What is Parkinson’s disease and how is it treated?

Parkinson's disease (tremor palsy) is a degenerative neurological pathology.

Short information about Parkinson’s disease

The nature of the disease is associated with several factors:

1. Disruptions inside nerve cells: for example, due to injury or complications from infectious diseases of the brain.
2. Disorders of the body as a consequence of interaction with harmful chemicals.
3. Mutations in genes.
4. The accumulation in nerve cells of special presynaptic proteins - alpha-synucleins.

The proteins alpha-synucleins are produced by the nervous system itself. When accumulated in large quantities, they become toxic and poison the brain. Human nerve cells begin to die, and the production of such an extremely important hormone for humans as dopamine is significantly impaired. While the level of dopamine determines how much a person is capable of learning, whether they are able to easily memorize information and even just hold a pen or pencil. The quality of sleep, the ability to concentrate, and coordination of movements depend on the same hormone. If there is little dopamine in the body, then the processes associated with thinking and physical activity slow down significantly.

Parkinson's disease is diagnosed more often today than 50 years ago. But this is not due to the fact that the disease is progressing, but to the fact that more often people suffer from it after 50-60, and even more often 70-80 years old. Since life expectancy has increased over the past half century, then, accordingly, the number of people who are diagnosed with this disease has also increased. Currently, Parkinson's disease affects about 1% of the world's population.

But pathology cannot be called a purely disease of the elderly. People under the age of 50 can also have Parkinson's disease. In percentage terms, the number of cases is several times less, but people in their 20s and 40s can also suffer from this disease.

It also cannot be certainly said that Parkinson's disease is an occupational disease for people of certain professions. But at the same time, practice shows: there are areas in which you can often find people with Parkinson's disease. For instance, high-risk professions include fields of extraction of minerals in mines and work with pesticides, agrochemicals.

Parkinson's disease symptoms

Parkinson's disease can begin with a wide variety of symptoms. In this case, the symptomatology can be associated both with impaired motor, mental activity, and functions that, at first glance, are not associated with the nervous system, but relate to the work of the digestive tract and even the nose. What are the most common symptoms of Parkinson's disease?

- Tremor at rest (in a calm state - sitting, lying down, a person shivers, but when starts to walk - the shivering goes away). Especially often, the problem begins with tremors of the hands and tremors of the head.
- Stiffness in the legs. A person cannot walk quickly - but not because they have shortness of breath (as is the case with diseases of the cardiovascular or respiratory systems), it is difficult for them to control the work of muscles. In this case, you can often hear "Legs do not obey."
- Balance problems.
- Circulatory disorders.
- Chronic constipation.
- Violations of the so-called phase of REM sleep: at the time of falling asleep, a person behaves not only restlessly, but actively - to the point of causing self-injuries. However, after awakening, a person cannot remember this.
- Loss of smell.

But despite the general symptoms, the development of the disease in young and elderly people, men and women, has some differences. Moreover, the differences relate to both the progression of the disease and the very first symptoms. Let's consider these differences in more detail.

Parkinson's disease symptoms in different patient groups

In young people:

If Parkinson's disease began to develop at the age of 20-40, then its progression (in the absence of treatment) is very rapid.

Usually, in young people, the disease begins with muscle problems. The first signs of pathology in young people are most often involuntary muscle contractions in the shoulders and feet. Moreover, at first they can be characterized simply as unpleasant, and then - as very painful sensations.

Moreover, sometimes the patient does not understand that it is the muscles that are contracting: it seems to them that the joints hurt. A person begins to use ointments for arthritis but the pain only intensifies. That is why, if such signs are present, it is important to see a doctor right away.

In the elderly:

In older people, the disease at the beginning  proceeds more slowly. If the disease develops after 60 years, then sometimes 10 years pass from the onset of the first symptoms to the diagnosis. And this is a great danger. After all, the sooner the disease is detected and treatment is started, the higher the chances that it will be possible to take measures that will prevent disability.

Most often, the disease in old age begins with changes in gait. The person begins to speed up and at the same time shorten the steps. This is often called a mincing gait.

Important! It is impossible to diagnose oneself by one of the symptoms. For example, mincing gait is a characteristic feature not only in Parkinson's disease. Very often this symptom is observed in patients with diseases of the hip joint. And only a doctor can recognize what is really the reason for the change in gait.

Another feature of Parkinson's disease in the elderly is the "disguise" of the disease as other diseases: for example, pathologies of the cardiovascular system. But there are differences. For example, if we are talking about problems with blood pressure, then in those suffering from Parkinson's disease it drops more often only when the person is standing, walking, and at rest the pressure stabilizes.

In women:

In women, more often than in men, the following symptoms appear already at the initial stage of the disease:

-Tension of the muscles of the neck, which at first is difficult (without a special examination) to distinguish from signs of osteochondrosis and periarthritis.
- Decreased intelligence.
- Strong emotional depression. Suicidal thoughts (especially during menopause).
- Intense painful manifestations begin in the area of the shoulders and neck.
- Difficulty putting on clothes (buttoning of buttons, turning up sleeves, putting on a blouse, dress, or any top through the head becomes problematic).

Important! In addition to the difficulties of putting on clothes, other everyday problems can arise, but since putting on clothes is one of the most common actions, neurologists most often include it in the mandatory test to identify signs of the disease in women. In men, this problem can also appear, but at the initial stage of the disease it happens much less often than in women.

In men:

For many men, Parkinson's disease is accompanied by problems with potency from the very beginning. This is due to the fact that an erection is directly controlled by the autonomic system - one of the parts of the nervous system.

Another characteristic feature is the difficulty in controlling the hands while walking. If a healthy person, when walking, instinctively bends their arms at the elbows, often waves the arms (which is important for efficient movement and conservation of energy), then in Parkinson's disease, great efforts have to be made to perform these actions.

As in women, in men with Parkinson's disease, the emotional background deteriorates. But instead of being depressed, men develop excessive aggression and anger.

The reasons of Parkinson’s disease development

The most common cause of pathology is heredity. Cell death is associated with the activation of apotosis, a mechanism that is genetically programmed. 20% of patients with Parkinson's disease have or have had relatives who are familiar with this disease. The risk group includes individuals with changes in one of the genes (PARK2 gene).

A significant problem is that the transmission of the disease through genes is autosomal recessive, which means that it manifests itself, as a rule, not directly from parents to children, but through a generation or even several generations. And many are unaware of the danger. But if there was a person in the family who suffered from this disease, it is highly advised to undergo regular neurological examinations especially after reaching the age of 50 years.

But besides the hereditary factor, there are other provocateurs of the development of the disease:

- Taking a number of medications. As practice shows, antidepressants, neuroleptics (metoclopramide), reserpine, calcium antagonists (diltiazem), and lithium preparations can lead to the disease. That is why these drugs are prescription drugs and require strict medical supervision. However, these drugs alone are unlikely to cause the disease. If they were really extremely dangerous, naturally, no one would prescribe them. Everything is very individual.
- All kinds of injuries (concussion of the brain is especially dangerous).
- Encephalitis - regardless of what nature they are - viral or bacterial. In both cases, there are high risks of damage to the structure of the autonomic ganglia - clusters of multipolar nerve cells
- Other diseases. Malignant formations, endocrine pathologies, atherosclerosis can act as provocateurs.

Diagnosis of Parkinson’s disease

Several methods are used to diagnose Parkinson's disease:

- Visual/physical examination.
- Functional diagnostics: method of clinical and accelerometric differential diagnosis of tremor, ultrasound transcranial sonography (TCS), tomography.
- Laboratory tests (blood, urine).
A number of these diagnostic methods are basic, priority ones, and a number are auxiliary clarifying ones.

First of all, a patient with suspected Parkinson's disease should undergo a visual/physical examination by a neurologist, do laboratory tests, clinical accelerometric differential diagnosis of tremor and ultrasound transcranial sonography.

Visual/physical examination

During a visual examination, the nature of the trembling of the fingers is necessarily studied. If this is really Parkinson's disease, then the rule of "rolling the pill" is most often triggered: it seems to the patient that the fingers are not just trembling, but an object that looks like a pill is rolling between them. In addition, the tremor is asymmetrical. On one hand it is more, on the other less pronounced. Very often, in the initial disease, by the nature of the tremor, it is possible to determine wheter it is necessary to continue to diagnose Parkinson's disease, or the patient has Wilson's disease accompanied by metabolic disorders.

Detailed gait analysis is also performed. The doctor asks the patient to walk around the office and watches the speed. The risk group includes patients in whom a clear acceleration is observed when moving forward. Thus, patients unwittingly try to compensate for difficulties with maintaining balance.

Functional diagnostics

The most effective are transcranial ultrasound sonography and clinical accelerometric differential diagnostics. They help not only to confirm or deny the presence of the disease, but also to choose the right treatment, including the dosage.

Ultrasound transcranial sonography helps to determine what area of nerve cells in the brain is affected and even a predisposition to Parkinson's disease, and accelerometric differential diagnostics is informative for analyzing the dynamics of tremor.

Tomography is auxiliary for diagnostics. It is indicated not to identify the nature of Parkinson's disease, but to distinguish it from other pathologies and (or) to identify neoplasms and degenerative pathologies in a patient.

According to indications, electroencephalography, Doppler ultrasound, ultrasound of the brachycephalic arteries can also be prescribed. The data obtained with the help of these surveys are also clarifying.

Stages of the disease

To determine the severity of the condition, Parkinson's disease is usually divided into several periods - stages. Understanding the stage is important for choosing the right treatment method.

Stage 1. Movement disorders of one of the hands, insomnia, problems with smell. Later, a tremor appears, handwriting worsens, stiffness is felt in the upper back, sometimes in the neck.
Stage 2. Movement disorders are visible on both sides. The lower jaw and tongue begin to tremble, speech may slow down, facial expressions may be distorted. Many have problems with perspiration (a characteristic symptom is wet or, on the contrary, excessively dry palms).
Stage 3. The gait changes. When walking, a person begins to involuntarily put their feet parallel to each other. The steps themselves become mincing, shallow. The so-called “beggar's pose” begins to form: bent legs + bent head + stooped posture. A person is still
able to serve themselve, but many things in everyday life become very difficult to do.
Stage 4. Complete loss of balance. A person can fall forward even when getting out of bed. The speech becomes slurred,  the voice becomes quiet. The mood is overly depressed. To do elementary things (for example, brushing  teeth) help is needed.
Stage 5. The patient cannot walk, sit down on their own. The process of urination becomes uncontrollable. Serious swallowing problems occur. Speech is like the babbling of a child.

Parkinson's disease treatment - is the disease curable?

Nowadays effective drug methods for symptomatic treatment are available. Unfortunately, drug therapy does not help to eliminate the cause of the pathology, but it significantly facilitates the manifestation of the disease, reduces complications, and increases the life expectancy of patients.

If the disease develops at the age of 40-65, then patients live for about 20 more years. If it started to develop at an earlier age, then the predicted life expectancy is about 40 more years.

The main thing is that it is important to timely carry out a comprehensive diagnosis and begin treatment under the supervision of an experienced neurologist, neurosurgeon. Some patients suffering from even the 3rd stage of the disease, having started treatment in time, return to work that requires physical and intellectual activity.

It is best to take the disease under control by using neurosurgical techniques or by combining drug treatment with physiotherapy - especially hypobaric oxygenation (procedures in a pressure chamber), massage.

Drug treatment

Modern drug treatment is based on the use of drugs of several groups:

- Monoamine oxidase-B and catechol-O-methyltransferase blockers. Thanks to them, obstacles are created for the destruction of the hormone dopamine.
- Activators/Agonists (stimulators) of dopamine receptors (Uprima (Apomorphine)).
- Medicines that inhibit the action of peripheral L-amino acid decarboxylase (inhibitors).
- Blockers of the action of choline and its analogs (such drugs can directly affect the mechanism of transmission of nerve impulses).
- Amantadines - drugs that increase the sensitivity of a number of receptors.
The choice of how to treat Parkinson's disease depends on the stage of the disease. If at the 1st stage of the disease the emphasis is on stimulators of dopamine receptors, then at the 5th stage the treatment implies the use of a set of medicines and non-drug treatments and the emphasis in drugs is made on the inhibitors of peripheral decarboxylase.
Find out about other/additional methods of Parkinson’s disease treatment in the next article.

Post by: Rachel Lewis, Senior Medical Advisor at Medibank, Sydney, New South Wales, Australia