Parkinson’s: A Debilitating Disease
Medikoe Health Expert
Koramangala, bengaluru, karnataka, india, Bengaluru Feb 9, 2017
Parkinson’s is a neurodegenerative disorder that affects movement, it refers to dysfunction and degeneration of neurons in the substantia nigra pars compacta and the nigrostriatal (dopaminergic) tract. This results in a deficiency of dopamine (DA) in the striatum, which controls muscle tone and coordinated movements.
Patients suffering from Parkinson’s will also have another neurological disorder that worsens the condition, starting from the inability to look up and down to dementia.
Symptoms of Parkinson’s
There are different parameters that explain the signs and symptoms:
Primary Parkinson’s disease symptoms include:
Tremor: Parkinson’s tremor usually occurs at rest, and it is initially unilateral but often progresses to bilateral.
Rigidity: Muscle movements become rigid and the person is often found struggling with the resistance to movement, described as “cogwheel effect”. Muscle tone is increased at rest and aggravated by movement.
Bradykinesia: there’s a delay in initiation of movement, and scantiness of all movements with hesitation as a result. Symptoms of bradykinesia include- Clumsy walk, Drags a foot while walking, Restricted facial expressions, Frozen muscles.
Postural Dysfunction and abnormal gait: difficulty in balancing and walking because of alteration in equilibrium and bradykinesia. Episodes of freezing are quite common, poor coordination for positional changes, hence falls.
The disability that is caused by the disease and its progression can be explained using Hoehn and Yahr Scale of Disability. One feature of this scale the classification of progression of the disease by virtue of symptoms asymmetry versus symmetry. This scale rates symptom on the scale of 1-5, 1 and 2 representing Parkinson’s early symptoms, 2-3 mid-stage and 4-5 advanced-stage Parkinson’s.
Different Parkinson Stages
- Stage I: Unilateral involvement; minimal functional impairment.
- Stage II: Bilateral involvement; no postural abnormalities.
- Stage III: Bilateral involvement with mild postural imbalance; patients can lead an independent life
- Stage IV: Bilateral involvement with marked postural instability; the patient requires help for completing daily activities.
- Stage V: Severe, the disease is completely developed; the patient is confined to bed or chair.
In addition to primary symptoms of PD, numerous other secondary symptoms are observed. Included in this category are constipation, dysphagia and drooling, shortness of breath, speech difficulties, writing impediment. Spasmodic twitching of the eyelids, dizziness and flat face.
Parkinson Plus Syndromes
It’s a group of neurological disorder along with idiopathic PD. Symptoms include multiple system atrophy, progressive supranuclear palsy PSP, Lewy body dementia. This is more rapidly progressive and less likely to respond to antiparkinsonian drugs.
Causes of Parkinson’s
The cause of idiopathic Parkinson’s disease is still in question. Hypotheses include age, environmental factors, genetic predisposition and oxidative stress. The main cause of the disease still remains the death of the cells that produce a neurotransmitter called dopamine. When the level of dopamine decreases it causes abnormal brain function hampering the motor functions.
Environmental factors: Factors include ingesting well water or living on a farm (ingesting insecticides/ pesticides, indirectly) have been linked to PD and so are industrial toxins such as heavy metals.
Genetic Predisposition: this is highly unlikely, except in rare cases with many family members affected by Parkinson’s disease. There is a specific gene mutation that may cause Parkinson’s.
Lewy bodies: clumps of eosinophilic inclusion bodies are observed in the patients suffering from PD. These substances are called Lewy bodies and hold a clue in the progression of the disease.
Ageing: Ageing induces defects in the mitochondrial electron transport chain.
A synthetic toxin N-methyl-4-phenyl tetrahydropyridine (MPTP): Which occurred as a contaminant of some illicit drugs, produces nigrostriatal degeneration and manifestations similar to PD by impairing energy metabolism in dopaminergic neurons.
Agents associated with drug-induced Parkinsonism: Reserpine, Lithium, methyldopa, SSRIs, Calcium channel blockers, Anticonvulsants, Antipsychotic are known to cause Parkinson disease.
Diagnosis of Parkinson’s
Parkinson’s can be diagnosed by examining a few characters shown by the patients-
The physician is known to examine the limbs of the patient.
The person suffering from PD is known to have a stooped posture.
The patient walks by dragging one’s feet along or without lifting them fully (Parkinson’s gait).
Parkinson’s tremor is examined, they are worse at rest and asymmetrical.
There’s resistance in movement resulting in reduced arm swing.
They struggle with completing basic daily tasks, often forget names.
The patient may be asked to draw or write a sentence.
Standing blood pressure is also checked.
For further confirmation of the disease, tests are done such as PET/ SPECT scans can be used to measure dopaminergic function in basal ganglia.
For the treatment of Parkinson’s disease, different approaches have been discovered, ranging from medical management to surgical management
Medical management includes the use of antiparkinsonian drugs for the treatment of idiopathic PD but the same would not be effective in Parkinson’s plus syndromes.
The goal of medical management of Parkinson's disease is to control signs and symptoms for as long as possible while minimising adverse effects.
Parkinson’s disease treatment also involves Managing Non-motor symptoms in PD like-
Depression and psychosis can be managed by taking relevant antidepressants and antipsychotic drugs.
Dementia can be managed by taking anticholinesterase inhibitors.
Sleep disorders such as Restless legs syndrome, periodic limb movements of sleep, REM sleep behaviour disorder can be managed by taking sedatives.
Autonomic disturbances such as urinary dysfunction can be managed by taking oxybutynin, weight loss, dysphagia, constipation can be managed by taking movicol, erectile dysfunction, orthostatic hypotension, sialorrhoea.
People suffering from Parkinson’s whose life has been completely hindered opt for a surgical method to mitigate the disease which involves deep brain stimulation.
Prevention of Parkinson’s
There a few ways that might prevent the disease before the symptoms arise.
Go Organic: Pesticides and herbicides are known to be a cause of Parkinson, people suffering from Parkinson’s have high levels of pesticides in their brain as compared to a healthy human being with normal dopamine level. In this way, you will eliminate the possibility of pesticides entering your body.
Eat Green Vegetables: greens are supposed to contain folic acid which reduces the chances of PD, foods like broccoli, spinach, collard greens, brussels sprouts, asparagus and okra help in fighting PD.
Vitamin D3: Animal fat is rich in vitamin D. Sunlight is also the main source of vitamin D. vitamin D not only helps you against PD but also helps you boost your immunity, protects against dementia, against cancer.
Caffeine: There is an inverse relationship between the development of PD and the use of caffeine, coffee.
Exercise: Regular aerobic exercise decreases inflammation in brain.
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