Updated on 06/07/2022
Parkinson's Disease (PD) is a brain disease that affects movement. It progresses over time and can also affect other brain functions such as learning and memory. However, the speed of this progress varies greatly from person to person. Many Parkinson's patients who receive treatment may experience no disability for many years.
Photo: Altan Akay
The cause of PD is unknown. Normally, some cells in the brain make a chemical called dopamine that helps control movement. In Parkinson's patients, nerve cells slowly lose their function and become unable to produce dopamine. As a result, the manifestations of PD develop gradually and progress over time. It is not known why these nerve cells lose their ability to function properly.
About 10-15% of people with PD have a first-degree relative (such as a mother, father, or sibling) with PD. A very small minority has familial transmission. Genetic mutations may play a role, especially in the disease that occurs at a young age.
PD is more common in men over 50 years of age.
PD causes mild symptoms at first. As the disease progresses, the symptoms may affect the person's work life and daily living activities. The signs and symptoms of PD can be roughly divided into motor and non-motor. Motor signs are those that affect movement. Main motor manifestations of PH are as below;
1. Tremor
2. Slow movement
3. Rigidity
4. Loss of balance or difficulty walking
Symptoms typically begin on one half of the body and spread to the other side within a few years.
The tremor is more pronounced when the person is at rest. It is initially intermittent and may not be noticed by others. When it becomes visible it is usually in one hand and is in the form of a money counting gesture. Anxiety, stress, and excitement can increase tremor. Other body parts such as legs, chin, lips or tongue may be affected. However, the PD tremor does usually not manifest in the head.
Slow movement develops in all Parkinson's patients. It can affect everyday movements such as button fastening, double-clicking a computer mouse, typing, getting up from a chair, and walking.
Rigidity may occur in the arms, legs, and trunk and may begin on one side of the body, like other early signs.
Normally, there are automatic reflexes in the brain that help us to keep our balance. In Parkinson's patients, these reflexes are impaired, and as a result, the balance disorder we call postural instability and a tendency to fall occur. However, these findings occur in advanced stages of PD. If postural instability occurs early, the diagnosis of PD should be suspected.
PD can also cause other non-motor symptoms in some people;
1. Loss of sense of smell
2. Loss of ability to think clearly
3. Hallucination
4. Feeling depressed, anxious, or losing interest
5. Sleep problems and daytime sleepiness
6. Fatigue
The autonomic nervous system controls unconscious or automatic functions in our body, such as heart rate, digestion, respiratory rate, sweating, urination or sexual functions. The disease can also lead to autonomic dysfunctions such as constipation, sweating disorder, swallowing disorder, urinary incontinence and sexual problems. Some patients may have a problem called "orthostatic hypotension". Orthostatic hypotension is the medical name for a sudden drop in blood pressure when a person stands up. It can cause dizziness, blackouts and even fainting.
Pseudobulbar emotional discharge (pathological laughing and crying or emotional inability to control oneself) is uncontrollable laughing and crying attacks. It is seen in diseases that affect the areas of the brain that control the expression of emotions, such as Parkinson's disease. Laughing and crying attacks are not in compliance for the situation and the feelings of the person.
Loss of sense of smell is one of the earliest onset disorders in PD with no symptoms.
Pain has been reported in more than 40% of people with PD. Pain is usually felt in the half of the body where the motor signs originate. It can be piercing or stabbing, burning or tingling.
There is no test used to diagnose PD. Diagnosis is made by looking at the findings. In addition, the response to treatment helps the diagnosis, and the motor findings of PD improve significantly with treatment. Sometimes doctors can do some tests to rule out other diseases. DaTscan is a neuroimaging tool to distinguish parkinsonism from essential tremor. Approximately 15% of patients with parkinsonism have atypical parkinsonism diseases. These diseases included in the differential diagnosis are multisystem atrophy, progressive supranuclear palsy, corticobasal syndrome, dementia with Lewy bodies, drug-induced parkinsonism and vascular parkinsonism.
It is difficult to predict the course of PD because it varies so much from person to person. Many patients do well for many years under treatment. Normally, most patients fear becoming dependent on others and dying of PD. But PD itself is not fatal. The risk of death depends on complications of PD such as falls, suffocation, or pneumonia. As a result, it is a slowly progressing disease and can be kept under control with drugs for many years.
There are many drugs that improve the symptoms of PD. However, there is currently no treatment that provides full recovery. Medications used to treat PD can sometimes have serious side effects. For this reason, some patients start their medication when they have symptoms that really affect their daily life. The goal of treatment is to use the lowest dose of medication that works.
Short-term side effects of levodopa therapy are nausea, headache, drowsiness and sleepiness. When first started, patients benefit greatly from levopopa therapy. However, over the years, problems called dyskinesia and motor fluctuations arise. Dyskinesia is the name given to abnormal movements that the person cannot control. Motor fluctuation is the sudden or very early termination of the effect of levodopa. The patient cannot suddenly move, cannot walk.
Those with PD who do not improve with other treatments sometimes benefit from a treatment called deep brain stimulation (DBS). In the treatment through DBS, the movements are controlled by surgically placing a battery in the brain of the person.
Exercise is important for a healthy life for everyone. However, exercise is vital for Parkinson's patients to maintain their balance, mobility and daily living activities. In addition, exercise has a protective effect on neurons.
Studies have shown that exercise can improve gait, balance, tremor, flexibility, muscle grip strength, and motor coordination. In addition to jogging, walking and cycling, Tai Chi, yoga, Pilates and dance are also beneficial. When compared to a still and sedentary life, movement has a positive effect on motor findings, regardless of its level. People with mild to moderate Parkinson's disease can exercise specific to their symptoms. Aerobic exercises help keep fit. Walking exercises are effective on walking and balance. Resistance exercises build strength. Exercise also keeps the mind fresh and reduces depression and fatigue.
