This year 2017 marks the 200th anniversary of James Parkinson’s description of the disease that bears his name and of which today is World Day. We learn from Dr. Arcaya Navarro, specialist in Neurology, its incidence in the population and the complexity of its treatment.
Incidence of Parkinson’s disease
Parkinson’s disease is the second most frequent of all neurodegenerative processes, after Alzheimer’s dementia.
At present, the disease still has no cure, nor can it be prevented; it is not fatal, but it can become disabling. On the other hand, it has very special features that differentiate it from other neurological diseases due to its complex pharmacological treatment, which can greatly improve the quality of life and life expectancy of well-treated patients.
The increase in incidence and its current long duration (20 years on average) makes it behave as a chronic disease that demands many resources. Moreover, it is not only a disease of “old people” since there are more and more cases in people under 50 years of age.
In 30% of cases Parkinson’s disease can be associated with dementia (different from Alzheimer’s), and 50% may also have depression, which leads to misdiagnosis (especially initially). A curious fact that has recently been discovered is that the clear and permanent loss of smell (logically if other manifestly local causes of the nose or olfactory bulbs are discarded) in some people can be premonitory of suffering from Parkinson’s disease in very early stages without the appearance (years before) of motor symptoms.
The complexity of Parkinson’s treatment
Neurologists have a wide range of possible drugs that will substantially improve the quality of life of these patients, but it is necessary to choose with criteria: which one and at what moment is the most appropriate to introduce them in the course of this long disease. This becomes even more complicated if we take into account that there is also the option of treatment with functional surgery, especially with subthalamic stimulation, which is gaining more and more followers and earlier due to its good results.
So, what is the guideline to follow to treat Parkinson’s patients well?
First of all, a diagnosis of early suspicion must be made by family physicians or by the family members themselves if they observe: a tremor, muscular rigidity or slowness of movement that usually also affects walking. The fundamental cause is a lack of dopamine in the brain. The neurologist will diagnose and assess which drug to use at the beginning (dopaminergic agonists and/or levodopa, etc.) and according to the progression of the disease will introduce the changes that will benefit the patient the most, but always minimizing possible future complications (abnormal involuntary movements and/or uncontrollable motor impairment) that may appear, more frequently, due to an inadequate initial medication.