Parkinson's Disease: Symptoms, Causes and Treatment

The Parkinson's Disease Is a neurodegenerative disorder that affects the nervous system and impairs brain function.

Usually this disease is associated with motor symptoms such as tremor or stiffness due to its remarkable appearance.

However, this disease degenerates several brain regions, and can cause many more alterations than those connotan in the movement.

In this article we will talk about the characteristics of this disease, its causes and current treatments.

Characteristics of Parkinson's Disease

The first description of Parkinson's Disease (PD) was made in the year 1817 by the physician James Parkinson , Calling it"agitating paralysis".

Subsequently the neurologist Charcot Gave it the current name of Parkinson's Disease.

PD is a neurodegenerative disease that affects the nervous system, damaging the dopaminergic neurons of the Black substance . '

East Type of neurons (Modeled by a substance called dopamine) perform a large number of brain activities, among which the control of Voluntary movements.

However, the role of Dopamine And dopaminergic neurons of our brain is not limited to controlling motor functioning, also They intervene in other mechanisms such as memory, attention, reward, sleep, humor and inhibition of pain.

It is for this reason that although the main symptoms of PE are changes in movement, this disease can also produce another type Of symptoms related to the functioning of these dopaminergic neurons.

In addition, PE has also been shown to affect other substances beyond dopamine, such as Serotonin , the Noradrenaline Or acetylcholine, which Reinforce the idea that The parkinson Can produce a large number of alterations.

In the same way, PE is a chronic and progressive disease, that is, there is nowadays a treatment that allows the eradication of Parkinson's disease, and as a result That the disease progresses this is usually manifested with greater intensity.

It usually originates around the sixth decade of life, affects men more than women, and is considered the second disease Neurodegenerative disease.

Motor symptoms

As we have said, the main symptoms of this disease are those that have to do with the coordination of movements.

The control of voluntary movements is performed in our brain, through the dopaminergic neurons located in the substantia nigra of the encephalon.

When Parkinson's disease appears, the functioning of these neurons is altered and they gradually degenerate (the neurons of this zone They begin to die).

Therefore, Our brain It is losing mechanisms to perform this type of actions, therefore, the messages of when and how to move are Transmit in an erroneous way, fact that is translated in the manifestation of the typical motor symptoms of the disease.

These are:

1. Tremor

This is probably the main symptom of PD, since 70% of people with this disease present tremor as the first manifestation.

This parkinsonian symptom is characterized by tremor when you are at rest. That is to say: although the limbs can be still and without To perform any activity, they present tremor.

They usually appear in the extremities such as the arms, legs, hands or feet, but may also appear in facial areas, such as Jaw, lips or face.

This tremor is usually reduced by performing some specific activity or movement, and increasing in situations of stress or anxiety.

2. Bradykinesia

Bradykinesia is based on the slowness of many Parkinson's patients to perform the movements.

Due to the involvement of PD in dopaminergic neurons, the patient takes much longer to perform a task involving movement than Before the onset of the disease.

Bradykinesia can make it difficult to start movements, reduce their amplitude, or make it impossible to perform specific movements such as buckling Buttons, sewing, writing or cutting food.

3. Rigidity

PE causes muscles to become more stressed and rarely able to relax properly.

In this way, the muscles (usually of the extremities) appear more rigid, shorten their range of movement, reduce the ability to turn.

Also, being always in tension is more likely to experience pain and cramping, and when stiffness affects the muscles of the face Diminishes expressiveness.

4. Postural Instability

Finally, although this is the least noticeable symptom of PD, it can be the most uncomfortable for the person who suffers.

As Parkinson's disease progresses, patients may adopt a stooped posture, a fact that contributes to imbalance.

This alteration can lead to instability in the patient and, therefore, increases the risk of falls in normal situations such as getting up from A chair, walk or crouch.

Non-motor symptoms

1. Dementia

Between 20 and 60% of patients with PD end up with a dementia syndrome due to Parkinson's Disease.

This is because the degeneration that produces this disease and that is reflected in the motor symptoms, also it alters the operation of Brain mechanisms related to the person's cognitive abilities.

Parkinson's disease dementia is characterized by motor and cognitive impairment, dysfunction of the ability to perform, and impairment of Evocation memory (ability to retrieve information stored in the brain).

One of the first presentations of the dementia Caused by PE are the frontal alterations, especially it connotes a generalized slowing Of the mental processes (bradifenia).

Also, in many cases it also highlights a noticeable attention deficit and great difficulties to concentrate.

All this triggers a behavior characterized by the slowing down of cognitive tasks and an increase in the time of information processing, That is, patients with PE are less mentally agile and need more time to learn.

In later stages, there are visuoperceptive deficits (decreased ability to recognize stimuli), and memory deficits, especially Learning ability and the memory of past events.

As regards language, it becomes more monotonous and slower, and there may be problems in the articulation of words ( Dysarthria ).

Finally, in advanced stages, temporary disorientation (not remembering the day, the week, the month or the year in which one lives) and spatial (not knowing Facing the street). Personal guidance is usually preserved.

2. Depression

Patients with PE often experience fluctuations in the State of mind And on many occasions depression appears as a capital symptom.

In fact, between 25% and 70% of patients with Parkinson's disease have a Depressive mood sometime.

This fact explains why the dopaminergic system that degenerates the PD is closely related to the reward systems and therefore plays a role Fundamental in the establishment of the mood.

In fact, when a person eats when he is hungry, drinks when he is thirsty or performs any pleasurable activity a release of d Opamine in the brain, which produces a sense of well-being and gratification.

Thus, since PE produces a reduction of this substance in the brain, it is expected that patients with this disease will have a greater Tendency to suffer depression.

Depression caused by PD is characterized by high levels of dysphoria, pessimism and constant irritability, and anxiety testing.

However, Guilty thoughts , The self-reproach and the feelings of low self-esteem , Symptoms that are usually very Common in other types of depression.

The autolytic or suicidal idea is usually very present in PD depressions, whereas consummate suicide is very rare. Rarely They have delusions and when they do they are usually a side effect of the medication.

Also, the symptoms of depression in Parkinson's disease contribute to the person's lack of motivation for things, slows down even more Their movements and sharpen their lack of concentration, the slowing of thinking and alterations in memory.

3. Sleep disorders

The sleep disorders Are a typical problem in Parkinson's disease.

Its mechanisms of onset are unknown but it seems that this type of disorder could be caused in part by Parkinson's own disease, and In part because of the antiparkinsonian treatment that these patients receive.

Usually appears insomnia And fragmentation of sleep with frequent awakenings at night.

Difficulty in initiating or maintaining sleep may be a primary disorder associated with PD, whereas sleep fragmentation and Difficulties in maintaining sleep could be a side effect of medication.

Another problem also frequent in PD is daytime sleepiness, and may appear, although more occasionally, very vivid dreams and vocalizations Night.

4. Others

Apart from these symptoms, PD may present hallucinations and delusions of jealousy or prejudice, and disorders of impulse control such as Hypersexuality, Gambling , Compulsive shopping or binge eating.

Other less habitual presentations are the puding (to do a task or hobby of addictive form) and the syndrome of dopaminérgica deregulation (to take the Compulsory antiparkinsonian mediation).

Also, at the physical level, PE can cause constipation, increased sweating, dizziness, sexual dysfunction, urinary symptoms, loss of Smell, visual disturbances, fatigue, fatigue and pain.

Causes of Parkinson's Disease

The cause of Parkinson's disease is unknown at present, however, as with most neurodegenerative diseases, there is A certain consensus in dictating that its appearance is due to the combination of genetic and environmental factors.

As regards genetics, certain mutations have been discovered in different genes that appear to be associated with greater susceptibility to To develop Parkinson's Disease. Between 15% and 25% of patients have a relative with PD.

However, it seems that the genetic component only predisposes the person to develop the neurodegenerative disease and not to develop it.

It is therefore believed that certain environmental components seem to be also associated with PD and may act as risk factors. These are:

1. Aging: Age has been shown to be a clear risk factor for PE. The possibility of suffering from the disease increases markedly from 60
   years.

2. Male gender: Men suffer more PE than women so this could be another risk factor for the disease.

3. Head injury: Numerous cases of PD among boxers have been connoted, which seem to have a clear relation between injuries and blows suffered in
   The brain area with the development of the disease.

4. Exposure to pesticides: These toxic chemicals can cause Parkinsonian symptoms and therefore represent a very high risk factor for PD.

Treatment

Parkinson's disease has no cure but can be effectively controlled through the following interventions, evidently under supervision Of a medical professional:

1. Antiparkinsonian drugs: Act on the nervous system to increase or replace dopamine. Levedopa is the most effective for treating PD and allows control of symptoms Engines.

2. Deep Brain Stimulation (ECP): Is a surgical treatment that may reduce some symptoms of PD. It is performed by electrodes that administer electrical stimulation in brain. It should be performed only in advanced stages.

3. Cognitive stimulation Perform exercises that work the cognitive functions of the patient (memory, attention, executive functions, etc.). Prevent the emergence of
   Dementia and decrease the progression of cognitive impairment.

4. Exercise and physiotherapy: A fundamental part of the rehabilitative treatment of PD, will attenuate the motor symptoms and slow movement.

5. Occupational Therapy Allows the patient to maintain its functionality, remain autonomous, learn to coexist with their Parkinsonian symptoms and can enjoy more Of their leisure activities.

6. Psychotherapy: To treat possible symptoms of depression, apathy , Stirring or anxiety Which produces PE.

References

1. Parkinson's disease: Current scientific evidence and future possibilities. P.J. García Ruiz. Neurologist. 2011 Nov; 17 (6 Suppl 1): S1. Doi: 10.1097 / NRL.0b013e3182396454.
2. Official guide to clinical practice in Parkinson's disease. Spanish Society of Neurology, 2010.
3. Iranzo A, Valldeoriola F, Santamaria J, Tolosa E, Rumia J. Sleep symptoms and polysomnographic architecture in advanced Parkinson's disease after chronic
   Bilateral subtalamic stimulation. J Neurol Neurosurg Psychiatry 2002; 72: 661-4.
4. Obeso J.A., Rodríguez-Oroz M.C., G. Evolution of Parkinson's disease. (1999). Actual problems. In:"Neuronal death and Parkinson's disease". J.A. Obeso, W.W. Olanow, A.H.V. Schapira, E. Tolosa (editors). Adis. Madrid, 1999; Chap. 2, pp. 21-38.
5. Olanow CW, Stern MB, Sethi K. The scientific and clinical basis for the treatment of Parkinson's disease. Neurology 2009; 72 (Suppl 4): S1-136.
6. Perea-Bartolomé, M.V. (2001). Cognitive impairment in Parkinson's disease. Rev neurol. 32 (12): 1182-1187.