What signs can indicate the onset of Parkinson’s disease?
Parkinson’s disease is characterized by so-called motor symptoms that include:
- Resting tremor (mostly one-sided onset)
- slowness of movement (hypokinesia)
- Rigidity and alterations in gait and stability.
However, it should be noted a number of symptoms that appear even earlier, which have been called non-motor symptoms, where we can find:
- Sleep disturbances, a very characteristic symptom is REM sleep behavior disorder.
- Decreased sense of smell
- Constipation
- Depression
Constipation and depression are common in the general population, so they should not be cause for alarm if they appear in isolation.
How do Parkinson’s symptoms evolve and do they appear more as the disease develops?
The patient will start follow-up and treatment by his neurologist, so the motor symptoms will improve and may remain stable during the first 3 – 5 years, but it is a progressive disease that will increase over the years and will force to modify the doses and treatment guidelines.
It should be emphasized that the evolution is very variable in each patient and, in the same way that there are individuals with a slow progression during 20 years, in others there are great limitations in the first 5 years of the disease.
What secondary problems or pathologies can this disease develop?
As the years go by, the same medication, which had been very effective at the beginning, stops having the same effect and even causes side effects such as involuntary movements, called dyskinesias. It is common to have to increase and fragment the treatment into more doses to achieve the same effect and to have to resort to a second or third drug to keep mobility under control and avoid complications.
As the disease progresses, we may also find symptoms of autonomic dysfunction which means poorer blood pressure control with a tendency to have low blood pressure levels, presence of different degrees of cognitive impairment and behavioral alterations with a tendency to impulsivity.
Is there a treatment for Parkinson’s disease and what progress has been made in this regard?
At the moment Parkinson’s disease has no cure. Treatment is aimed at improving the symptoms, and we have a large arsenal of drugs that today have managed to ensure that the life expectancy of patients is almost the same as that of other individuals. At the pharmacological level, there are several lines of treatment to replenish the deficit of a substance called dopamine, which is mainly responsible for the symptoms. These drugs are becoming more and more convenient to take and their possible side effects are better known.
For some years now, therapies have been developed for the more advanced stage of the disease. Surgical intervention consisting of deep brain stimulation by means of electrodes has been carried out for more than 20 years, and more and more progress is being made in the search for different treatment “targets”. Continuous medication infusion devices (infusion pumps) have also been created, which, with appropriate selection criteria, make it possible to improve some cases with an advanced stage of the disease.
Apart from what has been called symptomatic treatment, which only improves the symptoms of the disease, a great effort is currently being made in research into its causes, which will make it possible in the future to obtain treatments that, if started very early, can slow its progression. Gene therapy, cell transplants, immunotherapy and stem cell research are examples of this.
Is there any predisposition to Parkinson’s disease?
Genetic predisposition exists, as in most diseases. Years ago it was said that Parkinson’s disease was sporadic, that is, without a hereditary component. In the last 15 years, different familial forms of the disease have been discovered that have shown us a very different reality. At present, it can be said that 10-15% of cases have a genetic origin, but it is likely that this percentage will increase in the coming years.
In any case, genetics alone may not be able to justify the origin of the disease and we have to think of a combination of predisposing factors, where the environment also has a relevant role such as lifestyle habits, consumption or exposure to certain toxins.
Can it be prevented? Is it hereditary?
It cannot be prevented because it is not yet possible to determine its causes. In hereditary forms where a causal mutation has been detected, important research is being carried out to design molecules that can make up for the deficit caused by this genetic alteration. It is very promising, but still at a very preliminary stage.