Parkinson’s – Causes, Symptoms & Therapy

Parkinson’s or Parkinson’s disease is a nervous disease named after James Parkinson. He first described the symptoms of the disease in 1817.

Parkinson’s syndrome (Parkinson’s disease) is a neurological disease of the central nervous system in the basal ganglia area, where there is a shift in the balance of the neurotransmitters dopamine and acetylcholine.

A lack of dopamine develops a symptom complex with a superficial lack of motor drive and a general motor slowdown.

Parkinson’s disease occurs most frequently between the ages of 50 and 60. Triggers for the disease are, for example, a lack of dopamine, heredity, brain tumors and certain external influences.

Parkinson’s disease is not fatal and can be treated with medication or various therapy methods. However, the disease persists and is only alleviated and delayed in its course by both medication and therapies.

Parkinson’s is one of the most common neurological diseases and primarily affects people of advanced age. Just under 0.16 percent of the population suffer from Parkinson’s disease, among those over 80 the figure is around 3 percent.

causes

The Parkinson’s syndrome has to be subdivided according to its causes: In 2/3 of the cases, it is based on the clinical picture of Parkinson’s disease, in which the exact cause of the disease has not yet been clarified.In the remaining cases of Parkinson’s syndrome, there is an explanatory cause, such as an infection, a brain injury or often as a side effect of certain medications (neuroleptics, MCP, reserpine, flunarazine) or as a result of poisoning with substances such as carbon monoxide, methanol or synthetic drugs.

While the latter causes can of course be easily reversed, Parkinson’s disease usually progresses and leads to a severe reduction in quality of life.

symptoms and course

The main symptoms of Parkinson’s are rigidity, tremor and akinesia. Rigor is a stiffening of the muscles , especially in the arms, which can then only be passively moved jerkily against resistance (cog wheel phenomenon).

Tremor describes a fine-pitched shaking at rest. Initially, this mainly affects the hands, but shifts to other muscle groups, especially when holding on. The tremor usually decreases with movement. The trembling of individual muscle groups, balance disorders and personality changes, mostly in a negative range, are also among the symptoms of the disease.

The term akinesia refers to a general decrease in voluntary movements, starting difficulties when asked to move, which gives the sufferer a generally very lethargic picture. Speech becomes monotonous due to the motor impairment, the writing is very small, the facial expressions decrease and the person affected saliva runs out of the mouth due to a swallowing disorder.

A general drop in blood pressure with circulatory problems can occur as part of the disease, and many sufferers have an increased tendency to sweat and an increased flow of the sebaceous glands, which can lead to the so-called “ointment face”. Symptoms of the disease include sedentary lifestyle. This manifests itself in the fact that the movements of the body generally slow down. For example, you can see this in the face, if an affected person wants to smile, it takes much longer than a healthy person.

The disease progresses slowly and affects specific regions of the brain. These brain regions are responsible for the body’s voluntary and involuntary movements and are greatly affected by the disease. During the course of the disease, the nerve cells in the brain that produce the neurotransmitter dopamine die off and this is how the typical symptoms develop.

Thought processes become slower over time, which can lead to the transition to dementia. In hindsight, olfactory disorders or an often unnoticed fading of the sense of smell are the first symptom of impending Parkinson’s disease, often years before the first clear symptoms.

Diagnose

The doctor makes the diagnosis based on the course of the disease and a physical examination of the patient.

In the early stages, Parkinson’s disease is not easy to diagnose because the signs are non-specific. In the advanced stage, the doctor can recognize the disease at first glance. It is important for the diagnosing doctor to rule out other causes for the patient’s symptoms.

This is followed by a questioning of the patient about his medical history and his complaints. This conversation is enormously important because the doctor can assess whether it is Parkinson’s by describing the symptoms in detail. Ideally, relatives take part in the conversation and enrich it with information that is valuable for the diagnosing doctor. Questions from the doctor are usually:

• How long have your legs or hands been shaking?

• Do you feel like your muscles are constantly tight?

• Do you have pain in the neck or shoulder area?

• Do you have trouble keeping your balance?

• Do you find tasks such as buttoning clothes increasingly difficult?

• Do you have trouble sleeping?

• Did the illness occur in relatives?

In many cases, the first symptoms of the disease are reduced handwriting and a disturbed sense of smell. Furthermore, many of those affected are partially able to carry out everyday activities such as brushing their teeth, dressing and computer work. Some patients often fall down while walking. Others injure themselves and their partner while they sleep because they move violently during the dream phase. If several typical signs occur, this can indicate Parkinson’s disease.

There are also diagnostic procedures such as computer tomography and magnetic resonance imaging, which mainly serve to rule out other causes. Positron emission tomography shows a reduction in dopamine – releasing cells in the brain. A therapy attempt with levodopa, a precursor of dopamine, which is accompanied by an improvement in symptoms, indicates Parkinson’s disease. Levodopa converts to dopamine in the brain.

complications

In Parkinson’s disease, a so-called akinetic crisis can occur. This life-threatening complication usually occurs in the late stages of the disease and leads to the complete inability of the patient to move. The affected person can neither speak nor swallow and therefore no longer absorb liquids or medication. If the akinetic crisis is not treated immediately in intensive care, there is an acute danger to life.

Other possible complications are dystonia, i.e. acute movement disorders with an acute risk of injury, as well as what is known as freezing, in which the patient is temporarily unable to move. Parkinson’s can also cause various mental health problems. Depression, psychosis and hallucinations can occur. On the one hand, the symptoms are triggered by the Parkinson’s disease itself, which represents a considerable psychological burden for the sufferer. On the other hand, the prescribed medication causes psychological problems that can range from perception disorders and optical misperceptions to anxiety disorders and panic attacks. It can also cause nightmares, impulse control disorders, and sexual behavior disorders.

People with Parkinson’s also have an increased risk of dementia. The typical Parkinson’s complications affect almost all patients during the course of the disease. As the disease progresses, the symptoms increase, with medication only providing limited relief in the later stages of the disease.

treatment and therapy

The therapy of Parkinson’s disease is purely symptomatic, a cure is not possible according to the current state of science. Only in the case of other causes of Parkinson’s syndrome can a complete remission of the symptoms be achieved, for example by stopping the causative medication. In true Parkinson’s syndrome, however, a slow progression of the chronic disease can be expected.

It is important that the patient’s environment is also included in the therapy. In addition to general measures such as physiotherapy and ergotherapy, with the help of which the independence of the affected person is to be maintained for as long as possible, there are also several drug therapy approaches that can effectively delay the progression of the disease.The focus is on the active ingredient L-Dopa. This is a precursor of dopamine, of which there is a deficiency in the brain in Parkinson’s disease.

After ingestion, L-Dopa is transported across the blood-brain barrier in the body and converted there into dopamine, so that a rapid improvement in symptoms can be expected.

Unfortunately, in the course of treatment with L-Dopa, the body becomes accustomed to it and there is a loss of effectiveness. In this case, other drugs with similar effects are available. There is currently no known way to prevent Parkinson’s disease.