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How does Parkinson's disease begin? Causes, symptoms, stages, how to treat Parkinson's disease? Early form of parkinsonism

This year marks two hundred years since James Parkinson published An Essay on the Shaking Palsy, which detailed the disease that was later named after him. Over these two hundred years, hypotheses about the causes of the disease have replaced one another more than once. At first, doctors believed that the problem was solely due to external influences affecting brain structures. Then they began to talk about the purely hereditary nature of the disease. Now scientists are increasingly inclined to believe that both initial predisposition and external factors play a role in the development of Parkinson’s disease.

Be that as it may, the disease more often affects older people, and its frequency increases with age. If at 60 years of age the disease occurs in 1% of people who have reached this age, then at 80 years of age it occurs in 4%. As of 2015, there were 6 million sick people in the world, and WHO expects their number to double by 2030, and by 2050 to quadruple: whatever one may say, developed countries are aging. In Russia, there are many times fewer officially registered cases of Parkinson's disease than in other countries, but, alas, this does not mean that our elderly people are healthier than Europeans or Americans, but only about problems with diagnosis.

The disease spares neither the poor nor the rich: such famous people as Mohammed Ali, the famous boxer, fell victim to it; or Michael J. Fox, who played the main character in the Back to the Future film series. Like all neurodegenerative (caused by the death of neurons) diseases, Parkinson's disease develops gradually, but progresses steadily, sooner or later causing disability. But this progress can be slowed down.

Since the effectiveness of treatment for Parkinson's disease directly depends on how early the diagnosis becomes clear and treatment is started, let's talk about how it manifests itself.

Preclinical manifestations

It all starts with the death of neurons that produce the neurotransmitter dopamine. Neurotransmitters are substances through which nerve cells exchange signals both among themselves and with muscle tissue. The first signs of Parkinson's disease - the so-called preclinical manifestations - appear 6-10 years before the disease becomes obvious and, as a rule, go unnoticed.

Precursors of Parkinson's disease:

the sense of smell deteriorates for no apparent reason,
constipation appears,
if you suddenly stand up or sit down from a lying position, your blood pressure “drops” (orthostatic hypotension);
in men, sexual function decreases;
depression develops
I often have nightmares, very vivid and vivid ones: a person rushes about in his sleep, kicks, fights, and can injure himself and others.

A detailed clinical picture appears only when more than half of the dopaminergic neurons die, and 20-30% of the initial dopamine level remains.

Motor symptoms

For quite a long time, movement disorders (or motor symptoms) were considered the only manifestations of Parkinson’s disease, and it was based on their totality that the diagnosis was made. Movement disorders first appear on one side of the body, and only after 2-5 years they affect both sides. This asymmetrical onset is still considered one of the most accurate diagnostic signs of Parkinson's disease.

Bradykinesia

Or, speaking in Russian – slow movements. It becomes difficult for a person to plan and perform small actions first: fasten buttons, write. Handwriting becomes small, speech is quiet and fading. Then it becomes difficult to eat, hygiene procedures are violated. From the outside, you can notice that the patient does not swing his arms as actively when walking as before (hypokinesia).

A case is described when a 67-year-old former pilot noticed that his watch with automatic “winding” by hand movements stopped working, and several repair shops did not find the fault. The neurologist discovered that the man had developed hypokinesia on the left side of his body, and after a thorough examination, he was diagnosed with Parkinson's disease. Stage I"

As the disease progresses, speech and gait slow down, and facial expressions become poor.

In the early stages, bradykinesia can be detected using special tests:

Fournier test. The subject is asked to perform a series of movements as quickly as possible: sit down, stand up, bend over, and so on. Slowness of movement during this test becomes visible quite early.
Tapping test. As quickly as possible and with the greatest possible amplitude, alternately tap on the table with the thumb and index finger of first one and then the other hand. As already mentioned, the disease develops first on one side, and the lag of one arm becomes noticeable.
Hand clenching and unclenching test. You need to clench and unclench your fists as quickly as possible. The difference in tempo is also revealed quite early.

As the disease progresses, it becomes difficult for a person to get up and turn over in bed. The gait becomes shallow and shuffling. It may be difficult for the patient to step after stopping, as if he is “stuck.” Later a characteristic “ supplicant pose": half-bent legs and arms, bowed head.

Tremor

Trembling. In 40% of patients, it becomes the first symptom of Parkinson's disease, and it is noticeable at rest and disappears with movement. One of the characteristic manifestations is asymmetrical trembling of the hands, similar to “counting coins” or “rolling pills”. Later, tremors of the legs and chin become noticeable. Trembling of the hands when trying to hold a certain position (postural tremor) may occur many years before the disease becomes apparent.

Rigidity

Or stiffness of movement. Increases muscle tone. If you try to move your arms or legs for the patient, it seems as if he is consciously resisting these attempts. Another characteristic symptom of Parkinson's disease is the “gear phenomenon,” when, under external influence, the limb moves as if in jerks, as if there is a slipping gear in place of the joint.

Postural instability

It becomes difficult for a person to maintain balance. Often, when walking, the body continues to move forward as if by inertia, which can cause a fall. The patient often stumbles and needs walking aids.

Non-motor symptoms of Parkinson's disease

In addition to motor problems, dopamine deficiency causes other disorders:

Changes in cognitive (cognitive) functions:

the reaction speed decreases, from the outside the patient looks “slow” (bradyphrenia);
increased fatigue, difficulty concentrating for a long time;
“operative memory” decreases - learning something new, even, at first glance, elementary, becomes impossible;
it becomes difficult to plan;
inertia of thinking develops: a person makes decisions “on the fly,” often without noticing that the situation has changed and old strategies have become inadequate;
in the later stages, 80% of patients develop.

Emotional disorders

old interests disappear and new ones do not appear;
apathy;
: the ability to experience pleasure is lost, appetite decreases, thoughts of suicide appear;
anxiety disorder, up to panic attacks.

Sleep disorders

restless legs syndrome: discomfort when falling asleep that forces you to move and wake up;
apnea (stopping breathing) during sleep;
daytime sleepiness;
insomnia;
nightmares accompanied by physical activity.

Pain syndromes

Due to muscle stiffness, pain develops in the neck muscles and shoulder joints. Often such pain occurs in the early stages before movement disorders become noticeable. Therefore, patients are often diagnosed with osteochondrosis and prescribed appropriate treatment, which turns out to be ineffective.

Visual impairment:

difficult to navigate in the twilight,
difficult to adapt to changing lighting;
color sensitivity worsens;
visual illusions appear.

Psychoses

hallucinations

Usually occur in the later stages of the disease during treatment. In this case, it is necessary to sharply reduce the dose of antiparkinsonian drugs.

Autonomic disorders

One way or another they affect the activities of all organs and systems. The most common and noticeable to others is increased greasiness of the skin and hair, and dandruff.

conclusions

Despite the fact that statistically it is believed that the onset of the disease occurs on average at 60-65 years, the first nonspecific signs of Parkinson's disease develop much earlier, 5-10-15 years before characteristic motor manifestations appear. Unfortunately, most often these signs go unnoticed, or, if the patient does consult a doctor, they are misinterpreted: the diagnosis is made incorrectly and treatment, accordingly, turns out to be ineffective. In fact, there are currently no diagnostic methods for the early stages, when treatment is best able to slow the progression of the disease.

Gradually developing, Parkinson's disease affects all areas of life of both the patient and his relatives. Eventually, the patient begins to require constant care, not only because of motor problems, but also because of cognitive impairment, which most often ends in death.

Current treatments can slow the development of symptoms, but do not “resurrect” dead neurons. However, they can improve the patient’s quality of life, helping to remain active and self-care longer.

Parkinson's syndrome is a disease affecting the central nervous system. Its development is provoked by the death of cells that synthesize dopamine in the black substance of the brain, which entails a loss of muscle mobility. The process is typical for older people. However, sometimes it begins to develop in young men as a result of encephalitis, injury, or poisoning with chemicals or drugs.

It is impossible to cure the disease or completely stop its progression. However, with the help of supportive treatment, doctors reduce the rate of development of Parkinson's, giving the patient decades of high-quality, fulfilling life.

The reasons for the development of Parkinson's disease in men have not yet been thoroughly established by scientists. Certain factors are known that play the role of catalysts in specific cases, but scientists cannot yet say for sure what the reason is.

It was found that men get sick much more often than women.

Since the disease began to “get younger,” not only people over 60 are at risk. Nowadays, signs of Parkinson’s disease are found in middle-aged men.

Common causes of the syndrome:

heredity: in 15% of cases, one of the close relatives also suffered from Parkinson’s;
a complication that develops against the background of other diseases, usually encephalitis or brain tumors;

injuries;
poisoning with chemicals or salts of heavy metals;
frequent contact with pesticides;
drug addiction can lead to the development of Parkinson's disease in very young men, not even 30 years old;
use of heavy drugs that affect the central nervous system.

Such medications are especially often used in the treatment of mental disorders. As a rule, after stopping taking the pills, Parkinson's symptoms disappear. That is, it is parkinsonism, not a disease.

The list contains the most common causes of pathology. However, this does not mean that dopamine deficiency is excluded in a person who does not have a history of such factors.

Symptoms

Symptoms and signs of Parkinson's disease develop gradually in men. They even send doctors on the wrong track, since they coincide with the symptoms of other diseases characteristic of older people.

The first signs are quite difficult to recognize; they are not similar to the well-known symptoms of Parkinson’s disease in men, but they should already alert the person and provoke a visit to the doctor:

partial loss of smell;
problems with the gastrointestinal tract, urination;
speech becomes quieter, muffled, and its intelligibility decreases;
memory deteriorates;
stiffness of movements appears, gait slows down;
handwriting changes over a short period;
a slight tremor of one hand begins, intensifying during emotional outbursts or with severe physical fatigue;
sleep becomes restless.

One of the earliest signs of an impending threat is a violation of the automaticity of gait. In particular, when walking, the arms stop automatically swinging.

Later, signs of parkinsonism in men become more pronounced:

the tremor increases in amplitude, becoming more noticeable and spreading to the second arm and head;
the mobility of the facial muscles decreases, it freezes into an emotionless mask;
sweating increases;
dementia begins to develop.

After analyzing the symptoms and identified signs in a man, the neurologist determines Parkinson’s disease and prescribes the necessary treatment.

Diagnostics

Diagnosing Parkinson's disease in men is quite difficult, since its symptoms and signs largely coincide with other neurological diseases, and specific treatment is required. Therefore, when contacting a neurologist with symptoms that raise suspicion of this syndrome, a thorough diagnostic examination is carried out, consisting of 3 stages:

Initial reception and examination of the patient. Troubling symptoms are identified, and additional signs that the patient may not have paid attention to are checked. The doctor collects an anamnesis to establish the onset of the process and the rate of its progression.
Research is being carried out to exclude any other diseases with similar manifestations.

First of all, it is necessary to weed out tumors in the brain, poisoning, repeated strokes, and traumatic brain injuries. To do this, the necessary tests are taken and an MRI of the brain, ECG and rheoencephalography are performed.

Based on the collected anamnesis, development history, analysis of symptoms and research results, a final diagnosis is made and the stage at which the disease is located is specified.

After the doctor is convinced that it is definitely Parkinson's disease, he will determine what needs to be done in a particular situation based on the individual characteristics of the patient.

Treatment

When identifying signs and symptoms of Parkinson's disease in men at an early stage, it is necessary to select treatment methods that will help slow down the development of the disease as much as possible, maintain motor activity, and will not harm other body systems.

Medicine will not help to completely get rid of the disease: at the moment, the death of cells that synthesize dopamine is an irreversible process. But it can be slowed down, and some of the symptoms can be stopped. This will allow you to gain several years of a full life, but over time, the disease will still develop.

To maintain the patient's condition use:

Drug therapy.

The selection of drugs is carried out depending on the stage of the disease and the progression of symptoms. The medicinal component is aimed at maintaining the functioning of the substantia nigra of the brain and reducing dopamine deficiency. The second direction is symptomatic relief. In this case, the drug Levodopa is often used, especially in advanced stages of the disease.

The reason is that it has many side effects that complicate the functioning of other body systems.

Physical therapy with precise calculation of permissible physical activity.

Depending on the man’s initial physical fitness, the rate of development of parkinsonism and habitual activity, a number of different types of load are prescribed. This could be: special exercise therapy, gymnastics, massages, exercises in the water. In addition, maintaining an active lifestyle with regular cycling and swimming is encouraged, but overdoing it is also dangerous.

Surgical intervention.

The operation is performed only if absolutely necessary. For example, if medications do not have the required effect or cannot be used due to individual intolerance. Then, depending on the indications, neurostimulation of specific areas of the brain or pallidotomy is performed.

A pathology caused by the slow progressive death of nerve cells in humans that are responsible for motor functions is called Parkinson's disease. The first symptoms of the disease are trembling (tremor) of the muscles and an unstable position at rest of individual parts of the body (head, fingers and hands). Most often they appear at 55-60 years of age, but in some cases, early onset of Parkinson's disease has been recorded in people under 40 years of age. Subsequently, as the pathology develops, the person completely loses physical activity and mental abilities, which leads to the inevitable attenuation of all vital functions and death. This is one of the most difficult diseases in terms of treatment. How long can people with Parkinson's disease live with the current level of medicine?

Etiology of Parkinson's disease

Physiology of the nervous system.

All human movements are controlled by the central nervous system, which includes the brain and spinal cord. As soon as a person thinks about any intentional movement, the cerebral cortex already alerts all parts of the nervous system responsible for this movement. One of these departments is the so-called basal ganglia. This is an auxiliary motor system responsible for how quickly movements are made, as well as the accuracy and quality of those movements.

Information about movement comes from the cerebral cortex to the basal ganglia, which determine which muscles will participate in it, and how much each muscle must be tense in order for the movements to be as precise and targeted as possible.

The basal ganglia transmit their impulses using special chemical compounds - neurotransmitters. How the muscles work depends on their quantity and mechanism of action (exciting or inhibitory). The main neurotransmitter is dopamine, which inhibits excess impulses, and thereby controls the accuracy of movements and the degree of muscle contraction.

Black substance(Substantia nigra) is involved in complex motor coordination, supplying dopamine to the striatum and transmitting signals from the basal ganglia to other brain structures. The substantia nigra is so named because this area of the brain is dark in color: the neurons there contain a certain amount of melanin, a byproduct of dopamine synthesis. It is the lack of dopamine in the substantia nigra of the brain that leads to Parkinson's disease.

Parkinson's disease - what is it?

Parkinson's disease is a neurodegenerative brain disease that progresses slowly in most patients. Symptoms of the disease may gradually appear over several years.

The disease occurs against the background of the death of a large number of neurons in certain areas of the basal ganglia and the destruction of nerve fibers. In order for the symptoms of Parkinson's disease to begin to appear, about 80% of neurons must lose their function. In this case, it is incurable and progresses over the years, even despite treatment.

Neurodegenerative diseases are a group of slowly progressive, hereditary or acquired diseases of the nervous system.

Also a characteristic sign of this disease is a decrease in the amount of dopamine. It becomes insufficient to inhibit the constant excitatory signals of the cerebral cortex. The impulses are able to travel directly to the muscles and stimulate their contraction. This explains the main symptoms of Parkinson's disease: constant muscle contractions (tremor, trembling), muscle stiffness due to excessively increased tone (rigidity), and disturbance of voluntary body movements.

Parkinsonism and Parkinson's disease, differences

There are:

primary parkinsonism or Parkinson's disease, it is more common and irreversible;
secondary parkinsonism - this pathology is caused by infectious, traumatic and other brain lesions, and is usually reversible.

Secondary parkinsonism can occur at absolutely any age under the influence of external factors.

encephalitis;
brain injuries;
poisoning with toxic substances;
vascular diseases, in particular atherosclerosis, stroke, ischemic attack, etc.

Symptoms and signs

How does Parkinson's disease manifest?

rest tremor;
stiffness and reduced muscle mobility (rigidity);
limited volume and speed of movements;
decreased ability to maintain balance (postural instability).

A resting tremor is a tremor that occurs at rest and disappears with movement. The most typical examples of resting tremor can be sudden shaking movements of the hands and oscillatory “yes-no” movements of the head.

depression;
pathological fatigue;
loss of smell;
increased salivation;
excessive sweating;
metabolic disease;
problems with the gastrointestinal tract;
mental disorders and psychoses;
disturbance of mental activity;
impairment of cognitive functions.

memory impairment;
slowness of thinking;
disturbances of visual-spatial orientation.

In young people

Sometimes Parkinson's disease occurs in young people between the ages of 20 and 40, which is called early-onset parkinsonism. According to statistics, there are few such patients - 10-20%. Parkinson's disease in young people has the same symptoms, but is milder and progresses more slowly than in older patients.

In half of patients, the disease begins with painful muscle contractions in the limbs (usually in the feet or shoulders). This symptom can make it difficult to diagnose early parkinsonism because it is similar to arthritis.
Involuntary movements in the body and limbs (which often occur during dopamine therapy).

Subsequently, signs characteristic of the classic course of Parkinson’s disease at any age become noticeable.

Among women

Symptoms and signs of Parkinson's disease in women are no different from general symptoms.

In men

Likewise, the symptoms and signs of the disease in men are not particularly noticeable. The only thing is that men get sick a little more often than women.

Diagnostics

There are currently no laboratory tests that can be used to diagnose Parkinson's disease.

The diagnosis is made based on the medical history, results of a physical examination and tests. Your doctor may order certain tests to look for or rule out other possible conditions that cause similar symptoms.

One of the signs of Parkinson's disease is the presence of improvements after starting to take anti-Parkinsonian drugs.

There is also another diagnostic test called PET (positron emission tomography). In some cases, PET scans can detect low levels of dopamine in the brain, which is the main symptom of Parkinson's disease. But PET scans are generally not used to diagnose Parkinson's disease because they are very expensive and many hospitals do not have the necessary equipment.

Stages of development of Parkinson's disease according to Hoehn-Yahr

This system was proposed by English doctors Melvin Yahr and Margaret Hen in 1967.

Stage 0.
The person is healthy, there are no signs of illness.

Stage 1.
Minor motor disturbances in one hand. Nonspecific symptoms appear: impaired sense of smell, unmotivated fatigue, sleep and mood disorders. Then the fingers begin to tremble when excited. Later, the tremor intensifies, and tremors also appear at rest.

Intermediate stage(“one and a half”).
Localization of symptoms in one limb or part of the body. Constant tremor that disappears during sleep. The whole hand may tremble. Fine motor skills become difficult and handwriting deteriorates. There is some stiffness in the neck and upper back, and limited swing movements of the arm when walking.

Stage 2.
Motor impairments affect both sides. Tremor of the tongue and lower jaw is possible. Possible drooling. Difficulty moving joints, worsening facial expressions, slow speech. Sweating disorders; the skin can be dry or, on the contrary, oily (dry palms are typical). The patient is sometimes able to restrain involuntary movements. A person copes with simple actions, although they are noticeably slower.

Stage 3.
Hypokinesia and rigidity increase. The gait takes on a “puppet” character, which is expressed in small steps with feet placed parallel to each other. The face becomes mask-like. There may be a head tremor similar to nodding movements (“yes-yes” or “no-no”). The formation of a “petitioner pose” is characteristic - a head bent forward, a hunched back, arms pressed to the body and bent at the elbows, legs half-bent at the hip and knee joints. Movements in the joints are like a “gear mechanism.” Speech impairments progress – the patient becomes fixated on repeating the same words. A person serves himself, but with sufficient difficulties. It is not always possible to fasten the buttons and get into the sleeve (help would be desirable when dressing). Hygiene procedures take several times longer.

Stage 4.
Severe postural instability - the patient has difficulty maintaining balance when getting out of bed (may fall forward). If a standing or moving person is slightly pushed, he continues to move by inertia in the “given” direction (forward, backward or sideways) until he encounters an obstacle. Falls that can lead to fractures are common. It is difficult to change body position while sleeping. Speech becomes quiet, nasal, and slurred. Depression develops and suicide attempts are possible. Dementia may develop. In most cases, outside assistance is required to carry out simple daily activities.

Stage 5.
The last stage of Parkinson's disease is characterized by the progression of all motor disorders. The patient cannot stand up or sit down, and does not walk. He cannot eat on his own, not only because of tremors or stiffness of movements, but also because of swallowing disorders. Control over urination and bowel movements is impaired. The person is completely dependent on others, his speech is difficult to understand. Often complicated by severe depression and dementia.

Dementia is a syndrome in which cognitive function (that is, the ability to think) deteriorates to a greater extent than is expected with normal aging. It is expressed in a persistent decrease in cognitive activity with the loss of previously acquired knowledge and practical skills.

Causes

it was not possible to identify the exact reasons

Aging– with age, the number of nerve cells decreases, this leads to a decrease in the amount of dopamine in the basal ganglia, which in turn can provoke Parkinson’s disease.
Heredity– the gene for Parkinson’s disease has not yet been identified, but 20% of patients have relatives with signs of parkinsonism.
Environmental factors– various pesticides, toxins, toxic substances, heavy metals, free radicals can provoke the death of nerve cells and lead to the development of the disease.
Medications– some antipsychotic drugs (for example, antidepressants) disrupt dopamine metabolism in the central nervous system and cause side effects similar to the symptoms of Parkinson's disease.
Brain injuries and diseases– bruises, concussions, as well as encephalitis of bacterial or viral origin can damage the structures of the basal ganglia and provoke the disease.
Wrong lifestyle– risk factors such as lack of sleep, constant stress, poor diet, vitamin deficiencies, etc. can lead to pathology.
Other diseases– atherosclerosis, malignant tumors, diseases of the endocrine glands can lead to complications such as Parkinson’s disease.

How to treat Parkinson's disease

Parkinson's disease in the initial stages is treated with medication, by administering the missing substance. The substantia nigra is the main target of chemical therapy. With this treatment, almost all patients experience a weakening of symptoms, it becomes possible to lead a lifestyle close to normal and return to their previous way of life.
However, if after several years patients do not improve (despite increasing the dose and frequency of taking medications), or complications arise, a surgical option is used, during which a brain stimulator is implanted.

Under local anesthesia, two electrodes are sequentially inserted (along a path predetermined by the computer) for deep brain stimulation.
Under general anesthesia, an electrical stimulator is sewn subcutaneously into the chest area, to which electrodes are connected.

Treatment of parkinsonism, drugs

Levodopa. Levodopa has long been considered the best treatment for Parkinson's disease. This drug is a chemical precursor to dopamine. However, it is characterized by a large number of serious side effects, including mental disorders. It is best to prescribe levodopa in combination with peripheral decarboxylase inhibitors (carbidopa or benserazide). They increase the amount of levodopa reaching the brain and at the same time reduce the severity of side effects.

Madopar is one of these combination drugs. Madopar capsule contains levodopa and benserazide. Madopar is available in different forms. Thus, madopar GSS is located in a special capsule, the density of which is less than the density of gastric juice. This capsule remains in the stomach for 5 to 12 hours, and the release of levodopa occurs gradually. And madopar dispersible has a liquid consistency, acts faster and is more preferable for patients with swallowing disorders.

Amantadine. One of the medications that usually starts treatment is amantadine (midantan). This drug promotes the formation of dopamine, reduces its reuptake, protects neurons of the substantia nigra by blocking glutamate receptors and has other positive properties. Amantadine effectively reduces rigidity and hypokinesia and has less effect on tremor. The drug is well tolerated, side effects are rare with monotherapy.

Miralex. Miralex tablets for Parkinson's disease are used both for monotherapy in the early stages and in combination with levodopa in later stages. Miralex has fewer side effects than non-selective agonists, but more than amantadine: nausea, blood pressure instability, drowsiness, swelling of the legs, increased levels of liver enzymes are possible, and hallucinations may develop in patients with dementia.

(Newpro). Another modern representative of dopamine receptor agonists is rotigotine. The drug is made in the form of a patch applied to the skin. The patch, called a transdermal therapeutic system (TTS), ranges in size from 10 to 40 cm² and is applied once a day. Newpro is available by prescription for the monotherapy of early stage idiopathic Parkinson's disease (without levodopa).

This form has advantages over traditional agonists: the effective dose is lower, side effects are much less pronounced.

MAO inhibitors. Monoamine oxidase inhibitors inhibit the oxidation of dopamine in the striatum, thereby increasing its concentration in synapses. Selegiline is most often used in the treatment of Parkinson's disease. In the early stages, selegiline is used as monotherapy, and half of the patients report significant improvement during treatment. Side effects of selegiline are not frequent and not pronounced.

Selegiline therapy allows delaying the prescription of levodopa for 9-12 months. In later stages, selegiline can be used in combination with levodopa - it can increase the effectiveness of levodopa by 30%.

Mydocalm reduces muscle tone. Its use in parkinsonism as an auxiliary medicine is based on this property. Mydocalm is taken either orally (tablets), intramuscularly or intravenously.

B vitamins are actively used in the treatment of most diseases of the nervous system. Vitamin B₆ and nicotinic acid are needed to transform L-Dopa into dopamine. Thiamine (vitamin B₁) also helps increase dopamine in the brain.

How long do people live with Parkinson's disease?

research by British scientists

persons whose disease began at the age of 25-39 years live an average of 38 years;
with an initial age of 40-65 years, they live about 21 years;
and those who become ill over the age of 65 live about 5 years.

Prevention of Parkinson's disease

to eat well;
lead a healthy and fulfilling life;
protect yourself from unnecessary worries and stress;
do not abuse alcohol;
move more often;
train memory;
engage in active mental activity.

Author of the article: Sergey Vladimirovich, a supporter of reasonable biohacking and an opponent of modern diets and quick weight loss. I will tell you how a man aged 50+ can remain fashionable, handsome and healthy, and how to feel like 30 in his fifties. About the author.

Reading time: 4 min

Parkinson's disease is a neurological disease that affects older people. Parkinson's disease is characterized by a sluggishly progressive course and is classified as a degenerative pathology of brain structures located in its trunk and hemispheres. Its development is triggered by the progressive degeneration of neurons that produce the neurotransmitter dopamine. The disease in question is characterized by muscle rigidity, hypokinesia, trembling of the limbs and reflex dysfunction.

Modern medical science does not have the technical and other resources to completely cure Parkinson’s disease, but there are certain techniques that can improve the patient’s quality of life.

Causes of Parkinson's disease

Approximately 15% of subjects with Parkinson's disease have a history of the disease in their immediate family. However, the genes responsible for the onset of this disease have not been identified.

Parkinson's disease, what is it? Today, the pathogenesis of Parkinson's disease has not been fully determined. However, it is possible to identify a number of etiological factors, namely aging, ecology and genetic predisposition. Pathomorphologically, aging is accompanied by a decrease in the number of neurons located in the brain structures (substantia nigra) and the presence of Lewy bodies in neurons. In addition, the aging process is also accompanied by neurochemical transformations in the striatum - a decrease in the concentration of the enzyme tyrosine hydroxylase, dopamine content and a decrease in the number of dopamine receptors. The rate of destruction of neurons located in brain structures is much higher in Parkinson's disease than in physiological aging.

The causes of Parkinson's disease often lie in environmental factors (chemical compounds, metal salts), damage to the capillaries of the brain with subsequent dysfunction, and the use of pharmacopoeial drugs that contribute to the appearance of neurological complications found in motor disorders.

Parkinson's disease is interesting because it occurs less frequently in individuals who smoke than in individuals who do not have this destructive habit. It is assumed that this phenomenon is due to the stimulating effect of nicotine on dopamine production. In addition, this effect is explained by the presence of compounds in tobacco smoke that act like MAO inhibitors. Caffeine consumption also protects against the development of the described disease.

The causes of Parkinson's disease can be identified as follows:

Aging of the body, in which the number of neurons naturally decreases, which leads to a decrease in the production of dopamine;

Hereditary predisposition;

Permanent residence near highways, industrial enterprises or railways;

Lack of vitamin D, which is formed when exposed to ultraviolet rays in the body and protects brain cellular formations from the destructive effects of free radicals and various toxins;

Poisoning with certain chemical compounds;

The appearance of defective mitochondria due to mutation, which often leads to neuronal degeneration;

Neuroinfections (tick-borne encephalitis);

Tumor processes occurring in the brain or its trauma.

Early signs of Parkinson's disease are caused by degeneration of the brain structures that produce dopamine and are responsible for regulating fine motor operations. Dopamine production disorder causes a chemical imbalance in the brain, which reduces control over muscle function.

Parkinson's disease symptoms and signs

The pathology in question is characterized by 4 motor defects (tremor, hypokinesia, muscle rigidity and postural instability), autonomic dysfunction and mental disorders.

The symptoms of Parkinson's disease are thus divided into primary (i.e. movement disorders) and additional (defects in mental processes and autonomic dysfunction).

Trembling is the most obvious and easily identified symptom. The disease in question is characterized by symptoms observed at rest. However, other varieties are also possible (intentional or postural). Its frequency is noted in the range from 4 to 6 movements per second. Trembling usually begins in the distal segment of the upper limb, spreading to the second arm and lower limbs as the disease progresses. Multidirectional finger movements are reminiscent of counting coins or rolling pills (similar to the technique of making pills with your hands in pharmaceuticals).

The duration of the last stage of Parkinson's disease is determined by the state of health and the immune system, the therapeutic measures carried out, the quality of care and preventive procedures regarding pressure ulcers, cardiac function and pulmonary function. Death is a consequence of additional complications.

From the symptoms described above, it becomes clear that the disease in question is a difficult test not only for the individual suffering from it, but also for his relatives. Therefore, Parkinson's disease, the causes of the disease and ways to correct the condition require increased attention.

Parkinson's disease significantly changes the existence of a person and his immediate environment. Since the clinical manifestations, expressed in the disruption of everyday motor acts, are quite severe. In addition, ignoring the early signs of the disease can cause quite serious consequences.

Parkinson's disease, how long do you live with it? This is often a question of interest to all relatives. It all depends on the timely detection of the disease and the adequacy of the selected therapy, which allows the patient to not feel useless, unnecessary and helpless for many years.

Early diagnosis of Parkinson's disease allows people to maintain everyday activity and engage in professional activities for a long time, that is, to feel not like a burden, but a full-fledged member of society.

Diagnosis of Parkinson's disease

In order to diagnose the described disease, unified criteria have now been developed that have divided the diagnostic process into stages. The initial stage is to recognize the syndrome, the next is to search for manifestations that exclude this disease, the third is to identify symptoms that confirm the disease in question. Practice shows that the proposed diagnostic criteria are highly sensitive and quite specific.

The first step in diagnosing Parkinson's disease is recognizing the syndrome in order to distinguish it from neurological symptoms and psychopathological manifestations, similar in a number of manifestations to true parkinsonism. In other words, the initial stage is characterized by differential diagnosis. True parkinsonism is detected when hypokinesia is detected in combination with at least one of the following manifestations: muscle rigidity, resting tremor, postural instability not caused by primary vestibular, visual, proprioceptive and cerebellar disorders.

The next stage of diagnosing Parkinson's disease involves excluding other ailments that manifest themselves as parkinsonism syndrome (the so-called negative criteria for diagnosing parkinsonism).

The following criteria for excluding the disease in question are distinguished:

Anamnestic evidence of repeated strokes with stepwise progression of parkinsonism symptoms, repeated brain injury or significant encephalitis;

The use of antipsychotics before the onset of the disease;

Oculogyric crises;

Long-term remission;

Supranuclear progressive gaze palsy;

Unilateral symptoms lasting more than three years;

Cerebellar manifestations;

Early onset of symptoms of severe autonomic dysfunction;

Babinski's sign (abnormal response to mechanical irritation of the foot);

The presence of a tumor process in the brain;

Early onset of severe dementia;

Lack of results from consuming large doses of Levodopa;

The presence of open hydrocephalus;

Methyl-phenyl-tetrahydropyridine poisoning.

Diagnosing Parkinson's disease, the last step is to search for symptoms that confirm the pathology in question. In order to reliably diagnose the described disorder, it is necessary to identify at least three criteria from the following:

Presence of rest jitter;

The onset of the disease is with unilateral symptoms;

Stable asymmetry, characterized by more obvious manifestations on the half of the body with which the disease debuted;

Good response to the use of Levodopa;

The presence of severe dyskinesia caused by taking Levodopa;

Progressive course of the disease;

Maintaining the effectiveness of Levodopa for at least 5 years;

Long-term course of the disease.

Anamnesis and examination by a neurologist are important in diagnosing Parkinson's disease.

First, the neurologist finds out the patient’s area of residence, at what age the disease debuted and with what manifestations, whether there are known cases of the disease in question in the family, whether the pathology was preceded by various brain injuries, intoxications, whether trembling subsides at rest, what motor disorders appeared, their symmetry manifestations, whether he can take care of himself independently, cope with everyday activities, whether sweating disorders have appeared, changes in emotional mood, dream disturbances, what medications he took, whether there is a result of their influence, whether he took Levodopa.

After collecting medical history data, the neurologist evaluates the patient’s gait and body posture, as well as the freedom of motor acts in the limbs, facial expressions, the presence of tremors at rest and during exercise, identifies the presence of symmetry of manifestations, determines speech disorders and handwriting defects.

In addition to data collection and examination, the survey should also include instrumental research. Tests for diagnosing the disease in question are not specific. They rather have an auxiliary meaning. In order to exclude other diseases that occur with the symptoms of parkinsonism, the level of glucose concentration, cholesterol content, liver enzymes, the amount of thyroid hormones are determined, and kidney samples are taken. Instrumental diagnosis of Parkinson's disease helps to identify a number of changes characteristic of parkinsonism or other ailments.

Electroencephalography can detect a decrease in electrical activity in the brain. Electromyography displays the frequency of the tremor. This method contributes to the early detection of the described pathology. Positron emission tomography is also indispensable in the initial stages of the disease even before the onset of typical symptoms. A study is also being conducted to detect a decrease in dopamine production.

It must be remembered that any clinical diagnosis can only be possible or probable. To reliably determine the disease, a pathological examination is necessary.

Possible parkinsonism is characterized by the presence of at least two defining manifestations - akinesia and trembling or rigidity, a progressive course, and the absence of atypical symptoms.

Probable parkinsonism is characterized by the presence of similar criteria as with possible, plus the presence of at least two of the following manifestations: clear improvement from taking Levodopa, the occurrence of fluctuations in motor functions or dyskinesia provoked by taking Levodopa, asymmetry of manifestations.

Definite parkinsonism is characterized by the presence of similar criteria as in probable, as well as the absence of oligodendroglial inclusions, the presence of destruction of pigmented neurons, identified through pathomorphological examination, and the presence of Lewy bodies in neurons.

Treatment of Parkinson's disease

The key stages of treatment for the disease in question include several basic therapeutic methods: pharmacopoeial therapy (neuroprotective and symptomatic), non-drug treatment, neurosurgical treatment and rehabilitation measures.

Parkinson's disease symptoms and treatment are determined by the stage of the disease and imply two conceptual directions: the selection of drugs that can significantly slow down or stop the progression of symptoms (neuroprotection), and symptomatic therapy designed to improve the lives of patients.

There are several types of medications used to relieve symptoms. They eliminate the manifestations of the disease and increase the duration of active life of patients. However, today there are no means that can stop the degeneration of dopaminergic cells, so the pathology in question is classified as an incurable disease.

Treatment strategies vary significantly between the onset and late stages of Parkinson's disease. When identifying the pathology in question in the early stages, in order to determine the timing of the start of therapeutic measures with pharmacopoeial agents, it is necessary to analyze a number of circumstances, such as the severity of the course (severity of cardinal manifestations), duration of the course, rate of increase in symptoms, patient’s age, concomitant ailments, nature of work activity, etc. .

How to treat Parkinson's disease? The most common pharmacopoeial drug used to relieve symptoms of parkinsonism is Levodopa, which helps relieve motor dysfunction. Moreover, the described substance has a number of side effects. In order to minimize negative consequences, patients are prescribed additional drug therapy. Therefore, many neurologists try not to prescribe Levodopa at the onset of parkinsonism.

At the initial stage of development of Parkinson's disease, the category of patients who have not passed the fifty-year limit, the prescription of dopamine antagonists is recommended. Amantadines and MAO-B inhibitors are also often used. Patients over 50 years of age, regardless of the progression of the symptoms of the disease, are prescribed Levodopa. Instability of body position is quite difficult to respond to medication. Trembling and muscle hypertonicity can be corrected by taking an adequate dosage of the drug.

Patients in the third stage of Parkinson's disease are prescribed Levodopa in combination with dopamine antagonists (they are less likely to provoke dyskinesias and other motor dysfunctions compared to Levodopa, but more often cause edema, hallucinations, constipation, and nausea). MAO inhibitors selectively reduce the activity of enzymes that break down dopamine and slow the progression of Parkinson's disease. The pharmacological effect is similar to Levodopa, but its severity is significantly less. This group of drugs allows you to increase the effect of levodopa. Indirect dopaminomimetics increase the production of dopamine and inhibit its reuptake by neurons. The drugs in this group primarily suppress muscle rigidity and hypokinesia, and have a lesser effect on tremors.

When dysfunctions of the digestive tract are detected, Motilium is prescribed to activate motility. For dream disorders, algia, depressive moods, and increased anxiety, sedatives are prescribed. Prescription of antidepressants, for example, Cipramil, is less common. To activate memory and improve concentration, it is recommended to take Reminyl.

Many people are interested in: “How to treat Parkinson’s disease?” People are especially interested in whether it is possible to help patients with non-drug methods. In addition to pharmacopoeial medicine, gymnastic exercises have proven themselves to be excellent, which, when repeated daily along with the use of medications, give excellent results.

The seriousness of Parkinson's disease lies in the constant progression of symptoms, which leads to disability. Therefore, the quality of life of individuals suffering from parkinsonism and their adaptation directly depend on competent therapy and home care. In addition, it is very important to help the patient maintain the ability to independently care for himself and perform daily manipulations.

The following are important aspects of therapy and home care for subjects suffering from Parkinson's disease. First of all, it is necessary to adapt the situation in the home (rearrange the furniture so that the individual leans on it when moving around the apartment) and simplify daily activities. A person should adhere to a dietary diet, consume a lot of fruits (exclude bananas) and vegetables, eat more cereals, legumes, and black bread. For meat, preference should be given to lean varieties and poultry. You can consume low-fat dairy products. You should consume at least two liters of liquid per day.

Diet is important for a number of reasons. Firstly, following a proper diet helps speed up the effect of the drugs. Moreover, in the later stages there is a problem with swallowing. Therefore, it is necessary to create a daily diet taking into account the specific characteristics of the individual. Foods can also contribute to constipation or weight loss. This point should also be taken into account when developing dietary nutrition. A properly selected daily diet helps alleviate suffering from the autonomic manifestations of Parkinson's disease.

Gymnastic exercises are indispensable at any stage of pathology development. In order to improve coordination, it is recommended to do a scissors-type exercise with your hands, draw imaginary figure eights in the air, imitate rowing with your hands, and bend your torso. Stretching or stretching is ideal to prevent muscle stiffness. If the individual’s physical condition allows, then the “bridge” and “swallow” exercises will be useful. In addition, swimming, daily walking or light jogging are effective. You can eliminate shaking by holding something light in your palm. This helps reduce shaking and restore control over motor acts.

It is possible to correct speech disorders with the joint work of the speech therapist and the patient. Special exercises have also been developed to improve speech and return your life to its previous level. The first exercise consists of clearly and loudly pronouncing vowel letters in turn. Vowels should be pronounced with your lips stretched forward and stretched. Next exercise: you need to insert small nuts into your cheeks and read a book or recite a poem. In this case, reading or recitation should be leisurely and reproduced out loud. These exercises must be performed at least twice a day.

Exercises to enhance mental activity are represented by the so-called intellectual exercises, which include: solving crossword puzzles, solving puzzles, solving riddles, memorizing poems. You can also use special games aimed at maintaining mental activity (association).

Non-traditional treatments are used more to eliminate symptoms that interfere with normal life activities. So, for example, if a person suffers from constipation, then he is advised to take medicinal herbs that have a laxative effect, and to enhance intellectual activity, plants that stimulate brain activity are used. In addition, warm baths are considered indispensable among alternative medicine, helping to relieve muscle stiffness and calm. Baths should be taken in a course - once every 60 days, 10 procedures. A bath with sage leaves, which should be pre-brewed and allowed to brew, has an excellent effect.

Thus, in the initial stages of Parkinson’s disease, patients, as a rule, are not prescribed drug therapy. They are trying to relieve their condition with physical therapy. They try to introduce pharmacopoeial drugs later, since long-term therapy with such drugs causes addiction and many negative effects.

Doctor of the Medical and Psychological Center "PsychoMed"

The information presented in this article is intended for informational purposes only and cannot replace professional advice and qualified medical care. If you have the slightest suspicion that you have Parkinson's disease, be sure to consult your doctor!

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