Multi-Tasking, Dopamine, Tiredness and Marie Claire

I don’t usually pay much heed to what fashion magazines say, but flicking through the pages of November’s edition of Marie Claire (bought partly because the free tube of hand cream on the front reminded me of a tube of paint), I came across a snippet that neatly drew together a few things I’ve heard and read elsewhere.

5.TOO MUCH MULTITASKING
[…]
Simultaneously reading your email, chatting on the phone and doing bottom firming exercises at your desk isn’t necessarily productive. ‘Multitasking overstimulates the dopamine system,’ says Professor Paul Gilbert, consultant psychologist and author of The Compassionate Mind […]. ‘Dopamine is a chemical linked to rewards, drive and vitality and is easily depleted. When stores are low, this can lead to listlessness and depression,’ he explains. Professor Gilbert suggests balancing dopamine release by stimulating your endorphin system – the positive emotional pathway in the brain responsible for well-being. Try gentle activities such as gardening, hiking or meditation.

from “12 Reasons You’re Tired All The Time,” by Anna Magee, Marie Claire, November 2011

Potatoes. Harvested.

Don’t Stand So Close to Me

Relativity, by M. C. Escher. Lithograph, 1953.

I’ve been noticing, recently, that my spatial perception on the left (the side currently affected by Parkinson’s) is different to that on the right. I seem to need more space on the left, and I feel uncertain about where things are on that side – or, rather, where I am in relation to them. I often bump into obstructions such as door jambs or newel posts when passing them on my left (I’ve always been a bit clumsy, but I haven’t noticed the disparity between left and right before).

I feel uncomfortable when somebody is standing close to my left hand side, and I frequently ask people to move away before I feel able to perform an action that involves my left hand side. My children are very obliging in this, but my husband wanted to know why – and I couldn’t really explain. After I caught a mention of faulty spatial awareness in Parkinson’s (I’m not sure where; it may have been an incidental mention on a forum), I realised that there was something going on here, and that it might be worth investigating.

One of the first articles I found was entitled “Freezing in Parkinson’s May Be Linked to Perception of Space“. It reports on a 2009 Canadian study of how people behaved on approaching doorways of varying widths (narrow, normal and wide). Three groups of people were included in the study: people with Parkinson’s who experienced freezing episodes, People with Parkinson’s who did not experience freezing episodes, and a control group of people without Parkinson’s.

Unsurprisingly, the narrow doorway caused the most problems.

“While approaching the door, these patients [Parkinson’s patients experiencing freezing] took shorter steps, had more gait variability, and tended to widen their base of support.
[…]
Parkinson’s patients with no freezing episodes were also affected by the narrow doorway and tended to widen their base of support.”

 – Allison Gandey, Freezing in Parkinson’s May Be Linked to Perception of Space

The lead researcher, Quincy Almeida, PhD, (Wilfrid Laurier University in Waterloo, Ontario, Canada) suggested that there might be “a sensory-perceptual mechanism that contributes to — and potentially even causes — the observable freezing episodes identified clinically”.

“Probably the most surprising finding is that even Parkinson’s patients who do not have issues with freezing can be profoundly influenced by the perception of an upcoming narrow doorway,” Dr. Almeida said.

“In other, normal-sized doorways, the typical Parkinson’s patient behaves much more like a healthy older adult with no hint of a change in walking pattern prior to the doorway. Yet in the narrow doorway, there is a shift in behavior and the nonfreezer behaves more like a freezer.”

 – Allison Gandey, Freezing in Parkinson’s May Be Linked to Perception of Space

I find this very interesting. It recalls one or two occasions when I have got temporarily “stuck” in a confined space that I should have been perfectly capable of clambering out of; I started to understand what was meant when people talk about their feet feeling as if they are stuck to the floor.

Another study, this time made by researchers in Reading, England, looked into the perception of space in Parkinson’s patients. Two control groups were included: people with rheumatoid arthritis (who also experience motor difficulties, albeit with a physical cause), and an age-matched group with no motor disorder. The study was performed via a questionnaire, and the findings indicate that those with Parkinson’s:

… do notice significant changes in their perception of the world around them, reporting problems with judging distance and motion in the street and problems reaching for objects and moving through narrow spaces within the home.

[…]

The results of the study suggest visuospatial deficits in PD which may involve the parietal lobe and have implications for understanding the way in which PD patients interact with their environment.

Abstract, Problems with perception of space in Parkinson’s disease: a questionnaire study by Alison Lee and John Harris, published in Neuro-Ophthalmology Jan 1999, Vol. 22, No. 1, Pages 1-15: 1-15.

So it seems that I’m not imagining the phenomenon, at the very least.

Related posts:

• Australian Researchers’ Insight into Parkinsonian Freezing

And just in case there are any disappointed Police fans out there, here is a link to the titular song.

A Visit to the Skeleto-Muscular Podiatrist

Podiatrists are foot specialists – I once attended a college whose dual specialism was theology and podiatry (an odd combination). I did neither; I was doing IT (Information Technology, or, if you prefer, computing).

The podiatrist I saw last Thursday told me that I have an abductory twist in my gait. This means that my foot twists away from the midline of my body as my heel comes off the ground. Apparently both of my feet do this, and it is not uncommon. It is also not a very significant abnormality, or at least not at the level that I have it. When I asked if this was related to my Parkinsonian symptoms, she said she didn’t know.

Having thought this over, I’ve come to the conclusion that it probably isn’t due to Parkinson’s. I think that the ‘abductory twist’ was an underlying problem – one that has been present for a long time – and that its effects may have been exacerbated by Parkinson’s. Or possibly there isn’t a relationship at all; it may be that the pain I’ve been feeling along the outside of my foot is a muscular ache caused by the Parkinsonian curling of my toes, and absolutely nothing to do with the abductory twist.

Temporary orthotic insoles

I was given a pair of temporary insoles, which I’m to wear as much as possible – indoors and out. Constantly swapping the insoles between shoes is, it must be said, a little wearisome, but it is not as time-consuming as I had feared. I’m also impressed by quite how many of my shoes have removable insoles. I don’t think I’ve ever tried to remove most of them before – although I have often added extra insoles to improve the fit of various (unlaced) shoes and boots.

In 6 weeks (5 now, although I don’t have a confirmed appointment at present), I’m to return and possibly get a more permanent pair of insoles. The temporary pair are constructed from a standard insole with a wedge stuck to  the base. I think that the ‘permanent’ ones are custom-made. I’m wondering if I can somehow manage to wangle multiple pairs – two would be good, just to avoid an extra step during the morning rush to school.

Incidentally, the podiatrist seemed to approve of my primary choice of footwear – when I went to see her, I was wearing a pair of lightweight walking boots (despite having driven the 8+ miles). While I do like the idea of all-terrain footwear (and I do wear them ‘off road’ quite a lot), the main reason that I choose this type of style for casual wear is because I have long, narrow feet and it’s difficult to find reasonably priced shoes to fit my feet (I’m a UK 9 / EU 43, larger than average for a woman. Most ladies shoes are available in sizes up to 8, but it is getting easier to buy 9s). The long lacing pattern allows me to buy mens’ shoes and pull them tight, giving a good fit. I like the boots because they seem less exclusively masculine, as well as giving extra support on steep climbs.  I also wear trousers, usually jeans, a lot of the time (but I’m not sure how much of that preference is down to the uncomfortable/difficult-to-find shoes thing – the sort of shoes that are generally considered to ‘go’ with skirts tend to rely on a close fit to the foot), so the boots work well.

See ‘Return to the Skeleto-Muscular Podiatrist’ for the follow-up appointment.

Keep on keeping on

Last week was a busy one. On Monday, I went to see my consultant; on Thursday, I visited the skeleto-muscular podiatrist.

My consultant seemed happy with the way things were going and the way in which I have reacted to Rasagiline. I have another appointment in six months time; previously, he was seeing me every four months. I don’t think it’s due to an NHS cutback…

Thursday’s appointment was a result of my physiotherapist’s having noticed a twist in my gait and stance. She told me to ask my GP for a referral to Orthotics; my GP insisted that I see the podiatrist associated with the local practice first. She wasn’t entirely sure whether I needed orthotic assistance, but she referred me anyway. I delayed the appointment so that I could see if the newly prescribed Rasagiline would have any effect on the problem. It didn’t seem to.

I’ll write about the podiatry appointment in a separate post.