Parkinson's disease
The content of the article:
- Causes and risk factors
- Forms of the disease
- Disease stages
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
Parkinson's disease is a chronic, steadily progressive brain disease in which neurodegenerative changes are observed in the structures of the substantia nigra.
Parkinson's disease is diagnosed in 5% of people over the age of 60
This pathology is one of the leading in the group of neurodegenerative diseases, manifested by the death of nerve cells in the brain, impaired production of neurotransmitters and instability of the interaction of various structural divisions of the central nervous system.
The first mentions of the disease as an independent nosology are presented in the essay "Essay on shaking paralysis" by James Parkinson (1817), although in ancient India more than 4500 years ago a disease was described that has similar manifestations to Parkinson's disease - campa vata.
The disease is found everywhere, on all continents, in all ethnic groups, with an average prevalence of 60-160 cases per 100,000 population. The incidence on average is 20 episodes per 100,000 population per year, with age it increases significantly: for example, in 70-year-olds the indicator is 55 cases per 100,000, and in 85-year-olds - already 220 cases per 100,000 population per year. In recent decades, there has been a tendency towards the rejuvenation of pathology (debut at the age of 40).
According to statistics, Parkinson's disease is diagnosed in 1% of the population under 60 and in 5% of older people. The incidence among men is slightly higher.
According to the estimates of the World Health Organization, at the end of the twentieth century, there were more than 4,000,000 people diagnosed with Parkinson's disease in the world.
Synonyms: idiopathic parkinsonism, tremor palsy.
Causes and risk factors
In accordance with modern concepts, Parkinson's disease occurs as a result of impaired neurotransmitter metabolism due to the death of neurons in the brain system that provides the organization and construction of movements.
The biochemical substrate of the disease is a deficiency in dopamine production (specific symptoms appear with a decrease in hormone synthesis by at least 70%) and the development of neurotransmitter imbalance.
As the disease progresses, dopaminergic neurons of the thalamus, hypothalamus, the zone of positive emotions, which is part of the limbic system, the hippocampus, and the cerebral cortex, die.
Parkinson's disease occurs due to the death of neurons in the brain
The causes of the disease are not reliably known, presumably the following factors play a decisive role:
- hereditary predisposition (confirmed in approximately 10% of patients, the disease in this case is inherited in an autosomal dominant manner with incomplete penetrance of the mutant gene);
- elderly age;
- the impact of environmental factors (industrial hazards, unfavorable environmental conditions in the place of residence);
- transferred infections;
- intoxication with heavy metal salts, pesticides, cyanides, hexane, hydrogen sulfide, 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), etc.;
- damage to brain structures by free radicals.
Forms of the disease
There are several clinical forms of the disease according to the prevailing symptoms:
- akinetic-rigid-trembling (in 60–70% of cases);
- akinetic-rigid (15–20%);
- trembling (5-10%).
Development of Parkinson's disease
Based on the rate of progression, Parkinson's disease is classified as follows:
- rapidly progressing - the change in the stages of the disease (first - second / second - third) occurs within 2 or less years;
- moderately progressive - the change in the stages of the disease occurs in a period of 2 to 5 years;
- slowly progressive - the stages of the disease change after more than 5 years.
Disease stages
The generally accepted gradation of the stages of the disease, reflecting the severity, is as follows:
- stage 0 - no movement disorders;
- stage 1 - one-sided nature of the manifestations of the disease;
- stage 2 - bilateral manifestations of the disease, the ability to maintain balance does not suffer;
- stage 3 - moderately pronounced postural instability, the patient is able to move independently;
- stage 4 - a pronounced loss of motor activity, the ability to move is preserved;
- stage 5 - the patient is confined to bed or a wheelchair, movement without assistance is impossible.
Parkinson's disease stages on a Zen and Yar scale
The modified Hoehn and Yarh scale (1967) suggests the following division into stages:
- stage 0.0 - no signs of parkinsonism;
- stage 1.0 - unilateral manifestations;
- stage 1.5 - unilateral manifestations with the involvement of axial muscles (muscles of the neck and muscles located along the spine);
- stage 2.0 - bilateral manifestations without signs of imbalance;
- stage 2.5 - soft bilateral manifestations, the patient is able to overcome the induced retropulsion (acceleration of the patient backward when pushing from the front);
- stage 3.0 - moderate or moderate bilateral manifestations, slight postural instability, the patient does not need outside help;
- stage 4.0 - severe immobility, the patient's ability to walk or stand without support is preserved;
- stage 5.0 - the patient is confined to a chair or bed without assistance.
Symptoms
Parkinson's disease is characterized by movement disorders (hypokinesia, muscle rigidity, tremor, postural disorders) and concomitant autonomic and cognitive dysfunctions.
Hypokinesia implies difficulty in initiation and slowness of movements, while the amplitude and speed of repeated movements decrease with preserved muscle strength. The main manifestations of hypokinesia:
- poor facial expressions, rare blinking;
- slow, monotonous and quiet speech fading towards the end of the phrase;
- difficulty swallowing and the resulting drooling;
- respiratory disorders;
- loss of friendly movements (hand movements when walking, wrinkling of the forehead when looking up, etc.);
- shuffling gait in small steps with feet located parallel to each other ("doll gait");
- spontaneous freezing in a static position;
- small "trembling" handwriting with letters decreasing towards the end of the line;
- Difficulty changing body position;
- slowness in daily activity.
Parkinson's disease manifestations
Stiffness means a feeling of stiffness, tightness. Muscle tone in patients is plastic, "viscous": after flexion or extension of the limb during the examination, it freezes in this position ("wax doll symptom"). The tone in the extremities predominates over the tone of the axial muscles, which leads to the appearance of the characteristic "supplicant posture" ("mannequin posture") - a stooped, bent forward back, arms pressed to the body bent at the elbow joints, a bowed head, legs are also bent at the knee and hip joints.
When examining the muscle tone of the extremities, a "cogwheel symptom" is noted: flexion and extension does not occur smoothly, but stepwise, intermittently, in the form of uniform jolts.
The most characteristic symptom is tremor, that is, trembling, however, in about 15% of patients, this symptom is absent throughout the course of the disease. The specificity of tremor in Parkinson's disease is its maximum severity at rest (including in sleep), when stretching the arms or during movement, the tremor significantly decreases or completely disappears, increases with excitement, emotional and physical stress.
Hand tremors are the most common symptom of Parkinson's disease
Trembling begins in the early stages of the disease from the tips of the fingers of one hand, spreading further to the entire limb, and then to other parts of the body (sometimes trembling of the tongue, lower jaw, eyelids, head is noted as "yes-yes" or "no-no", stop).
Characterized by multidirectional rhythmic small movements in the 1st, 2nd and 3rd fingers, like counting coins or rolling pills.
Postural instability is the loss of the ability to maintain body balance when walking or changing body position, turning in place, getting up from a chair or bed, which provokes the patient to frequent falls (more often forward, less often backward). This phenomenon usually appears in the later stages of the disease.
It is difficult for a patient with postural instability to both initiate movement and end it. For example, having started walking, the patient cannot stop on his own, the body, as it were, continues to move forward by inertia, ahead of the limbs, which leads to a shift in the center of gravity and a fall.
Autonomic disorders most common in Parkinson's disease:
- orthostatic hypotension (a sharp decrease in blood pressure with a change in body position);
- incontinence of urine and feces;
- erectile disfunction;
- lacrimation;
- thermoregulation disorder;
- violation of sweating (hypo- or hyperhidrosis);
- sensory disorders in the form of tingling sensations, numbness, burning, itching (50% of patients);
- impaired sense of smell (90% of patients).
Mild to moderate cognitive disorders in the first 5 years are observed in the bulk of patients. Signs of dementia appear after 5 or more years, extremely rarely at the onset of the disease.
In the expanded stage, mental disorders are possible (depression and anxiety, the development of obsessive-compulsive syndrome, delirium, hallucinations, identification disorder, delirium).
Diagnostics
Laboratory or instrumental research methods that can confirm or deny the presence of Parkinson's disease do not exist.
To confirm the appropriate diagnosis, it is necessary to combine hypokinesia with at least one of the following symptoms:
- muscle rigidity;
- rest tremor;
- postural instability not associated with primary visual, vestibular, cerebellar, or proprioceptive disorders.
In addition, at least 3 confirmation criteria (unilateral onset, progressive course, persistence of asymmetry of symptoms with predominance on the initially involved side, etc.) and the absence of exclusion criteria (recurrent strokes and traumatic brain injury in history with a stepwise progression of symptoms parkinsonism, treatment with neuroleptics at the time of onset of symptoms, the presence of long-term remission, etc.).
Treatment
The neuroprotective potential of none of the drugs used for the pharmacotherapy of Parkinson's disease has been convincingly proven, and therefore the treatment is symptomatic.
The choice of the drug at the initial stage is made taking into account the age, the severity of the symptoms of the disease, the type of work of the patient, the state of the neuropsychic sphere, the presence of concomitant diseases, and the individual response to therapy.
Principles of drug therapy for Parkinson's disease
It is customary to begin treatment when a motor defect significantly impairs the patient's functional capabilities (hinders labor activity or limits the ability to self-service).
The individual dose is selected by slow titration to obtain an adequate effect that allows you to maintain the patient's social activity in the absence of side effects for as long as possible.
At the moment, 6 groups of drugs are classified as antiparkinsonian drugs:
- preparations containing levodopa;
- dopamine receptor agonists;
- anticholinergics (anticholinergics);
- amantadine preparations;
- type B monoamine oxidase inhibitors;
- inhibitors of catechol-O-methyltransferase (COMT).
In addition to drug treatment, auxiliary therapeutic measures are needed: neuropsychological trainings, speech therapy, remedial gymnastics, spa treatment, etc.
Therapeutic gymnastics is an important stage in the treatment of Parkinson's disease
With the ineffectiveness of conservative therapy, the question is raised about surgical intervention on the brain: pallidotomy, thalamotomy, implantation of intracerebral stimulants into the globus pallidus, thalamus, subthalamic nucleus, intracerebral transplantation of embryonic adrenal tissue or substantia nigra.
Possible complications and consequences
The consequences of Parkinson's disease are:
- violation of the intellectual sphere;
- mental disorders;
- decrease, up to complete disappearance, the ability to self-service;
- complete immobilization, loss of speech function.
Forecast
The prognosis for Parkinson's disease is conditionally unfavorable, which is associated with its steady progression. In the absence of treatment, patients lose the ability to self-care for about 8 years, after 10 years, complete immobilization occurs more often. Patients receiving pharmacotherapy become dependent on their caregivers after an average of 15 years.
Life expectancy in Parkinson's disease is reduced, as symptoms progress, the quality of life irreversibly deteriorates, and the ability to work is lost.
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
