About Parkinson's disease

What is Parkinson's disease?

Parkinson's disease is an incurable chronic progressive disease that damages the brain cells that produce dopamine, which is used to transmit signals from the brain to the central nervous system. The disease has many faces and its symptoms differ from patient to patient. The main impact of the severe disease is on the patient's ability to function, which over time becomes highly disabled, who needs close and constant help in performing even the simplest actions. The burden of caring for the patient falls mainly on his family members, who need guidance, advice, encouragement and support. In the various stages, the disease manifests itself in tremors, muscle stiffness, involuntary and uncontrollable movements, indistinct and monotonous speech, and a decrease in facial expression and body language. On top of that, there are disorders in the digestive, urinary and sphincter control systems. The disease also has mental aspects such as: cognitive decline, depression, anxiety and hallucinations.
Despite the image that the disease mainly affects the elderly population, sometimes its signs are also detected among young people in their thirties and forties. The average age at which the disease is detected is 58 and according to the estimate, the number of patients with Parkinson's disease in Israel reaches about 35,000.

Parkinson's disease belongs to a group of diseases with a disorder in the motor system. The four main symptoms are: tremors (tremors in the hands, arms, legs, jaw and face), stiffness in the limbs and torso, slowness of movement, and instability or impaired balance and coordination. When these symptoms increase, patients may have difficulty walking, speaking or completing other simple tasks.
The disease has a continuous and progressive course that worsens over time. It is not contagious and usually not hereditary, that is, it is not passed directly from one family member to another or from generation to generation.

What is it caused by?

Parkinson's disease is caused when the nerve cells (neurons) in the brain in an area called Substantia Nigra die or are damaged. Normally, these neurons produce an important chemical called dopamine. Dopamine is a kind of chemical messenger responsible for transmitting signals between the Substantia Nigra and the next "relay station" in the brain, the Corpus Striatum, in order to create purposeful and smooth muscle action. Loss of dopamine, causes the neurons of the striatum to send out purposeless nerve impulses, leaving the patients unable to lead or control their movements normally.
Studies have shown that Parkinson's patients lose 80% or more of the dopamine-producing cells in the Substantia Nigra region. The reason for the death of the cells or damage to them is unknown, but studies continue to yield important findings that provide new clues about the disease.

According to one theory, free radicals - unstable and potentially harmful molecules formed as a result of normal chemical reactions in the body - can cause the death of nerve cells and thus lead to Parkinson's disease. Free radicals are unstable because they are missing one electron. In an attempt to complete the missing electron, the free radicals interact with nearby molecules (especially with metals such as iron), in a process called oxidation. The hypothesis is that the oxidation process damages the tissues and the contents of the neurons. Evidence that oxidation may cause the development of Parkinson's includes the finding of high levels of iron in the brains of Parkinson's patients, especially in the area of ​​the substantia nigra, and alternatively the finding of low levels of ferritin, which protects the cells by binding the iron or forming a ring around it. for iron and its insulation.
Some scientists have hypothesized that Parkinson's disease may appear when an internal or external toxin selectively destroys dopaminergic neurons - neurons that operate using dopamine as the transmitter of nerve stimulation. This theory is based on the fact that there are several toxins (such as MPTP) and neuroleptic drugs known to cause parkinsonian symptoms in humans. However, no study has provided conclusive proof that a toxin causes this disease.
Animal studies have shown that MPTP interfered with mitochondrial function in nerve cells. Researchers have become interested in the possibility that damage to mitochondrial DNA could cause Parkinson's. The mitochondria, found in all animal cells, is an essential intracellular organelle that converts the energy in food into fuel for the cells.
A relatively new theory investigates the role of genetic factors in the development of Parkinson's disease. Fifteen to twenty percent of Parkinson's patients have a relative who has experienced Parkinsonian symptoms such as tremors.
Another theory hypothesizes that Parkinson's disease occurs when, for unknown reasons, the normal age-related wear and tear of dopamine-producing neurons is accelerated in some people. The fact that the loss of antioxidant protective mechanisms is related to Parkinson's disease and aging together strengthens this theory.
Many researchers believe that a combination of these four mechanisms - oxidative damage, environmental toxins, genetic predisposition and accelerated aging - will eventually prove to be the cause of the disease.

What are the early signs of Parkinson's disease?

The early signs of Parkinson's disease are not noticeable and appear gradually. Patients may:

      •  feeling tired or generally feeling bad.
      •  feel a slight instability.
      •  Difficulty getting up from sitting.
      •  Notice that they speak too softly and that their handwriting looks shrunken and spidery.
      •  forget a word or lose their train of thought.
      •  feeling irritated or depressed for no apparent reason.

This very early period can last a long time before the classical symptoms that stand out to the eye appear. Friends and family may be the first to notice the changes. The patient's face can become expressionless and lifeless ("mask face"). The same person can stay for a long time in the same position or not move his arms and legs normally. The patient may appear stiff, unsteady and unusually slow.
As the disease progresses, the tremor that affects most Parkinson's patients may begin to interfere with daily activities. Patients may not be able to hold objects steadily, or may find that the tremor makes it difficult to read a newspaper. Parkinson's tremor may increase when the patient is calm or relaxed. The tremor, for example, will be felt to a greater extent a few seconds after placing the hands on a table. For most patients, the tremor is the symptom that causes them to seek medical help.

Even an experienced neurologist will have difficulty accurately diagnosing Parkinson's disease in its early stages. There are still no blood or laboratory tests that can diagnose the disease. The doctor should observe the patient over time until he sees that he suffers from tremors consistently and that additional classic symptoms (one or more) join him. An accurate diagnosis as soon as possible is essential to start giving appropriate drugs to the patient.

Symptoms

Parkinson's disease does not affect all patients in the same way. In some patients the disease progresses rapidly and in others it does not. Although some patients become severely disabled, others experience only mild motor disturbances. The tremor is the main symptom for some patients, while for others it is only a marginal phenomenon compared to other problematic symptoms.

tremor - The typical tremor of Parkinson's disease is characterized by back and forth movements of the thumb and index finger at a rate of three beats per second. Sometimes the phenomenon is called "Pill Rolling". The tremor usually starts in the hand, although sometimes the leg or jaw is affected first. The tremor is most pronounced when the hand is at rest or when the patient is tense. In three out of four patients, the tremor affects only one part or one side of the body, especially in the early stages of the disease. Then it becomes more general. The tremor rarely limits the patient and usually disappears with sleep or improves when movements are directed.

rigidity - or resistance to movement, affects most Parkinson's patients. A main principle of body movement is that all muscles have opposing muscles. Movement is made possible not only because one muscle becomes more active, but because the opposite muscle relaxes. In Parkinson's disease, stiffness occurs when the delicate balance between opposing muscles is disturbed in response to signals sent from the brain. The muscles remain tense and contracted all the time and the patient suffers pain or feels stiff or weak. The stiffness is more noticeable when another person tries to move the patient's arm, and the arm moves only in short, sharp movements called "cogwheel" stiffness.

Slowness of movement (Bradykinesia) - Slowing down or losing the automatic and spontaneous movement is particularly frustrating because it cannot be anticipated in advance. One moment the patient moves easily, and the next moment he may need help. This symptom can be the most frustrating or disturbing of all the signs of the disease because the patient cannot perform routine movements quickly. Actions that were previously performed quickly and easily, such as bathing or dressing, may take several hours.

instability - or impaired balance and coordination, causing patients to lean forward or backward more easily. Patients who lean backward tend to step back when they are bumped in front or when they start walking, a phenomenon called retropulsion. This instability can result in a hunched posture where the patient's head is bowed and shoulders are slumped.

As the disease progresses it is also affected the walking. Patients may stop in the middle of walking and "freeze" in place or stumble, and there are patients who take small, quick steps as if rushing forward to maintain their balance. This phenomenon is called fast and involuntary walking (Festination).
Additional symptoms accompany Parkinson's disease, some marginal, others more disturbing. Many of them can be treated with appropriate drugs or physical therapy. No one can predict which symptoms will affect a particular person. The intensity of the symptoms also varies from person to person. Neither is fatal, although swallowing problems can cause suffocation.

depression - This is a common problem that may appear early in the course of the disease, even before other symptoms have been diagnosed. The depression does not have to be severe, but drugs that treat other symptoms of the disease may increase it. Fortunately, depression can be successfully treated with antidepressants.

Mood swings - Some Parkinson's patients become anxious and unsure of themselves. They may be afraid that they will not be able to cope with new situations. They may not want to travel, go to parties or socialize with friends. Some lose their motivation and become dependent on their family members. Others become unduly irritable or pessimistic.

Memory loss and slow thinking - may appear, although the ability to think logically is not impaired. The question of whether Parkinson's patients suffer from intellectual impairment, also known as dementia, is controversial and is still being researched.

Difficulties in swallowing and chewing - The muscles used for chewing may work less efficiently in the later stages of the disease. In such cases, food and mucus may accumulate in the throat, and the patient may choke or drool. Medicines can often reduce these problems.

Speech changes - About half of Parkinson's patients suffer from speech problems. They may speak very softly or monotonously, hesitate before speaking, swallow or repeat words, or speak too quickly. Speech therapy may help patients reduce some of these problems.

Urinary tract problems or constipation - In some patients, bladder or bowel problems may appear because the autonomic nervous system, which is responsible for regulating the smooth activity of the muscles, does not work properly. Some patients will not be able to hold back while others will have difficulty urinating. Others will suffer from constipation due to the slow action of the intestines. Constipation may also be caused by inactivity, poor diet or drinking little. It can be a persistent problem and in rare cases will be severe enough to require hospitalization. Patients should not allow constipation to last more than a few days before taking steps to relieve it.

skin problems - In Parkinson's disease, the facial skin often becomes very oily, especially on the forehead and sides of the nose. The scalp also becomes greasy and scales form. In other cases, the skin may become very dry. These phenomena are also caused by the abnormal functioning of the autonomic nervous system. Standard treatments for skin problems help. Excessive sweating, also a common symptom, can be controlled with medication.

Sleep problems - These include difficulty sleeping at night, restless sleep, emotional dreams and nightmares or drowsiness during the day. It is not clear if these symptoms are related to the disease or the drugs used to treat it. Patients should not use over-the-counter sleeping pills before consulting their doctors.