Parkinson's disease: what it is and how it manifests itself

Parkinson's Disease is a chronic neurodegenerative disease that primarily affects the motor system.

Described by British physician James Parkinson in 1817, it is characterized by progressive loss of motor function, tremors at rest, muscle rigidity, slowness of movement (bradykinesia) and postural instability. It usually occurs after age 60, but can occur even before age 50.

It is caused by the degeneration of dopaminergic neurons in the substantia nigra, a region of the brain critical for movement control. Dopamine deficiency leads to ineffective communication between nerve cells, resulting in typical motor symptoms. In addition to motor symptoms, Parkinson's may present with non-motor symptoms such as depression, sleep disturbances, and cognitive impairments.

Parkinson's disease: Symptoms, Causes and Diagnosis

Symptoms

The symptoms of Parkinson's Disease can vary greatly among patients and are divided into motor and non-motor. The main motor symptoms include:
- Resting tremor: an involuntary shaking that generally starts in one hand or arm.
- Bradykinesia: slowness in voluntary movements and difficulty initiating movements.
- Muscle stiffness: resistance to passive limb movements.
- Postural instability: balance and coordination problems that can lead to falls.

Non-motor symptoms may include:
- Sleep disorders: such as insomnia, fragmented sleep and nightmares.
- Cognitive problems: memory decline and difficulty concentrating.
- Depression and anxiety: common in patients with Parkinson's disease.
- Autonomic dysfunction: constipation, urinary problems, and orthostatic hypotension.

Causes

The precise causes of Parkinson's Disease are still being studied, but a combination of genetic and environmental factors are believed to contribute to the development of the disease. Specific genetic mutations, such as those in the LRRK2 and PARK7 genes, have been identified in a small percentage of cases, indicating an inherited predisposition in some families. The SNCA gene, which codes for the protein alpha-synuclein, is also involved in the formation of abnormal protein aggregates in the neurons of Parkinson's patients.

Environmental factors such as exposure to pesticides, herbicides and other chemical toxins can significantly increase the risk of developing the disease. Studies have shown a correlation between these exposures and the incidence of Parkinson's disease, suggesting that the environment plays a crucial role in the pathogenesis of the disease.

In addition, advanced age is a major risk factor, with the incidence increasing significantly after age 60. This could be due to the natural reduction of dopamine in the brain that occurs with aging, making individuals more vulnerable to degeneration of dopaminergic neurons.

Diagnosis

The diagnosis of Parkinson's Disease is based primarily on a clinical evaluation of symptoms by a neurologist. There are no specific tests for a definitive diagnosis, but tests such as magnetic resonance imaging (MRI) and positron emission tomography (PET) can rule out other conditions. Brain scintigraphy with DatSCAN can detect a reduction in the dopamine transporter, but it is not definitive and is used in conjunction with other evaluations.

Positive response to dopaminergic medications, such as levodopa, is often a strong diagnostic indicator. If symptoms improve with these medications, the diagnosis of Parkinson's is likely to be correct. Evaluation of the medical history and observation of symptoms over time are crucial to an accurate diagnosis.

In addition, research is exploring the use of biomarkers to improve diagnosis of the disease. Some promising biomarkers have been identified, such as proteins in cerebrospinal fluid and genetic markers, but these studies need further investigation. The goal is to find reliable biomarkers to facilitate early diagnosis and monitor disease progression.

Parkinson's Disease Therapies and Treatments

The drug treatment is critical to managing the symptoms of Parkinson's disease. Levodopa is the most effective drug, converting to dopamine in the brain and relieving motor symptoms. However, over time, the effectiveness of levodopa may decline, leading to motor fluctuations and dyskinesias. Other drugs include dopamine agonists, MAO-B inhibitors and COMT inhibitors, which help prolong the effect of levodopa.

For patients who do not respond adequately to medication, deep brain stimulation (DBS) can be an option. This treatment involves implanting electrodes in the brain that emit electrical impulses to regulate motor functions. DBS can significantly reduce symptoms and improve patients' quality of life.

In addition to conventional treatments, many people with Parkinson's find benefit in complementary therapies such as physical therapy, occupational therapy and speech therapy. These treatments help maintain mobility, improve voice quality and facilitate daily activities. Regular exercise is especially important to maintain muscle function and improve balance.

Innovative therapies for Parkinson's disease include, the AMPS Gondola Therapy (Automated Mechanical Peripheral Stimulation) is gaining attention. This noninvasive therapy uses a special device that mechanically stimulates specific points on both feet, sending impulses to the brain that increase functional connectivity between brain areas involved in movement. This leads to improved gait and balance, consequently reducing the risk of falls and freezing episodes. Clinical studies have shown that Gondola AMPS therapy can help improve walking, balance, and stability in patients with Parkinson's disease, providing an additional tool for managing the disease.

Research and the Future of Parkinson's Disease Treatment

Parkinson's Disease research is constantly evolving, with new studies seeking to better understand the causes of the disease and develop innovative treatments. Gene therapies and stem cell approaches are the focus of much research, with the goal of repairing or replacing damaged neurons. In addition, studies are underway to develop new drugs that can slow disease progression rather than simply relieve symptoms.

The use of technology is opening new avenues for monitoring and treating Parkinson's disease. Wearable devices and mobile applications can help patients manage their symptoms and share data with physicians.

Parkinson's is a complex and debilitating disease that requires a multidisciplinary approach to its management. With continued research and innovation in treatments, there is hope for improving patients' quality of life and eventually finding a cure. Early diagnosis and individualized treatment are critical to best cope with this disease. In addition, psychological and social support plays a crucial role in supporting both patients and their families in the management of Parkinson's disease.