Parkinson's Disease

Parkinson\’s Disease

Parkinson\’s disease is also called motor system disorder. It belongs to the larger group of neurological conditions. Historians have found that the disease is dated back as far as 5000 B.C. In 1817 British doctor James Parkinson mentioned it as \”the shaking palsy\” for the first time. Because of Parkinson\’s early effort in identifying symptoms, the disease is named after him.

Symptoms

Parkinson\’s disease is included in a large group of conditions called movement disorders. The four most important symptoms of Parkinson\’s are:

Tremor, or trembling in hands, arms, legs, jaw, or head
Rigidity, or stiffness of the limbs and trunk
Bradykinesia, or sluggishness of movement
Postural instability or impaired balance.

Other symptoms

Digestion problems– the ability to process food slows down, causes low energy and constipation.
Depression– Parkinson\’s brings about chemical changes in the brain that may result in depression. This can be an early alarming sign, but as depression becomes more common in aged persons, it is not regularly associated with the disease.
Low Blood Pressure– can develop light headedness and fainting.
Temperature sensitivity– sensitivity of temperature can be affected, and may result in hot flashes and excessive sweating.
Leg discomfort– several patients sense burning sensations and cramp in the legs.

Parkinson\’s disease causes neuropsychiatric disturbances, which include mainly cognition, mood and behavior problems and can be as disabling as motor symptoms.

Cognitive disturbances take place even in the early phases of the disease in some cases. An exceptionally high proportion of sufferers will have mild cognitive impairment as the disease proceeds. Most common cognitive discrepancies in non-demented patients are executive dysfunction, which interprets into impaired set shifting, poor problem solving, and fluctuations in attention among other complexities; restricted cognitive speed, memory problems; specifically in reminding learned information, with an important improvement with cues; and visuospatial skills difficulties, which are viewed when the person with PD is for example asked to carry out tests of facial recognition and perception of line orientation .

Generally Parkinson\’s symptoms commence gradually and deteriorate over time. As the symptoms turn into more critical, people with the disorder may face trouble in walking, talking, or completing other easy tasks.

It is both chronic, meaning it lasts for a long time, and progressive, meaning its symptoms grow worse over time. It is not contagious.

Causes

Brain Chemicals
In Parkinson\’s disease nerve cells, or neurons, in an area of the brain that controls movement die or become damaged. Normally, these neurons produce an important brain chemical known as dopamine. When the neurons die or become impaired, they generate less dopamine. This scarcity of dopamine causes the movement disorders of people with Parkinson\’s.

People with Parkinson\’s also possess loss of the nerve endings that produce the neurotransmitter norepinephrine. Norepinesphrine is closely related to dopamine. It is the principal chemical messenger of the sympathetic nervous system which executes many automatic functions of the body, like heart rate and blood pressure. The loss of norepinephrine might help to explicate several of the non-movement characteristics of Parkinson\’s, such as fatigue, irregular blood pressure, decreased gastric motility or movement of food through the digestive tract, and postural hypotension. Postural hypotension is an abrupt fall in blood pressure when a person stands up from a sitting or lying-down position. It may cause dizziness, lightheadedness, and in some cases, loss of balance or fainting.

Many brain cells of people with Parkinson\’s have Lewy bodies. Lewy bodies are unusual deposits or clumps of the brain protein alpha-synuclein, along with other proteins. Those are seen upon microscopic examination of the brain. Researchers do not yet identify the reasons why Lewy bodies form or what role they play in the growth of Parkinson\’s. The clumps may prevent the cell from functioning normally, or they may actually be helpful, perhaps by keeping harmful proteins \”confined\” so the cells can function.

Other risk factors–

Advancing age: The disease can flourish in a young adult but that was exceptional. It is generally noticeable in the middle to late years of life. The risk persists on as the age increases.

Sex– Males are more prone to Parkinson\’s than females. Possible reasons for this may be that males have greater exposure to other risk factors such as toxin exposure or head trauma. It has been theorized that oestrogen may have neuroprotective effects. Or, in the case of genetic predisposition, a gene predisposing someone to Parkinson\’s may be linked to the X chromosome.

Family history– Having one or more close relatives with the disease enhances the possibility that you might get it, but to a nominal level. This proves the fact that there is a genetic connection in developing Parkinson\’s.

Exposure to an environmental toxin like a pesticide or herbicide keeps you at greater risk. Some of these toxins slow down dopamine production and paves the way of free drastic damage. The farmers and persons related to farming are therefore open to the elements to such toxins have a greater risk of having Parkinson\’s symptoms.

Genetic factors- A Mayo Clinic led international study disclosed that the gene alpha-synuclein can play a role in the likelihood of developing the disease. Studies showed that individuals with a more active gene had a 1.5 times greater risk of developing Parkinson\’s.

Diagnosis

Pakinson\’s Disease can not be diagnosed with a single test.

Neuroimaging
Single-photon emission computed tomography (SPECT) is utilized along with a radio labeled compound. The compound will connect to the dopamine receptors and can be observed using SPECT. This method allows the measurement of the amount of dompanime releasing neurons. PET scans are also useful and offer 3D images of the brain. This allows one to examine the distinctive images of brain of each patient.

Genetic Testing
Different mutations that contribute to the pathology of Parkinson\’s disease have been recognized. From genetic testing and genetic counseling couples can find out whether they are carriers of the mutated genes and, therefore, how possibly they are to pass them on to their children.

Olfactory system testing
The olfactory system is used by the body to sense smell. It is now well established that Parkinson\’s sufferers have the problem to recognize the appropriate odor of a particular thing. Therefore testing this system can signify the presence of Parkinsonism. In this test patient is asked to smell a variety of odors, and then he/she has to choose the correct answer among a variety of possible answers.

Management

Presently, there is hardly any cure for Parkinson\’s disease, but medications, surgery and multidisciplinary management can provide relief from the symptoms.

PD is a chronic disorder that engrosses broad-based management including patient and family education, support group services, general wellness maintenance, physiotherapy, exercise, and nutrition.

Medications
Principal families of medicines useful for motor symptoms of PD are Levodopa, dopamine agonists and MAO-B inhibitors. Concerning medications the treatment approach depends on the stage of the person with the disease. Two phases are usually considered: In the early phase the PD victims has faced some disabilities for which he needs pharmacological treatment, and in a second stage the sufferer develops motor complications related to levodopa usage. Treatment in the initial state tries to reach equilibrium between condensed dopaminergic therapy and well management of symptoms.

By and large, people take levodopa along with another medication called carbidopa. Carbidopa delays the body\’s adaptation of levodopa into dopamine until the levodopa get into the brain. This cut downs some of the side effects that often go along with levodopa therapy. Carbidopa also prevents the volume of desirable levodopa.

Segeline – It\’s an MAO-B inhibitor. MAO-B is an enzyme that degrades dopamine, therefore restraining this enzyme keeps longer effect of the dopamine in the brain.

Dopamine agonists– Dopamine agonists were initially is usually prescribed for patients experiencing on-off fluctuations and dyskinesias as a complementary therapy to L-dopa but they are now mostly used on their own as an initial therapy with the aim of delaying motor complications.

Agonists generate important, though mild, side effects like somnolence, hallucinations, insomnia, nausea, and constipation.

Anticholigernic medications – They obstruct nerve impulses that regulate muscle movement. They also block acetylecholine, a neurotransmitter that aids to control muscle movement. Anticholigernics work best in aged patients who are over 70 and their core symptoms are tremors and drooling.

Some surgical options–

Pallidotomy – This practice entails making a lesion in the globus pallidus. That is, devastating some of the cells in a specific part of the brain that controls movement. Pallidotomy has been found to lessen dyskenasias (involuntary movements) by 70%-90%.

Deep Brain Stimulation (DBS) – Involves implanting a small metal electrode into the brain. The electrode is then connected to a pulse generator which is stored and implanted in the chest subcutaneously (under the skin).It is believed that though DBS has limitations to treat Parkinson\’s disease, but it can weaken the drug induced symptoms. A programming device is used to regulate the pulse generator. This is all done wirelessly. At this phase, the physician only holds the device which controls the intensity of stimulation. The patient is provided with a device which determines whether the pace maker is on or off.

Thalamic stimulation
Pallidal stimulation
Subthalamic DBS

Speech therapy has been found to be effective for some Parkinson\’s Disease patients. It is employed to treat Dysarthrya (difficulty speaking) and Dysphagia (trouble in swallowing).

Diet

Muscles and nerves control the digestive process which may be affected by PD. It is natural for patients to experience constipation and gastroparesis. A balanced diet is hence suggested to improve digestion system. Patient should take high-fiber foods including whole grain breads and cereals as well as fruits and vegetables and plenty of water. They should avoid caffeine and alcohol and iron salts. Too much protein should also be avoided because it affects the absorption of Levodopa.

Future
Scientists and researchers are carrying on the research on PD and trying to explore the reasons of PD. They keep on searching for potential environmental factors, like toxins, that may cause the disorder. They study genetic factors to determine how defective genes play a role. A group of scientists are involved into the research on new protective drugs that can delay, prevent, or reverse the disease.