Parkinson’s disease

Parkinson’s disease or illness is a disease that affects the CNS and is associated with the destruction of dopamine-producing neurons. Its cause is still uncertain, being more prevalent in the elderly population over 65 years.
Symptoms are characterized by neuromuscular disorders (tremors, stiffness, muscle flaccidity) and other non-motor disorders (sleep disorders, depression, anxiety).

The diagnosis is based on the patient’s clinical history and the standard treatment adopted is levodopa, a dopamine precursor.

Definition

Parkinson’s disease or Parkinson’s disease was initially discovered by the English physician James Parkinson in 1817. It is characterized by being a neurodegenerative disease (affecting the central nervous system), progressive, chronic that, in general, affects people over 50 years of age. age.

Its cause is still not known (idiopathic disease), and its development is associated with a loss of neurons (nerve cells that transmit information in the nervous system) that produce a neurotransmitter called dopamine. This loss occurs mainly in a region of the brain called the substantia nigra. Deficient production of other neurotransmitters such as serotonin, noradrenaline and acetylcholine are also associated with the onset of the disease.

Epidemiology

US data show that the disease has a prevalence of about 160 people per 100,000 inhabitants.

In Brazil, it is estimated that the disease affects 250,000 patients.

According to the World Health Organization, 1% of the population over 65 years old has this disease, with a prevalence of 150 to 200 cases per 100,000 inhabitants.

According to the UN, there are about 4 million people in the world with Parkinson’s disease. With increasing life expectancy and an aging population, this number is expected to double by 2040.

Causes

Parkinson’s disease or illness is not transmissible. Its cause is still not fully known and many patients who have this disease are described as having idiopathic Parkinson’s disease. Some hypotheses are attributed as possible causes of Parkinson’s disease, such as genetic causes, contact with toxins that reach the central nervous system (such as pesticides, which generate reactive oxygen species) or trauma to the head.

The neurons that produce dopamine in the basal ganglia ( substantia nigra ) are known to be destroyed or die.1 . With about 60% of neurons destroyed in the brain (substantia nigra), the brain is no longer able to communicate properly with the body’s muscles.

Groups of risk

Parkinson’s disease mainly affects the elderly population over 65 years of age. There is no difference in incidence and prevalence regarding gender or socioeconomic status. It is estimated that the prevalence in the Caucasian population is 120-180 cases per 100,000 inhabitants.

In the Parsi community in Mumbai, India, this rate is approximately double. However, ethnicity is not a risk group for Parkinson’s disease, since this condition is considered idiopathic.

– People suffering from melanoma, a serious form of skin cancer. According to a study published in May 2017 by the Mayo Clinic (United States) in the scientific journal Mayo Clinic Proceedings , people with melanoma are 4 times more likely to be affected by Parkinson’s disease. The reverse is also true, meaning that a person who has Parkinson’s is statistically 4 times more likely to develop melanoma. For now, scientists are talking about an association rather than cause and effect.
Levodopa (L-Dopa), a drug widely used in Parkinson’s disease, may be at the origin of the increased risk of melanoma, but studies have contradictory results and are not yet conclusive. Genetics can also play a key role.

Symptoms

Parkinson’s disease affects movements, causing motor disorders. In addition, there are other associated non-motor symptoms that include autonomic dysfunctions, neurobehavioral and cognitive problems, sensory difficulties, sleep problems, among others.

Motor dysfunctions
The most common motor symptoms are tremor, rigidity, bradykinesia (abnormal slowness of voluntary movements) and postural instability. Other symptoms include walking difficulties, changes in writing, stuttering, dystonia (freezing movements during an action), fatigue, salivation, akathisia (restlessness), hypomimia (decreased facial expression), among others.

Non-Motor Disorders Non-motor
symptoms are often overlooked in the diagnosis and treatment of Parkinson’s disease. These include cognitive dysfunctions, emotional disorders, depression , anxiety, olfactory disorders, sleep difficulties, apathy, among others. The incidence of dementia in patients with Parkinson’s disease is about 6 times higher than in the general population, and its prevalence ranges from 10-50%. Symptoms of autonomic dysfunction include urinary dysfunction, seborrheic dermatitis, excessive salivation, altered sexual functions and orthostatic hypotension. Gastrointestinal symptoms include: constipation and reduced gastric motility. Other symptoms that patients with Parkinson’s disease may have are a decrease in the rate of eye blinking, irritation of the ocular surface, changes in the tear film, visual hallucinations, loss of visuospatial perception, etc.

Early symptoms
Before the typical symptoms of Parkinson’s disease, such as tremors or stiffness, appear, the first symptoms may develop (tens of) years earlier, according to the Mayo Clinic , such as:
– Constipation
– Loss of smell or change in sense of smell smell (this symptom may appear more than 40 years before the onset of physical and classic Parkinson’s symptoms)
– Anemia
– Sleep problems
– Anxiety
– Subjective memory loss
– Visual disturbances
– Depression

Diagnosis

The initial diagnosis of Parkinson’s disease is not easy, and often the patient must be observed for a long time by a doctor, preferably a neurologist. The doctor will decide if the disease has an unknown cause or if it is secondary to other causes, such as the use of drugs that cause the so-called “pharmacological parkinsonism” (phenothiazines, lithium, haloperidol, flunarizine, cinnarizine, etc.).

In 2021, there were no biomarkers to clearly identify Parkinson’s disease in the blood, for example2.

The diagnosis, therefore, is based on the patient’s anamnesis (interview that the doctor conducts with the patient) together with neurological examinations. These tests aim to identify asymmetry at the onset of symptoms, presence of tremor at rest, muscle stiffness, etc. A PET scan (positron emission tomography with fluorodopa) reveals the function of dopamine-producing neurons in the brain. SPECT (Single Photon Emission Computed Tomography) is also useful in identifying the dopaminergic functions of the brain. It is important to emphasize that these exams reveal the activity of dopamine-producing neurons in the brain, not being conclusive about the diagnosis of Parkinson’s disease. As such, there are no imaging tests or blood tests that diagnose Parkinson’s disease. The method used by physicians is therefore based on clinical evidence presented by patients. It is important that the doctor also performs the differential diagnosis, so as not to confuse Parkinson’s disease with another condition (such as essential or familial tremor, pharmacological parkinsonism, Central Nervous System infections, head trauma, normal pressure hydrocephalus, etc.).

Complications

Parkinson’s disease results in a deterioration of the patient’s voluntary movements. It may present cognitive and psychological complications, such as sleep disturbances, depression, anxiety, emotional disturbances, etc. In addition, the use of drugs to treat Parkinson’s disease (such as levodopa) can cause motor fluctuations and dyskinesias, in addition to other adverse events, with loss of therapeutic benefit. Oropharyngeal dysfunction is also a complication associated with the disease and can lead to reduced swallowing, aspiration, pneumonia and, eventually, death. Other associated complications include urinary dysfunction and infection, respiratory changes, skin breakdown and injuries due to falls.

As mentioned above in the Risk Groups section , a 2017 study conducted by the Mayo Clinic (see references in the Risk Groups section ) showed that people with Parkinson’s disease were 4 times more likely to develop skin cancer.

Treatments

The treatments available for Parkinson’s disease are aimed at controlling the symptoms, since no pharmacological or surgical treatment prevents the progression of the disease. Parkinson’s disease medications such as levodopa work well3 . According to aMayo Clinic, people who suffer from Parkinson’s have nearly the same life expectancy as those without the disease, living on average about a year less. However, there is no cureforParkinson’s disease. The disease evolves slowly and dementia can appear after many years.

Levodopa
Levodopa is the standard treatment for patients with the disease. It increases dopamine levels in the striatum of the brain. Levodopa is today the main drug for the treatment of idiopathic Parkinson’s disease (without exact knowledge of the cause)4.

Neuroprotectors
The use of neuroprotectors delays neuronal degeneration and slows down disease progression. Selegiline (Zelapar® in the US) is a medication used for this purpose. Rasagiline and safinamide are two other drugs belonging to the MAO-B inhibitors.

Monoamine oxidase (MAO) inhibitors
Another treatment option is monoamine oxidase (MAO) inhibitors, which delay the breakdown of dopamine. In the case of patients using MAOIs, some medications should be avoided, such as serotonin reuptake inhibitors (fluoxetine, paroxetine, sertraline), tricyclic and tetracyclic antidepressants (maproptyline, imipramine), meperidine, opiates, dextromethorphan and tryptophan. The association of levodopa with peripheral decarboxylase inhibitors (carbidopa and benzerazide) decreases the incidence of nausea and vomiting and facilitates the passage of levodopa into the brain.

Dopamine agonists
Doctors sometimes use this family of drugs. They prevent the on-off effect of levodopa, but unfortunately they also have serious side effects (read below). Dopamine agonists include, in particular, pramipexole, ropinirole, apomorphine and rotigotine, the latter used as a transdermal patch.
The action of dopamine agonists is, as the name suggests, to act as an agonist (which has the same effect as dopamine) and therefore reduce the symptoms of Parkinson’s. However, dopamine agonists appear to be less effective than levodopa.

Other medications
– Amantadine is sometimes prescribed by doctors for mild Parkinson’s disease and in the early stages of the disease, as noted by the Mayo Clinic . Amantadine can also help with the involuntary movements (dyskinesia) caused by levodopa.
-COMT inhibitor antiparkinsonians such as entacapone or opicapone are sometimes used with levodopa (+ carbidopa) to increase its effectiveness, according to the Mayo Clinic.
– Anticholinergics (e.g. biperiden) are relatively infrequently used against Parkinson’s disease5.

General note on drugs against Parkinson’s disease:
– In very young people with Parkinson’s disease, therapy can be started with dopamine agonists (eg pramipexole, ropinirole) but guaranteed to have a real advantage over levodopa. On the other hand, in older people with Parkinson’s, dopamine agonists often lead to more psychiatric side effects (e.g., hypersexuality) than levodopa.6.

Surgery (Deep Brain Stimulation) Surgery
is sometimes used to treat Parkinson’s disease, usually in patients who do not respond well to drug treatments. Especially in patients whose tremors are quite debilitating. Electrodes are placed on the brain to modulate the stimulation, the effectiveness of this technique is usually excellent. In English, we speak Deep Brain Stimulation (DBS). The surgery has risks, including infections and brain bleeding, according to the Mayo Clinic .

Stem Cells Stem
cells are sometimes offered by certain companies, especially American ones. But according to the Mayo Clinic , as of July 2021, stem cell treatments are too expensive and do not cure Parkinson’s disease.

natural treatments

CBD (cannabis compound) does not act against Parkinson’s disease, as summarized in 2021 by the Mayo Clinic in its August 2021 monthly newsletter. of cannabis in the prevention or therapy of Parkinson’s disease.

Tips

Here are some tips to make life easier for patients with Parkinson’s disease:

– To shave, use electric machines. Cuts from sharp blades are avoided.

– Use bedroom lamps in the bedroom, bathroom, kitchen and hall or hallway. This will prevent the patient from tripping over things, especially when waking up groggy or lacking sleep.

– Keep floors clear of obstacles. Avoid small rugs that can cause slips and falls. If the patient has coordination difficulties, avoid flimsy furniture and glass. They are dangerous if the patient becomes unbalanced and falls.

– Drink the liquids through straws, which will strengthen your facial muscles.

– Use paper or plastic cups, which avoids the problems of broken glass when they fall.

There are associations specializing in care for patients with Parkinson’s Disease and companies that have specific materials for the care of these patients. It is important that the caregiver talks to a doctor to find out about these associations and companies that can facilitate the conditions of the carrier of the disease.

– To combat constipation, sometimes a symptom of Parkinson’s disease, eat plenty of fiber. You can also take fiber-rich food supplements, for example based on psyllium .

– A low level of vitamin B12 in the blood can be responsible for a worsening of the symptoms of Parkinson’s disease7 . In Parkinson’s patients in particular, a low level of vitamin B12 in the blood must be corrected. Patients should take vitamin B12 as a dietary supplement or as an injection.

Prevention

– Parkinson’s disease is idiopathic and its specific causes are not yet known, so there are no preventive measures in this case. Some studies point out that the use of antioxidants, such as vitamin E and vitamin C , help prevent oxidative stress and neuron degeneration. In addition, clinical practice indicates that the use of selegiline at the onset of the disease helps to delay its progression. It is important that the doctor is aware before using any medication.

– Practicing certain physical exercises can help reduce the progression of Parkinson’s disease, according to a study (Parkinson’s Outcomes Project)8.

Sources:
Mayo Clinic, “100 wichtige Medikamente (100 Important Drugs)” – Infomed (2020)

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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