How Parkinson’s Disease Begins

What are the main symptoms of Parkinson’s disease?

Parkinson’s disease is a chronic neurodegenerative disease that manifests itself through its cardinal symptoms:

  • Bradykinesia (slow movement)
  • Rigidity (increased muscle tone)
  • Tremor and loss of postural control
  • Slowing and a reduction of movements commonly asymmetrical (impoverishment of movement) with bradykinesia (slowing down of movement)
  • Stiffness
  • Resting and/or postural tremor in gait disorder with postural instability.

There are also many non-motor symptoms such as anxiety, vegetative dysfunction, olfactory disorders and sleep disorders.

Some patients affected by this disease show signs of cognitive impairment, which usually appears in more advanced stages of the disease, especially in people with a genetic predisposition.

What is the treatment of Parkinson’s disease and what advances are there?

Drug and non-drug treatment options for Parkinson’s disease have improved considerably over the years. However, we still cannot cure the disease, but only treat its symptoms.

A diagnostic indication is usually the therapeutic test, which consists in the application of pharmacological therapy with levodopa (which is considered the drug of choice in the treatment of Parkinson’s disease) for at least 30 days while closely observing the patient’s evolution. It is considered positive if the patient responds radically to levodopa treatment and negative if there is no response at all. Therapeutic testing with levodopa is usually confirmatory if the disease is suspected; however, if the test is negative the physician will have to further investigate other probable causes of the disorder or perform more in-depth studies such as genetic markers.

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In general, treatment can be said to work well for the first 7 years of the disease. This period is also often referred to as the “honeymoon” period, as the symptoms of the disease usually subside and the patient can usually feel the movements again. Then the complications of the disease and its treatment usually begin. For these patients, there is the possibility of improving mobility by means of electrical brain stimulation.

Deep brain stimulation (DBS) is the most widely used surgical treatment, developed in the 1980s. It involves the implantation of a brain “pacemaker”, which sends electrical impulses to specific parts of the brain. DBS is recommended for people who have Parkinson’s disease with motor fluctuations and tremor not controlled with drugs, or for those who are intolerant to medication, as long as they do not have severe neuropsychiatric problems. We have more than 25 years of experience in the field of deep brain stimulation and have the devices to control and adjust this brain pacemaker.

To what extent is this disease hereditary and what tests can we perform to detect it?

It is estimated that approximately 5-10% of Parkinson’s cases have a monogenetic cause, i.e. one gene is responsible for the disease (PARK 1-13). In addition, there are several genes that are probably involved in the disease, but they are not the only ones responsible for it, but their combination with other genetic or environmental factors. Generally speaking, it can be said that the younger the onset of the disease, the more likely it is that there is a genetic cause.

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Screening is recommended above all in relatives of patients with early-onset disease. First a thorough neurological examination and anamnesis is performed, then a radiological/nuclear medicine study can be performed to visualize the Dopamine receptors, which usually decrease before the onset of symptoms.

Parkinson’s disease dementia (PDD) is the highest degree of cognitive impairment and there are a series of genetic mutations that determine a greater predisposition of the patient to develop it; that is, a Parkinson’s patient who has this genetic marker is more likely to have PDD than a non-carrier patient.

What are the characteristics of the Parkinson’s patient?

The disease can affect any adult person regardless of gender. The vast majority of patients are over 65 years of age. Globally, the prevalence of the disease in the population is about one hundred and sixty-four cases per hundred thousand inhabitants. The prevalence of Parkinson’s disease on the European continent is 1.43% in people over sixty. Estimates in Spain show that about one hundred and twenty thousand inhabitants are affected by this disease. In North America, it is estimated that approximately one million patients suffer from this disease, with 1% of the population over 65 years of age being affected.

At early ages, specifically before the age of forty, Parkinson’s disease is exceptional and its prevalence is less than 1/100,000. The incidence of this disease begins to increase from the age of fifty and does not stabilize until the eighties.

Several studies have shown a marked prevalence of Parkinson’s disease in rural areas, especially among men. This may be due to the fact that life in the countryside sometimes includes different risky environmental exposures, such as contamination of well water by the use of pesticides and insecticides.