The text is presented for informational purposes only. We urge you not to self-medicate. When the first symptoms appear, consult a doctor. Recommended reading: " Why not self-medicate?". Parkinson's disease is a neurological disease with slow progression, which most often occurs in the elderly. Parkinson's disease is also referred to in medical sources as idiopathic parkinsonism syndrome, or "shaking paralysis". This is a degenerative disease in relation to the extrapyramidal motor system, caused by the death of brain neurons that produce the neurotransmitter dopamine, which leads to the activation of the influence of the basal ganglia on the cerebral cortex.
Classification of the disease
Parkinson's disease is one that doctors can identify in patients worldwide. The disease can be classified according to many criteria - the age when the first signs of the disease began to appear, manifestations, stages of the course, and so on. Knowing the basics of the classification of parkinsonism helps to develop the right tactics for treating the disease in the early stages.
- Disease classification
- Causes and mechanism of development
- Main manifestations
- Progression of the disease and its severity
- Diagnosis of the disease
- Principles of treatment
- How to avoid pathology
- Recommendations for patients
- Complications and consequences
- How long patients live
- Disability in Parkinson's disease
According to the age of onset of the disease
Many elderly people suffer from Parkinson's disease, after 65 years this diagnosis is heard by 1% of the entire population of the planet, and after 85 - more than 2.5% of people. On average, the disease begins in patients after 55 years of age, but there are cases of early-onset parkinsonism - in 10% of all cases known to science, the disease occurred before the age of 40, or even before the age of 20, which indicates juvenile parkinsonism.
Juvenile parkinsonism should be understood as early genetically determined parkinsonism that occurs before the age of 20-25 years. The clinic of such a pathology manifests itself with symmetrical static and kinetic tremors, dyskinesia, pyramidal signs, and intellectual preservation. Juvenile pathology is a hereditary disease of the central nervous system, which is transmitted genetically through autosomal recessive mechanisms. Hereditary character is the main difference between juvenile pathology and standard Parkinson's disease, which is caused by multifactorial etiology. After the discovery of the Parkin gene in 1998, the introduction of DNA diagnostic techniques for defects in this gene into medicine allowed specialists to detect cases of juvenile parkinsonism much more often. The prevalence of this pathology has no territorial restrictions, in terms of gender - it is more common in women.
Early-onset parkinsonism is a disease that occurs in people under 45 years of age, most often due to genetic factors. An association of Parkinson's disease with some gene polymorphisms of xenobiotic detoxification, in the system of antioxidant cellular defense, in the metabolism of dopamine, in the process of lipid metabolism has been established. When the carriage of allelic genes is detected, the risk of developing Parkinson's disease in the body increases, and a hereditary predisposition to pathology arises. The combination of unfavorable polymorphisms provokes an early manifestation of the disease. It is important to understand that it is at a young age that genetic predispositions most often become the causes of Parkinson's disease, while in the elderly this pathology is more often provoked by environmental and other factors.
Late onset Parkinson's disease is considered to occur after the age of 85 without any previous symptoms.
According to the manifestations of the disease
Depending on the manifestations and symptoms of the disease, the pathology under consideration can be divided into:
- a trembling form, which is very characteristic of a tremor of the head, limbs, lower jaw with high or medium amplitude, as well as increased (sometimes normal) muscle tissue tone;
- a tremor-rigid form, in which tremor occurs in the distal extremities and, as the disease progresses, stiffness during voluntary movements is added;
- akinetic-rigid form (the most unfavorable of all), in which the activity of the patient's movements drops sharply, often reaching immobility, and muscle tone rises sharply, which threatens to cause muscle contracture;
- a mixed form, in which all of the above forms can appear both together and flow into one another;
- an atypical form characterized by synucleinpathies ( dementia with Lewy bodies, idiopathic parkinsonism, and others) or taupathies (corticobasal dementia, supranuclear gaze paresis, and others).
Each form of Parkinson's disease, in addition to differences in presentation, may require specific therapy and patient care.
Causes and mechanism of development
The causes of Parkinson's disease do not always provoke the disease directly, more often under their influence, a syndrome of parkinsonism is formed, which responds well to treatment, unlike the main form of the disease. Among the main causes of Parkinson's disease are:
- damage to high doses of free radicals of the substantia nigra;
- highly toxic damage to the meninges, which can occur during periods of poisoning, with internal intoxication due to the release of toxins from the liver;
- heredity, which manifests itself in about 20% of cases of all diagnosed pathologies of this kind and has an indirect effect on the occurrence of the disease;
- a genetic factor in which the presence of mutated genes in the genetic code provokes parkinsonism at a young age;
- deficiency of vitamin D, which is responsible for building protective barriers that prevent the penetration of free radicals and toxic substances into the body, the lack of which becomes especially noticeable in old age;
- inflammations provoked by bacterial or viral infection, such as encephalitis and others;
- brain injuries of various degrees of severity;
- high cholesterol provoking atherosclerotic changes;
- degenerative brain processes due to impaired blood circulation.
All of the above factors can form the etiology of the disease, but they are not stable in this matter and do not always provoke such processes.
The mechanism of the development of the disease at the initial stage is characterized by a decrease in the production of dopamine, which provokes changes in the brain. Degeneratively altered areas of the brain begin to die, which leads to the characteristic symptoms of the disease. At the onset of the disease at a young age, it should be understood that the cause of the processes is hereditary factors, and with a late onset of the disease, in the vast majority of cases, it is worth keeping in mind the mechanism for the development of pathology due to various external influences on the patient's body.
Despite the fact that the clear causes of Parkinson's disease have not yet been identified, the ways of diagnosing and treating the pathology have long been known, they are determined in each case individually and often help to maintain the patient's condition at the proper level.
The main manifestations of Parkinson's disease are considered to be tremor, hypokinesia, muscle rigidity and postural instability, as well as mental and autonomic disorders.
Tremor or trembling is the most obvious and pronounced symptom of the disease, which most often disturbs a person at rest, but can also occur as a postural or intentional manifestation. The frequency of tremor in parkinsonism reaches 4-6 movements per second. The tremor usually begins with the distal part of either arm, and in the course of progression spreads to the second arm and both legs. The movement of the patient's fingers during tremor may outwardly resemble the counting of coins. A tremor of the head may also occur, manifested by “yes-yes” or “no-no” movements, trembling of the eyelids, jaw or tongue. Very rarely, a tremor in parkinsonism covers the entire body. Most often, it increases in stressful situations, it can usually be seen in a patient at rest, and when moving, the trembling subsides or disappears completely.
Hypokinesia is understood as a decrease in the level of spontaneous activity of movements, which results in many hours of immobility of the patient.
There is stiffness in the human body, he can actively move only after some delay and then at a slower pace (characterizes the resulting bradykinesia). The steps of a person become small, the gait is puppet, while the feet are clearly parallel to each other. At the same time, the patient's facial expression and gaze are frozen, there is a pronounced amimia, a smile, and a crying grimace appears on the face very slowly, inhibited.
The person often freezes in the pose of a mannequin. His speech is monotonous and gradually disappears. The handwriting becomes intermittent and small, which characterizes the development of micrography. Also, as a manifestation of hypokinesia, oligokinesia and synkinesia can occur, that is, a reduction in the total number of movements and the disappearance of friendly movements in the patient, such as sweeping hand movements when walking, wrinkles of the forehead when looking up, and so on. The patient can no longer perform parallel actions, all his movements become automatic.
Rigidity of muscle tissue is manifested by a uniform increase in muscle tone of the plastic plan. In this case, the limbs freeze in a bent position or in a fully extended state, which is a manifestation of plastic wax flexibility. If rigidity begins to predominate in some muscle groups, then a pose of a mannequin or petitioner occurs, in which stoop is expressed, the head is tilted forward, the arms are half-bent at the elbows and pressed against the body, and the legs are half-bent at the hip and knee joints. If you try to passively bend and unbend the wrist joints, forearms, you can feel the gradation of muscle tension or the “cog wheel” symptom.
With a change in muscle tone, the limbs can no longer spontaneously return to their original position after any action performed. This characterizes the occurrence of the Westphal phenomenon, when, with a sharp dorsiflexion of the foot, it remains in this position for some time and does not unbend on its own.
Postural instability occurs in the later stages of the disease. The patient cannot spontaneously overcome either the inertia of rest or the inertia of movement; can hardly start moving, and once started, can no longer stop. When moving forward, the body begins to outstrip the legs, the center of gravity in the body is disturbed, there is a loss of stability and the person falls. This symptomatology can resolve itself after sleep or under the influence of other factors, but after some time it returns again.
In addition to impaired motor activity in patients with Parkinson's disease, mental and vegetative disorders are usually pronounced, metabolism is disturbed. As a result, the patient may experience obesity, malnutrition, increase the secretory activity of the sebaceous, sweat and salivary glands.
Progression of the disease and its severity
Parkinson's disease tends to progress and the overall prognosis of the disease largely depends on the degree of such progression. Pathology can have a fast rate of progression, when the stages of the disease follow each other for 2 years, a moderate type of progression, if the change of stages occurs over 5 years, and a slow rate, at which the change of stages of Parkinson's disease occurs no more than once every 5 years, or less often.
The inevitability of the progression of pathology necessitated a detailed study of its stages, each of which has its own symptoms and signs and requires specific therapy. The classification of the stages of parkinsonism was adopted in medicine as early as 1967 and since then it has only been slightly adjusted. To date, the classification of the disease includes 6 main stages:
- Zero degree of Parkinson's disease has no obvious signs. Asymptomatic course provokes its aggravation due to the lack of timely treatment. At the same time, many do not pay attention to such signs of the zero stage as forgetfulness, obsession and other signs that, in the understanding of an ordinary person, are not symptoms of the disease. However, if you pay due attention to them and start timely treatment, the progression of the disease can be stopped, preventing its development.
- In the first degree of the disease, one-sided damage to the body or limbs in a mild form may occur, due to which patients and their environment also rarely pay attention to these pathological changes and do not start treatment.
- The second degree of parkinsonism is characterized by the gradual addition of pathological processes in the second half of the body or limbs. Again, the second degree proceeds in a mild form, so it is rare for any of the patients, even at this stage, to pay attention to their own health and go to the doctor. In the second degree of parkinsonism, the balance is completely preserved and there are no postural symptoms.
- When the disease progresses to the third stage, patients may begin to complain of some restrictions in the performance of work or movements, however, these restrictions do not affect daily life, therefore, in the vast majority of cases, this stage remains almost unnoticed and untreated.
- At the fourth stage of the disease, all the symptoms that had previously appeared in a mild form sharply increase, which leads to the patient losing independence in actions and movements. In the fourth stage of parkinsonism, people do not have problems with standing, but there are already problems with movement.
- The fifth degree of Parkinson's disease is the most severe and difficult to treat, since a person without outside help becomes literally bedridden, he is completely unable to do without outside support, his body ceases to obey him.
Diagnosis of the disease
Parkinson's disease is more characteristic of the elderly and is irreversible, but diagnosis is necessary to maintain a normal level of the patient's vital activity and timely selection of appropriate treatment. Early diagnosis in this aspect plays a key role.
The diagnosis of Parkinson's disease is easily made even on the basis of external symptomatic manifestations of the disease. The difficulty lies in the fact that other neurological pathologies can have similar symptoms, so doctors are in no hurry to make a diagnosis without examinations. The more complete the picture of the course of the disease, the more effective the therapy will be selected and the longer the patient will live, while maintaining the quality of life.
Still, the main method for diagnosing parkinsonism is the clinical picture of the disease. All data indicating the occurrence of this pathology, the specialist takes into account and considers in a complex. Topical diagnosis of Parkinson's disease is also often carried out, which is a complex diagnosis, with the help of which the localization of the pathological focus in the patient's brain or a complex of such foci is easily determined. The basis for topical diagnosis is often the clinical picture of the disease. In addition, there are other methods for diagnosing parkinsonism, an important place among which is differential diagnosis.
The differential diagnosis of Parkinson's disease implies a very careful consideration of clinical data and their study. The fact is that if there are no pronounced symptoms of parkinsonism in the patient's history, then making a diagnosis can become a whole problem for the doctor.
It is important to differentiate a patient's symptoms from those of chronic depression, post-stroke, and other pathological conditions.
At the same time, it is important to understand that in medicine today there are no special tests that can be used to determine Parkinson's disease. The importance of differential diagnosis is determined by the fact that it must be carried out regularly between courses of treatment in order to understand their effectiveness and timely make competent adjustments to them.
Diagnosis of the disease using MRI
To confirm the diagnosis of parkinsonism at any stage of the disease, you can perform MRI of the brain of the patient, since the death of nerve cells in degenerative changes is reflected by a change in visualization in the form of characteristic radiological signs.
In addition, MRI does not use X-rays, which can have a negative effect, this examination is non-invasive, since no human tissues and structures are damaged during the course. Magnetic resonance imaging is completely painless for people. To make the MRI result more informative, sometimes special contrast agents are used during diagnostics, which are introduced into the body by intravenous injections. Contrast increases the information content of the MRI, and based on such data, it is possible to make a more accurate diagnosis and prescribe effective treatment.
Principles of treatment
Effective treatment of Parkinson's disease requires timely diagnosis and appropriate therapy. Comprehensive treatment of this pathology implies a whole range of measures:
- the use of drug therapy, which, in addition to symptomatic drugs, must necessarily include the use of neuroprotectors;
- rehabilitation procedures, including medical and social means;
- neurosurgical methods of intervention.
Modern medicine in the treatment of Parkinson's disease adheres to two main principles - to prevent the development of the disease by stopping the process of degeneration of brain tissue and to eliminate the symptoms of the disease so that the patient begins to feel much better. Both of these goals should be achieved taking into account the degree of development of the disease in the patient.
How to avoid pathology
The mechanism of the development of the disease is the process of death of brain cells in those parts of the brain where dopamine is produced. Most often, according to experts, the process is caused by age-related changes, and the occurrence of pathology due to other diseases is rarely detected. This suggests that at any age it is necessary to monitor your body, maintaining all its functions in working order. These actions will act as a prevention of parkinsonism.
The most important aspect of disease prevention is proper human nutrition.
With the help of food, you can maintain the health of the cardiovascular system in a normal state, prevent atherosclerotic changes, fully nourish brain cells that produce dopamine and other substances that are important for the functioning of the body.The text is for reference only. We urge you not to use diets, do not resort to any medical menus and fasting without medical supervision. Recommended reading: " Why you can't go on a diet on your own". The diet for the prevention of Parkinson's disease includes the following aspects:
- you should constantly eat a lot of fresh vegetables, greens and fruits, bran, whole grains, which accelerate the process of peristalsis and prevent constipation ;
- high protein foods should not be eaten while taking Levodopa, as proteins reduce the effectiveness of such treatment;
- should monitor their own weight, for which it is necessary to exclude from food, if possible, simple carbohydrates and excess amounts of fats.
If you eat according to these principles, you can not only prevent the development of the disease, but also preserve the beauty and youth of all body systems for a long time, increase efficiency at any age.
In order to prevent parkinsonism, doctors recommend not to forget about physical activity. It is important to be in the fresh air often, lead an active lifestyle, do gymnastics or engage in any sport in order to improve the oxygen supply of all tissues. At the same time, the process of blood circulation is stabilized and the performance of brain structures improves.
Throughout life, and especially in retirement age, it is important to regularly and continuously load your brain with work. And if in youth people most often work, and there is no need for additional brain training, then after retirement, many people stop paying attention to this, but in vain. It is important to solve crossword puzzles, learn something new, create something with your own hands.
Preventive procedures for the occurrence of parkinsonism must necessarily include immune-strengthening measures. With a weakened immune system, many viral diseases weaken the body, and after that all sorts of complications often arise, as a result of which the meninges can be affected. This process can often be irreversible, so stimulation of the immune system should also be given enough attention.
Advice for Patients
Eating properly when diagnosed with Parkinson's disease is essential. The diet should largely correspond to the one that was named as the prevention of the disease. First of all, you can not eat foods that provoke constipation. It is better to enrich the diet with fiber, which contributes to the improvement of the digestive system. It is also very important to observe the drinking regimen and consume enough liquid for the full viability of the whole organism.
Blood clotting due to lack of fluid provokes thrombosis, which, in turn, leads to disruption of the normal functioning of the vascular system and, as a result, in some cases, to the death of brain cells.
The menu for Parkinson's disease should be varied, the products should contain a full range of vitamins and minerals. Alcohol and tobacco are categorically contraindicated, especially in case of parkinsonism in old age with a history of concomitant pathologies.
Among the main contraindications in Parkinson's disease is the use of drugs without a doctor's prescription. With this pathology, before prescribing medications, the specialist necessarily conducts a comprehensive examination of the patient's body, identifies related problems and prescribes medications that will not contribute to the strengthening or occurrence of other diseases. Certain anti-Parkinsonian medicines are used to treat Parkinson's disease. These include dopamine activators, which inhibit the process of brain cell death. However, it must be remembered that some other drugs can block the production of dopamine or inhibit the activity of the brain receptors responsible for its performance in the body.
Among such drugs, experts distinguish:
- vasoactive drugs (cinnarizine);
- antipsychotics (torekan, haloperidol);
- antihypertensive drugs (Adelfan).
In addition to not taking the above remedies, it should be remembered that taking any treatment, even non-drug (folk), must be agreed with the doctor. It is also categorically impossible to cancel the drugs prescribed by a specialist without permission.
Any interference with the treatment regimen for Parkinson's disease is a contraindication. All patients should remember that they should not perform physical exercises that require sudden movements, or perform such gymnastics where hypodynamia will prevail. Any physical activity in parkinsonism should prevent the process of tissue atrophy in the patient's body.
Complications and consequences
As a result of Parkinson's disease, a patient can face a whole range of consequences. All of them are provoked directly by the disease and lead to various pathologies, or to the progression of parkinsonism itself.
The presence of tremor in patients alters the appearance of patients and their behavioral responses. With muscle disorders, a person loses a significant proportion of facial expressions, his appearance acquires features of indifference. Stiffness and rigidity of muscle tissues contribute to awkward postures of a person in which he is comfortable, but which look rather strange. Disorders of the nervous system provoke the occurrence of seizures, insomnia, constipation, hallucinations and even dementia.
The consequences of Parkinson's disease are largely determined by the stage of its course. Some forms of the disease are not so dangerous, others often lead to the rapid development of pathology.
With competent support of the patient, it is possible to ensure his life with a minimum of changes due to illness. People do not die from Parkinson's disease, but complications of the disease provoke death. Even an elementary cold in the last stage of parkinsonism can lead to bronchitis and pneumonia, from which a person can die.
How long patients live
Parkinson's disease itself does not cause the patient's death, but it greatly impairs the quality of life and can lead to disability. Among the main causes of death in parkinsonism patients are such processes as:
- dysphagia or choking ;
- infectious diseases with complications;
- cardiovascular pathologies;
- somatic changes;
- neuroleptic syndrome due to chronic use of Levodopa.
With respect to Levodopa, it is worth noting that in general, the life expectancy of patients who use this treatment is several times higher than that observed in people without such therapy.
The basis for the prognosis of life expectancy in the detection of parkinsonism is the degree of progress and stage of the patient's disease, as well as the age at which the disease made itself felt. Symptoms of the disease can grow over many years, gradually leading to disability. However, everything is individual and is largely determined by the effectiveness and timeliness of the treatment started. Many patients with Parkinson's disease live for more than 20 years, and at the same time, death occurs not from the disease or its complications, but due to the natural aging of the body.
The prognosis for a complete recovery is poor, since Parkinson's disease cannot be completely eliminated to date. All therapy for this pathology is not aimed at overcoming it, but at delaying the progress of the clinical picture and inhibiting the process of death of neurons in the patient's brain.
Disability in Parkinson's disease
Disability in Parkinson's disease occurs when a person's movements become noticeably limited due to pathology. Due to the development of this pathology, the patient loses not only working capacity, but also the possibility of self-service. However, in the early stages of parkinsonism, patients are not classified as disabled. If their physical work becomes no longer possible, they are offered to change their profile of activity and find a more suitable job for themselves, taking into account the development of the disease.
However, in some cases, the assignment of a disability group for Parkinson's disease is absolutely necessary. This is necessary if a person has progressive impairment of motor activity and is no longer able to do his job, as well as in the case of a very sharp progression of the disease, the need for social protection, the ineffectiveness of the therapy.
To register a disability group for Parkinson's disease, it is necessary to collect such documents as the results of MRI, ECG, CT, written opinion of a psychologist and therapist. It is also necessary to undergo a special study to assess the autonomic system and its functionality and provide documentary evidence of this study. Sometimes the commission may require other documents that will characterize other diseases in the patient's history.
In case of parkinsonism, ITU can assign 3 disability groups. The first group is given to patients with a severe form of the disease, severe restrictions in movement, and also, if necessary, undergoing psychiatric treatment in a hospital. The second group is assigned to those patients who have been diagnosed with an average form of parkinsonism, however, restrictions on motor activity do not allow the patient to fully work and provide and serve themselves independently. The third group of disability is given to those patients who have been diagnosed with moderate parkinsonism, however, motor restrictions allow only partially performing habitual actions.
It is important to understand that disability in Parkinson's disease is most often given if the patient has had the disease for at least 5 years.
- GBUZ “GP No. 2 DZM”. – Parkinson's disease - causes, signs and symptoms, treatment of Parkinson's disease.
- MSD Handbook. – Parkinson's disease.
- Scientific Center of Neurology. – Parkinson's disease.