Parkinson's Disease

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Aging is one of the sad realities of life. With growing age when an individual exceeds in knowledge and wisdom, he/she also gets weaker and falls prey to many diseases. Aging is a result of cellular damage occurring with the passage of time. Parkinson’s disease is among several age-related diseases and is the second most common neurodegenerative disease around the globe.

This disease is named after James Parkinson, who was a British physician, and first diagnosed it in the year 1817 and described it in his writing “An essay on the Shaking Palsy”. It is a progressive disease in which dopaminergic neurons have deteriorated mainly in a specific region of the brain called substantia nigra, which is critically important in controlling the motor functions of the body. This neurodegeneration of causes a deficiency of dopamine in CNS. Dopamine is a neurotransmitter responsible for carrying signals between neurons and its deficiency results in decreased control of muscular movement. This neuronal damage and formation of Lewy bodies are the main pathological conditions found in Parkinson’s disease. Lewy bodies are abnormal clumps and aggregates of proteins formed inside neurons, blocking regular neuronal transmission. The hallmark of Parkinson’s disease (PD) is tremors which makes a patient’s life difficult.


Symptoms:

Generally, the symptoms appear gradually over years and they develop differently in different patients. The most common symptoms include uncontrolled tremors, impaired balance, bradykinesia (rigid body), dementia (loss of memory), slurred speech, insomnia, depression, gait abnormalities and mood swings. 


Causes:

The main cause of Parkinson’s disease is still unknown and under investigation. The scientists believe that it includes many pathways and multiple genetic and environmental factors are involved in pathogenesis. Irregular proteostasis, oxidative stress, mitochondrial dysfunction, imbalance calcium homeostasis and neuroinflammation are some of the possible reasons for PD. Some genes have also been reported to involve.


Diagnosis:

Any test cannot specifically diagnose PD. It is usually diagnosed by the medical history and clinical examination of the patient. Analysis of speech, handwriting and movement of the body is done for diagnosis. Nowadays different neuroimaging techniques such as MRI, PET and SPECT are also employed to identify the changes in brain occurred due to parkinsonism. Scientists are doing research to identify certain biomarkers so that it can be diagnosed earlier and the loss due to PD can be minimized. Unfortunately, the disease is diagnosed at the stage when several dopaminergic neurons have lost as the progression of symptoms is very slow.


Complications:

Although Parkinson’s disease is not fatal but different complications caused by PD is quite dangerous. According to the Centre of Disease Control and Prevention (CDC) PD is ranked as the 14th highest cause of deaths in the US. Generally, it is considered only as a disorder of motor activity but other than movement disabilities it also causes sleep disorders, loss of smell and taste, digestive problems, constipation, impaired cognition and depression. The severity of Parkinsonism is evaluated using Hoehn and Yahr Scale1. This rating method has described five progressive stages of PD.

  • Stage 1: It is the first stage of PD and symptoms are very mild. Functional disability is minimal and only on one side of the body. The first stage symptoms are often unnoticed and usually the disease is not diagnosed at this stage. 
  • Stage 2: The disease progresses to produce symptoms at both sides of the body i.e., bilateral or at the midline of the body but the patient is still able to keep the balance of the body. 
  • Stage 3: At this stage, the patient develops impairment in balance and moderate disability and symptoms are so visible that disease is easily diagnosed. Even at this stage the patient is independent in performing personal tasks such as brushing teeth, washing and eating.
  • Stage 4: The disease has progressed to severe disability. At stage four patient start getting dependent on others. But still can walk and stand without assistance but may need a helper.
  • Stage 5: The patient gets bound to a wheelchair or completely bedridden.

Treatment:

No any drug or therapy is available for the treatment of PD but symptomatic treatments are given to improve the quality of life in suffering patients. Basically, different drugs are given to manage disease progression. Levodopa is considered as the most effective medicine in Parkinsonism2, it is a precursor of dopamine and converts into dopamine in CNS and delays the progression of the disease. Carbidopa is also prescribed along with levodopa and it prevents the breakdown of levodopa in the periphery and makes it easier to cross the blood-brain barrier. But this treatment also cannot be given for long-term as it produces some severe side-effects.

As the disease is uncurable the major challenge is to support the patient emotionally and carefully so that he/she may not feel alone or may not fall into severe depression which further reduces the life expectancy. So, if you find your elders at such a condition treat them with your love and affection so that they can also enjoy their lives.

 

By: Mehwish Hamid


References:

  1. Hoehn, M. M., & Yahr, M. D. (1967). Parkinsonism: onset, progression. and mortality. Neurology, 50(2), 318-318.
  2. Ferreira, J. J., Lees, A., Rocha, J. F., Poewe, W., Rascol, O., & Soares-da-Silva, P. (2015). Bi-Park 1 investigators. Opicapone as an adjunct to levodopa in patients with Parkinson’s disease and end-of-dose motor fluctuations: a randomised, double-blind, controlled trial. Lancet Neurol, 15(2), 154-165.
  3. Poewe, W., Seppi, K., Tanner, C. M., Halliday, G. M., Brundin, P., Volkmann, J., Schrag, A. E., & Lang, A. E. (2017). Parkinson disease. Nature reviews. Disease primers, 3, 17013. https://doi.org/10.1038/nrdp.2017.13



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