Parkinson’s disease is a progressive neurological disorder that affects body movements. It is due to the degeneration of nerve cells in the substantia nigra (a part of the brain). Nerve cells of the substantia nigra are responsible for dopamine production (a neurotransmitter), But the loss of nerve cells results in a deficiency of dopamine neurotransmitters. Dopamine is a neurotransmitter which transmits the signal between the different parts or body and coordinates the body movements. Deficiency of this chemical substance causes the disturbance in body movements and coordination which means body movements become slow and abnormal. It is a slow process and this disease only starts to develop when 80 percent of the nerve cells have been damaged.
Parkinson’s disease is one of the clinical syndromes which are characterized by difficulty in initiation of movements, slowing of movements, tremors, and loss of reflexes. Genetic factors play a major role in causing the disease. Whenever a person’s first-degree relative suffers from Parkinson’s, there is three time risk that the person will suffer the disease at one of the stages of his life. It becomes prominent as the disease progress and reduces the overall quality of life.
It mostly affects the old people due to the gradual loss of nerve cells. How these nerve cells are destroyed, is still under study. People with Parkinson’s disease are diagnosed clinically because they present with involuntary, repeated movements of hands. Parkinson’s disease symptoms can’t be treated but can be improved by medication.
Causes Of Parkinson’s disease
The exact cause of Parkinson’s disease is not yet known but both environmental and genetic factors play an important role in Trigger Parkinson’s disease. There are a variety of viruses that can cause this disease as well. The main cause of Parkinson’s is due to reduce levels of dopamine and norepinephrine in the body which and every disease which causes the reduced level of dopamine will Trigger Parkinson’s.
Age: the disease usually appears between 50 and 60 e usage. 5 to 10% of cases develop the disease before the age of 40.
Sex: whites are more prone to get Parkinson’s disease as compared to Asians and Americans.
Race: the men are two times more prone to develop Parkinson’s as compared to women
Family history: people with Parkinson’s disease who have one or more family members of acute disease are likely to develop the disease in the later stages of life. There is three times increase tendency to develop this disorder if the person has his relative suffering from this disease
Environmental factors: plenty of environmental factors like exposure to certain toxins may Trigger disease.
Head injuries: dangerous head injuries may cause the disease
Parkinson’s disease Symptoms
Parkinson’s disease symptoms vary from patient to patient and progress gradually. It starts from a mild to severe form. It may affect one side of the body or both sides of the body depending on the type of seizures.
Parkinson’s disease signs and symptoms include:
Tremors start in a limb, mostly your fingers or hands. These tremors or shaking movements may be at rest or during activities. A major clinical symptom to diagnose Parkinson’s disease.
2- Bradykinesia (Slowed movements)
The second main symptom of Parkinson’s disease is slow movements which develop gradually and make your simple tasks difficult. This slowness in your body movements is too much time-consuming. The patient walks on short steps, writes slowly, eats slowly, and even unable to get out of a chair easily. The reason for this slowness in movements is due to the depletion of dopamine neurotransmitter which controls the body movements in a balanced way.
3- Loss of automatic movements.
Your involuntary, unconscious movements such as blinking of an eye, smiling, breathing, swinging of your arms, are decreased because your body becomes unable to perform them.
4- Postural Changes
Your posture becomes stooped because you have a problem balancing their body. Therefore, your posture altered.
5- Writing Changes
You may have difficulty to write and your writing become smaller.
6- Muscle Rigidity
Muscles stiffness or rigidity may occur at any part of body which is very painful and may restrict your body motion.
The face is expressionless, soft and Rapid speech, flexed posture and impaired postal reflexes. The person may also suffer reduced sensation of smell, anxiety, depression, constipation and decreased amount of sleep. There is increasingly small handwriting which is also called micrographia and the person suffers difficulty in tying shoelaces or buttoning clothes. The speech becomes soft as the disease progresses.
There is prominent dementia which impair the quality of life of Parkinson’s disease patient. Other problems include depression, affects the patients, sleep disturbance, hypersomnolence, fatigue, Sexual problems, loss of libido, drooling of saliva, weight loss, and sphincter disturbances.
How to Diagnose the Disease?
The diagnosis for Parkinson’s disease is done by your neuropsychiatrist. When you head to watch your doctor, he will ask you about certain questions like
- when did the disease begin?
- do you suffer any dementia?
- what is the type of your tremors?
- for how long the tremors last?
- do you suffer any memory problems?
- are there slowing of movements?
- do you feel rigidity while you move your limbs?
- is your walking posture changed?
After asking certain questions he will perform your general physical examination and then will prescribe you some test which you have to do and they will help you the doctor to diagnose you and treat you accordingly. The main diagnosis of Parkinson’s disease a clinical.
- CT scan
- City scan is usually normal for age and not every helpful for diagnosing disease.
The MRI is normal but it supports when the cause of Parkinson’s is suspected as a vascular cause.
PET or SPECT
These imaging studies are abnormal even during the early course of the disease but it does not differentiate between kinds of Parkinson’s.
When people suffering from the disease are thought to be due to some genetic condition, then genetic testing is required.
Treatment of Parkinson’s disease
The first line agents for the disease are carbidopa and levodopa but monoamine oxidase inhibitors also play a vital role to treat the disease.
If it is so enough to cause hindrance to daily activities of life, then treatment is indicated.
The combination of levodopa and carbidopa is the mainstay of treatment. This is particularly effective in improving slowness of movements, rigidity and the combination is given. If levodopa is administered by mouth, it is decarboxylated to do dopamine peripherally and only a small portion of the drug reaches the brain.
The peripheral conversion of levodopa is minimized by some decarboxylase which is carbidopa in this case and it does not cross the blood brain barrier along with levodopa.
The dopamine agonists are all less effective in the levodopa and they have more side effects. Nonergot derivatives ( ropinirole, pramipexole) of dopamine agonists are preferred over ergot derivatives( bromocriptine, cabergoline)
Monoamine Oxidase Inhibitors
Monoamine oxidase inhibitors (selegiline, rasagiline) are used as the monoamine oxidase enzyme is involved in the breakdown of dopamine in the body.
They prevent the breakdown of levodopa and they extend the duration of action of levodopa.
Agents: entacapone, tolcapone
these drugs are effective in relieving the signs and symptoms of tremors and rigidity but they have a wide range of Side Effects like constipation, dry mouth, and fatigue.
Agents: benztropine, trihexyphenidyl
It is an atypical dopamine agonist and is not preferred usually because of its wide range of Side Effects like peripheral edema and seizures.
deep brain stimulation to treat tremors.
brain stimulation of Globus pallidum and subthalamic nucleus.
The deep brain stimulation is done only for drug-resistant cases
Conservative Treatment for Parkinson’s disease
Physiotherapy is the mainstay of treatment and all the patients with every stage of Parkinson’s disease get benefited from Physiotherapy effects. It reduces rigidity and also corrects the flex poster of the patient.
speech therapy can treat dysarthria and dysphonia. When the patient is not able to communicate he suffers from mental disorders like depression and anxiety. The non-motor symptoms aggravate as a result patient should be managed by speech therapy so that he can speak efficiently.
Taking occupational therapy may help to overcome different kinds of limitations like toilet and bathing equipment.
The patient of Parkinson’s should be treated with a multidisciplinary team which includes nurses, PD Specialists, neuropsychiatrist and neuro physicians.
How to Prevent the Disease?
The disease progression is different in each person that’s why it is still not clear that how can the disease be prevented but many researchers suggest that the disease can be prevented by maintaining ideal BMI eating a diet which is rich in antioxidants, which have a protected effect exercising regularly eating plenty of fresh fruits and vegetable. If you have a family history of the disease you should get early Parkinson’s testing
There are five stages of PD and it is a progressive disease that progresses over the period of time. The disease is Classified on the basis of symptoms.
In the first stage, the disease is mild and the patient does not experience symptoms that are noticeable.
The second stage causes the patient to suffer from muscle stiffness, tremors and trembling.
In the third stage, the patient may experience unnoticeable symptoms like balance issues and it hinders the daily task. People with stage 3 can perform their daily activities without any assistant
The fourth stage of disease will require the patient to depend upon someone and living alone is totally unsafe at this point.
The last stage is stage 5 and the patient becomes handicapped at this stage. He will need a wheelchair as the patient will not be able to move on his own. The complication may appear at this stage.
There are a lot of complications for Parkinson’s and it can greatly reduce the prognosis and overall quality of life of a person. The person may experience falls and my experience a vast majority of head and overall injuries.
The disease prognosis can be improved if a person gets a proper treatment but it is not possible to decrease the disease progression. The overall quality of life can be improved by commencing the treatment on time.
The Final Verdict:
Parkinson’s disease is a group of disorders that change the dopaminergic Pathways which are involved in voluntary control of muscle movements. Dopamine is one of the main neurotransmitters in the brain and when it reduces the signs and symptoms of the disease occurs. When you start to feel the tremors, slowness of movements handwriting getting smaller and mask-like face symptoms appear, you should consult your doctor immediately.
Your doctor may prescribe you some medications which will not stop the disease progression but it will decrease the disease complications which will impact the overall quality of life.