World Parkinson’s Disease Day: What should we know?

Today, April 11, on the occasion of World Parkinson’s Day, Dr. Javier Ruiz Martínez tells us about the disease, what it consists of, the symptoms and how to diagnose it in time. This disease manifests itself mainly in patients between 60 and 80 years of age, although there may be forms of early presentation, below the age of 50. In addition, unlike other neurodegenerative diseases, such as Alzheimer’s disease, it is less common for symptoms to begin above the age of 80.

What are the symptoms?

The symptoms of Parkinson’s disease are diverse and can be classified into two groups:

  • Motor symptoms: these are the typical symptoms such as resting tremor (mostly unilateral onset), slowness of movement (hypokinesia), rigidity, and gait and stability disturbances.
  • Non-motor symptoms: these are more general symptoms, where we can find sleep disturbances, especially REM sleep behavior disorder, decreased sense of smell, constipation or depression. It is important not to be alarmed by non-motor symptoms if they appear in isolation, because of their frequency in the general population.

How is Parkinson’s disease diagnosed?

The diagnosis of Parkinson’s disease is mainly clinical, and sometimes confirmation is required with nuclear medicine tests (DaTSCAN), or to rule out other causes by other imaging tests (nuclear resonance or cranial CT).

To classify the degree of involvement, the Hoehn and Yahr scale is usually used, grading from 1 to 5. At grade 1, unilateral symptoms begin. From grade 2 onwards, bilateral involvement can be perceived without alteration of balance. Later, from grade 3 onwards, the ability to walk begins to be affected, although physical independence can still be preserved. In grades 4 and 5, severe disability begins to appear, and finally, in grade 5, the patient is totally dependent and may become wheelchair-bound.

How to recognize Parkinson’s disease?

Non-motor symptoms often appear before the patient goes to the first visit to the specialist. However, the patient comes to the doctor when he/she has observed slowness of movement in domestic activities such as beating an egg, or difficulty in turning in bed. Early diagnosis of the disease is desirable in order to receive the appropriate treatment for the symptom. In the future, we hope to have drugs that can halt the progression of the disease, which should be used in the early stages of the disease.

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Treatments for the disease

At this time there is no curative treatment, but symptomatic treatment. This means that the symptoms can improve, allowing a good quality of life, while maintaining a high degree of autonomy. With these drugs, the life expectancy of patients is almost equal to that of other individuals. The drugs used for treatment are mainly responsible for replenishing dopamine, which is the main neurotransmitter of the neurons that are lost as a result of the neurodegenerative process.

These drugs are not free of side effects that are usually quite predictable, but it is advisable to be aware of them in order to change the medication as soon as they begin to manifest themselves.

In recent years, therapies have also been developed for more advanced stages of the disease. Surgical intervention consisting of deep brain stimulation, and has been performed for more than 20 years, with great efficacy and safety. Infusion pumps have also been an important advance in achieving an optimal situation in patients who could no longer be controlled with conventional medical treatment.

What is the future of Parkinson’s disease?

Studies on Parkinson’s disease are very promising in the search for treatments that can modulate or slow progression, but it is still in a very preliminary phase. In the future there will be drugs that can slow down the disease, but as I mentioned, they will have to be used in the early stages of the disease, before the degenerative process is at an advanced stage, and early diagnosis is important in this respect.

The ultimate goal will be to prevent neuronal death, but to do so we must make further progress in understanding the cause of the disease, which to date remains unknown. It is known that there is a multifactorial mechanism where genetics, and the environment, in the context of aging play a major role.