled with oral from the dog increasing her daily exercise. Service medication, she was started on a subcutaneous apomor- (trained) dogs are reported to help people with PD by phine pump (5 mg/h for 14 h/day) which led to a marked interruption of rest tremor on stroking the dog and dimin- improvement in her physical signs (‘on-state’ UPDRS part ishing propulsive gait perhaps by providing visual cues In our case the dog provided general health and psy- chosocial benefits for the patient. Although there are no Department of Clinical Neuroscience, Imperial College London, other papers concerning the role of trained animals for PD, Charing Cross Hospital Campus, London W6 8RF, UKe-mail: [email protected] national surveys have shown that pet owners are healthier and also visit their doctor 15% less frequently than those 2. Goodwin VA, Richards SH, Taylor RS et al (2008) The who cease to have or never had a pet Furthermore, effectiveness of exercise interventions for people with Parkinson’sdisease: a systematic review and meta-analysis. Mov Disord service animals were reported to decrease pulse rate, loneliness and as required medication consumption and 3. Duncan SL (2000) APIC State-of-the-art report: the implications improve quality of life for residents of nursing care and of service animals in health care settings. Am J Infect Control rehabilitation facilities [–There is no evidence for a 4. Lewis GN, Byblow WD, Walt SE (2000) Stride length regulation breed effect amongst service dogs [].
in Parkinson’s disease: the use of extrinsic visual cues. Brain Psychosocial interventions in medicine are often met with skepticism, as doctors and patients alike feel familiar 5. Headey B, Grabka MM (2007) Pets and human health in Germany with the traditional pharmacological approach. In this and Australia: national longitudinal results. Soc Indic Res80(2):297–311 regard a dog has particular advantages over many other 6. Lust E, Ryan-Haddad A, Coover K, Snell J (2007) Measuring interventions in providing both companionship, motivation clinical outcomes of animal-assisted therapy: impact on resident to exercise and a (four-legged) therapist.
medication usage. Consult Pharm 22(7):580–585 7. Banks MR, Banks WA (2005) The effect of group and individual Written informed consent for publication has animal-assisted therapy on loneliness in residents of long term care 8. Bernstein PL, Friedmann E, Malaspina A (2000) Animal-assisted therapy enhances resident social interaction and initiation in long- term care facilities. Anthrozoo¨s 13(4):213–224 1. Sutoo D, Akiyama K (2003) Regulation of brain function by Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.


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