Parkinson’s disease is a type of Parkinsonism, although there are other types such as vascular, secondary to drugs or the so-called atypical Parkinsonism, among others. This disease is also heterogeneous and variable among patients. There are mainly three different types: “tremoric” Parkinson’s disease, in which tremor is the predominant symptom, rigid-kinetic Parkinson’s disease, if rigidity and clumsiness predominate over tremor, and Parkinson’s disease affecting balance and gait.
What are the stages of Parkinson’s disease evolution?
The evolution of Parkinson’s disease is variable among patients. In general there is an initial stage in which the response to medication is stable and there are no variations in motor status during the day. Most patients can move to another stage where there are motor fluctuations: the response to medication is not the same during the day/night and there are OFF and ON times.
When motor fluctuations are not well controlled with oral medication, patients are said to be candidates for “advanced therapies”. The duration in years of each stage is not equal among patients, and not all patients have to go through all stages or be candidates for “advanced therapies”.
Depending on the type of Parkinson’s disease, in some patients the most bothersome symptoms may be other than motor fluctuations, such as balance problems and falls or cognitive impairment. There are other accompanying symptoms during the evolution of the disease that are also very important because they affect the quality of life of patients: non-motor symptoms. These symptoms include mood, sleep, memory or dysautonomic symptoms (constipation, orthostatic hypotension, or urinary urgency), among others.
What is the first symptom that is indicative of the need to see a specialist?
The symptoms that motivate consultation are the so-called motor symptoms such as tremor in an arm or leg or slowness of movement. The clumsiness or slowness of movement may be present in one limb or may be generalized. For example, family members or the patient may notice loss of speed in day-to-day movements such as walking, dressing or getting up from a chair. There may also be stiffness in the limbs or trunk and unsteadiness in walking.
Although it is known that non-motor symptoms may appear before motor symptoms, at present the diagnosis is based on motor symptoms. Before any symptom, it is best to consult a neurologist to rule out other pathologies, clarify doubts and have more information.
What tests are performed to detect it?
The diagnosis is based on a rigorous clinical history and neurological examination, so that only with these data can a diagnosis of Parkinson’s disease be made. Although it is not always necessary to perform complementary examinations, imaging tests such as cranial resonance imaging can be helpful to rule out other causes of Parkinsonism or to demonstrate dopamine deficiency (dopamine SPECT or DATSCAN).
Genetic studies are only indicated in young patients or if a family history is known.
Can it be detected early?
Before motor symptoms appear (when the diagnosis is made) there may be “early” symptoms called “pre-motor” such as loss of smell, constipation, depression or REM sleep behavior disorder (gesticulating, talking or shouting while dreaming). So there are cases in which we can make an “early” diagnosis and diagnostic criteria are not yet met because the motor symptoms have not yet appeared. Although at the present time, there are no drugs for these “early” cases, research is still active in finding effective drugs capable of slowing the progression of the disease.
Is there prevention?
At present there are no preventive treatments for Parkinson’s disease. In general, a healthy diet and physical exercise are recommended. One of the goals in the field of Parkinson’s disease research is focused on finding effective drugs that can modify the course of the disease.