Parkinson’s disease, or PD, is a previously incurable disease of the brain. Typical signs are a visible and severe deterioration of mobility and motor skills. In addition, a strong tremor is noticeable. Parkinson’s is a common neuronal disease and usually occurs between the ages of 55 and 65.
What is Parkinson’s disease?
Parkinson’s disease or Parkinson’s disease is a disease of the central nervous system. It mainly involves disturbances of involuntary and voluntary movements. Furthermore, a persistent loss of nerve cells occurs in the brain. Especially the black matter in the brain (so-called basal ganglia) are degraded. They are responsible for the movements and the control of motor skills. They also produce the hormones norepinephrine and epinephrine, as well as the neurotransmitter dopamine. As a result, Parkinson’s disease leads to a pronounced lack of movement or even immobility. Due to the lack of dopamine, the tremor typical of Parkinson’s develops. Likewise, tension or stiffness of the muscles occurs.
Causes
To date, the causes of Parkinson’s disease are not well understood. These unexplained causes are called idiopathic Parkinson’s syndrome in medicine. Only the trigger is known so far. Thus, the lack of dopamine (again triggered by the death of nerve cells) ultimately leads indirectly to the onset of the disease. Why the nerve cells begin to die has not yet been clarified by medical research. Nevertheless, there are already known causes for Parkinson’s disease. On the one hand, genetic or hereditary causes play a role. In this case, the Parkinson’s disease often already occurs up to the age of 40. Other causes are environmental influences, such as poisoning, manganese and carbon monoxide (produced by smoking). Other diseases (metabolic disorders, brain tumors, trauma) can also be considered as causes. In addition, some medications are suspected to trigger Parkinson’s disease. These include blood pressure-lowering drugs and neuroleptics.
Symptoms, complaints, and signs
Initial symptoms of the disease may appear long before the typical symptoms, without being suspected of being related to Parkinson’s. These early-onset disturbances include, for example, a decline in the ability to smell, muscle and joint pain, slowing of routine activities in everyday life, visual disturbances, fatigue, lassitude, or depression. However, since these symptoms can also be attributed to other diseases, they are difficult to associate with Parkinson’s disease. Only in the further course, when the typical complaints develop, one can recognize in retrospect that there were already indications of the disease. The main symptoms come insidiously and often show up only on one half of the body in the beginning. Movements slow down and reduce. This can increase in the late stages to complete immobility. Facial expressions also appear frozen. The steps become smaller; typical are the patients’ tripping steps. The muscles become stiff (rigor). At rest, they often begin to tremble (tremor). The entire body becomes unstable over time and standing upright becomes difficult. Affected persons usually keep slightly bent forward and can only walk shuffling. Characteristic is the difficulty to start a movement, so that several attempts are needed to stand up or to start walking. Other symptoms may include bladder weakness,constipation and increased salivation.
Diagnosis and course of the disease
The course of Parkinson’s disease is relatively slow. Nevertheless, the course may differ from case to case. Whether or not therapy or treatment is given is also crucial. With good medical treatment, the quality of life and life expectancy in Parkinson’s can be significantly increased. The further prognosis of the disease depends on the advanced stage of the disease. A complete cure for Parkinson’s is not yet possible. With proper treatment, mental and motor decline can be delayed or slowed to more than twenty years. Nevertheless, death is unfortunately inevitable in Parkinson’s. Affected individuals most often die as a result of the disease from pneumonia or other respiratory infections.
Complications
Parkinson’s disease does not always have to be associated with severe complications.Thus, with professional therapy, a life without the need for care is quite possible for a longer period of time. In some cases, however, the affected persons suffer from serious sequelae. Three to four Parkinson’s patients suffer from dysphagia during the disease. These in turn can cause malnutrition. In addition, there is a risk that bacteria will enter the trachea if swallowed and cause pneumonia in the further course of the disease. This is one of the most common causes of death in Parkinson’s disease. Another serious complication is akinetic crisis. In medicine, this is when the Parkinson’s patient abruptly becomes completely unable to move. In such cases, immediate hospitalization of the patient is required. As a rule, the akinetic crisis manifests itself only rarely. It primarily affects late-stage patients. The complication is usually caused by other illnesses such as pronounced febrile infections or surgical procedures. Sometimes the interruption of the Parkinson’s drug treatment is the reason for the serious sequelae. During the akinetic crisis, the patient suffers from severe muscle stiffness (rigor) and is unable to speak or swallow. Because he also no longer absorbs fluids, his body is quickly threatened with dehydration. Other common effects of PD include diffuse back pain, joint and muscle pain, sleep disturbances, and depression.
When should you see a doctor?
If the typical early signs of Parkinson’s disease appear and do not subside within one to two weeks, a doctor should be consulted. For example, symptoms such as unusual tremors, rigidity of the limbs or sudden movement disorders indicate the nervous disease. Persistent sleep disturbances or psychological complaints that do not appear to have any underlying cause must also be examined by a physician in a timely manner. The physician can make a tentative diagnosis using imaging techniques such as CT, MRI, and positron-emission tomography. If the therapy attempt with levodopa is successful, this indicates Parkinson’s disease. The patient is then referred to a specialist who can prescribe the necessary medication. If a Parkinson’s patient experiences muscle stiffness and can no longer swallow his or her pills, family members must call 911. In the event of confusion, delusions or hallucinations, medical advice is also required. The family doctor or a neurologist is responsible. In addition, physiotherapists, surgeons and, depending on the type and severity of the symptoms, alternative medical practitioners are involved in the treatment of the nerve condition.
Treatment and therapy
Therapy for Parkinson’s is based primarily on early detection and treatment. Because Parkinson’s is currently incurable, the goals of treatment are mainly in the area of general improvement of quality of life. The aim is to reduce the mental, emotional and motor symptoms. An attempt is made to ensure that the person affected can maintain his or her own independence for as long as possible. Therapies based on medication and physiotherapy are used. However, a change in diet can also have a supporting effect. Medications (levodopa and dopamine agonists) are used to compensate for the lack of dopamine. Furthermore, deep brain stimulation with radiofrequency can also be used for therapy. This fairly new procedure is intended to stimulate and excite the affected brain regions without destroying nerve cells in the process. However, it only treats the symptoms and does not cure the actual Parkinson’s disease. In the future, however, there could be therapy methods based on stem cell transplantation (stem cell therapy), so that the dead nerve cells are replaced by new and cultivated cells. Supportive measures include a low-fat diet, drinking plenty of fluids, and adequate exercise, such as walking and swimming.
Aftercare
The peculiarity of Parkinson’s disease entails that follow-up cannot prevent recurrence. This objective is commonly known in tumors. Parkinson’s, in contrast, is not curable. Rather, the symptoms progress slowly. Scheduled examinations after a diagnosis are aimed at eliminating complications and enabling the patient to lead a symptom-free life.Consequently, permanent treatment becomes necessary, the extent of which depends on the respective complaints. The doctor and patient agree on the frequency of examinations. Follow-up care initially includes an intensive discussion about existing complaints. This is followed by a targeted physical examination. If the patient is in an advanced stage, the typical signs are often recognizable at first glance. Some doctors order neuropsychological examinations from time to time. The EEG and positron emission tomography (PET) are also informative. The latter procedure can be used to map the metabolic activities of the nerve cells. In addition, drugs play an important role in therapy. By taking them, patients usually prevent a lack of dopamine. Follow-up care includes regular treatments with physiotherapists, speech therapists and psychologists. The physician prescribes these treatments insofar as restrictions in movement, breathing or articulation, and mental recovery occur.
Outlook and prognosis
Parkinson’s now offers a relatively good prognosis. Although the disease is progressive, meaning that symptoms increase, it can be well treated with modern medications and therapies. Forms of therapy such as brainwave stimulation or stem cell therapy could further improve the prognosis in the future. Currently, Parkinson’s patients are dependent on painkillers and other medications. They also need support in everyday life and are no longer allowed to perform various activities such as driving. All these things affect the quality of life. There is no prospect of a life free of symptoms. However, those affected can live with the disease for several decades. The prognosis depends on the stage at which the disease is diagnosed and on the patient’s constitution. Young people can overcome strenuous therapies quickly, but they also have to live with the disease for many years and suffer more and more losses in the course of their lives. Basically, an early start of therapy is important. The prognosis is made by the neurologist in charge or another specialist. It must be regularly adjusted to the patient’s current state of health. Accompanying the prognosis, the patient receives comprehensive counseling and information about current treatment methods.
What you can do yourself
Even small changes in everyday life can help to maintain the quality of life with Parkinson’s for a long time. A safe living area reduces the risk of falls and injuries: classic tripping hazards are carpets, door thresholds and loose cables, and handrails should be installed on stairs. Grab bars are particularly important in the bathroom next to the bathtub, shower and toilet, and non-slip rubber mats ensure safe footing. Shower stools, a raised toilet and, if necessary, a height-adjustable washbasin simplify daily personal hygiene. Clothes with Velcro and zippers are more suitable for independent undressing and dressing than clothes that have to be buttoned. If tying shoes is difficult, slip-on shoes are a good alternative. A long shoehorn makes it easier to slip them on. For household use, retailers have a wide range of other aids such as special cutlery, closure openers and drinking aids. In order to maintain as much mobility and coordination as possible, gymnastic exercises should be performed daily. Special exercises train facial expressions, gestures and the fine motor skills of the hands. A balanced diet provides the body with all the necessary vital substances and helps to maintain body weight. Parkinson’s patients should take their time when eating and drinking, chew their food well and ensure that their head and body posture is upright. Thorough oral hygiene prevents tooth damage, bad breath and inflammation caused by leftover food.
