The onset of Parkinson’s symptoms usually appears in the sixth decade of life (but there are early cases in the fourth decade and late cases in the eighth decade). It is not abrupt but insidious and progressive, over months or years.
The patient usually goes to the neurology specialist when he/she notices that a hand trembles, although other symptoms may be present much earlier, manifesting with slowness of movement, short steps, etc., but these are confused with age-related deterioration. In addition, non-motor symptoms may appear before motor symptoms, such as depression and gastrointestinal disorders (constipation or slow digestion) or lack of smell, among others. However, they are not usually related, neither by the patient nor his or her relatives, nor even by many of the physicians who see him or her on a regular basis.
What symptoms does Parkinson’s disease present with?
The basic motor symptoms included in Parkinson’s disease are:
- Tremor (resting or postural).
- Bradykinesia: Slowness of movement (dressing, turning over in bed, eating, walking, etc.), with poor arm swinging when walking
- Muscle stiffness with forward stooped posture.
During the examination, the so-called “pushing maneuver” is performed, where a tendency to lose balance is usually detected. In addition, a hypomimic face with seborrhea and little blinking, together with a low voice volume and tendency to micro-writing are also characteristic.
When should the patient see a specialist for a case of Parkinson’s disease?
The diagnosis is clinical, due to the symptoms mentioned above, and it is the relatives who usually detect them before the patient himself. Normally, patients come for consultation because of a tremor in the hand and/or leg. However, the sooner you go to the clinic, the sooner you can be diagnosed and improve, with symptomatic treatment (not curative) to improve the quality of life.
It is also important to make a differential diagnosis to other processes, such as essential or thyroid tremor, or parkinsonisms of another cause:
- For being taking any medication
- For visible brain lesions in a cranial CAT scan.
In cases of doubtful clinical diagnosis there is a Nuclear Medicine test called DAT Scan that allows to see how affected the dopaminergic pathway is (when there is a lack of dopamine, a type of brain neurotransmitter).
It is important to note that Parkinson’s is a neurodegenerative disease that progresses over years. Its main problem is the progressively emerging physical disability, sometimes coupled with cognitive impairment in later stages of the disease (usually mild or moderate, distinct from Alzheimer’s disease). Life expectancy is usually quite similar to that of a person without the disease.
What is the best treatment for Parkinson’s disease?
Treatment should be established and followed by a neurologist, who will use the appropriate combination of drugs, which will vary according to the stage of the disease and the patient.
The decision making in this regard varies greatly depending on the patient, having to choose and change the medications and doses, as well as the schedules for taking them.
The most potent treatment is oral levodopa (with its multiple formulations), which is converted into dopamine and what it does is to try to replace the missing dopamine in the brain. However, dopaminergic agonists, which do not convert to dopamine but stimulate by “tricking” the dopamine receptors in the striatal nucleus of the brain, are also used and are often used in early stages of the disease, having certain advantages over levodopa, such as avoiding, reducing or delaying the unpleasant side symptoms that arise from chronic levodopa treatment. But they tend to be somewhat less effective than levodopa in correcting symptoms.
Another therapeutic option may be functional surgery, with implantation of stimulating electrodes with microsurgery inside the brain (subthalamic nucleus). This procedure is performed with the patient conscious in the operating room. The electrodes are connected to a device (similar to a cardiac pacemaker) implanted inside the skin. To activate it during the day or deactivate it at night, contact with a special magnet must be made. It is a technique that has had very good results, especially in cases where treatment with medication is not working.
Currently, there are also other treatments for specific cases:
- Duodopa, for example, which is a direct levodopa in the duodenum, and it is performed by gastrostomy. It uses a small tube through which it is administered, to avoid any inactivation by the stomach.
- Ultrasounds from outside the skull that lesion a deep and specific intracerebral nucleus, and thus avoid any possible lesion with electrodes that go through the brain. Unlike these, which only stimulate and are reversible (if necessary), ultrasounds cause a definitive lesion.
How does Parkinson’s affect the patient?
Patients suffering from Parkinson’s disease see their physical capacity diminish over time, depending on their clinical stage of evolution.
In addition, symptoms caused by the chronic treatment itself may appear over the years, such as involuntary movements, mobility fluctuations affecting walking or motor blocks.
Also, in a percentage of about 30% of cases there may be symptoms of cognitive impairment with slowing of executive mental processes (rather than memory problems). On the other hand, non-motor symptoms may also appear (sometimes appearing even before motor symptoms), such as:
- Depression
- Anxiety
- Digestive disorders due to slowing during gastric emptying
- Constipation
- Loss of smell
- Nonspecific pains in specific parts of the body or the back
- Apathy
- Dizziness
- Sleep disturbances
Later, in very advanced stages, some patients may also complain of small repetitive hallucinations, speech or swallowing problems. Hence, it is a disease that requires an adequate and global approach and treatment, often multidisciplinary with other specialties.