Parkinson's disease in women. Parkinson's disease: symptoms and signs, causes, treatment of the disease in men and women. Parkinson's disease: what does the diagnosis mean?

Parkinson's disease- symptoms and treatment

What is Parkinson's disease? We will analyze the causes of occurrence, diagnosis and treatment methods in the article of Dr. T. A. Polyakov, a neurologist with an experience of 11 years.

Definition of illness. Causes of the disease

Parkinson's disease- this is one of the most common neurodegenerative diseases, affecting mainly dopamine-producing (dopaminergic) neurons in a certain area of the brain, called the substantia nigra, with the accumulation of alpha-synuclein protein and special intracellular inclusions (Lewy bodies) in the cells. This disease is the most common cause of Parkinson's syndrome (80% of all cases). The prevalence of Parkinson's disease is about 140 (120-180) cases per 100,000 population. The disease most often manifests itself after 50 years, but there are frequent cases of the onset of the disease at an earlier age (from 16 years). Men are affected slightly more often than women.

The reason remains largely unknown. It is assumed that the onset of the disease is influenced by genetic factors, the external environment (possible exposure to various toxins), and aging processes. Genetic factors play a dominant role in the early development of Parkinson's disease. Young patients with the disease and with a family history of the disease are more likely to carry genes associated with Parkinson's disease, such as SNCA, PARK2, PINK1 and LRRK2. One recent study showed that 65% of people with early-onset Parkinson's before age 20 and 32% of people with onset in their 20s and 30s had a genetic mutation thought to increase their risk of developing Parkinson's.

If you experience similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of Parkinson's disease

Many of the symptoms of Parkinson's disease are not related to movement. Non-motor ("invisible symptoms") of Parkinson's disease are common and can affect everyday life more than the more obvious movement difficulties. They may include:

At the beginning of the disease, an incorrect diagnosis is often made - humeroscapular periarthritis, manifested by pain and tension in the muscles of the arm and back.

Parkinson's syndrome is the main clinical manifestation of Parkinson's disease, its symptoms are:

slowness of all movements;
exhaustion of fast repetitive movements in the arms and legs;
muscle stiffness (muscle rigidity);
trembling of arms and legs (but almost never of the head), most pronounced at rest;
unsteadiness when walking;
shortening of the stride length and shuffling when walking, marking time, freezing when walking, lack of friendly hand movements when walking.

Initially, symptoms occur only on one side of the body, but gradually become bilateral. Symptoms remain pronounced on the side where they appeared at the beginning of the disease. Symptoms on the other side of the body often do not become as severe as symptoms on the original side. Movements become progressively slower (the main symptom of parkinsonism). Symptoms of the disease fluctuate during the day and depend on many factors.

The pathogenesis of Parkinson's disease

Parkinson's disease belongs to the group of synucleinopathies, since excessive accumulation of alpha-synuclein in neurons leads to their death. An increased level of alpha-synuclein may be due to a violation of the intracellular system of protein clearance, carried out by lysosomes and proteosomes. Patients were found to have impaired functioning of this system, among the causes of which are aging, oxidative stress, inflammation, toxins. environment. Cells die presumably due to the activation of a genetically programmed mechanism (apoptosis).

Classification and stages of development of Parkinson's disease

Parkinson's disease is classified according to the form, stage, and rate of progression of the disease.

Depending on the predominance of a particular symptom in the clinical picture, the following forms are distinguished:

1. Mixed (akinetic-rigid-tremulous) the form is characterized by the presence of all three main symptoms in different proportions.

2. Akinetic-rigid the form is characterized by pronounced signs of hypokinesia and rigidity, which are usually joined early by walking disorders and postural instability, while resting tremor is absent or minimally expressed.

3. trembling the form is characterized by the dominance of the rest tremor in the clinical picture, the signs of hypokinesia fade into the background.

To characterize stages of Parkinson's disease used Hoehn-Yar scale, 1967:

at the 1st stage akinesia, rigidity and tremor are detected in the extremities on one side (hemiparkinsonism);
at the 2nd stage symptoms become bilateral;
at the 3rd stage postural instability joins, but the ability to move independently remains;
at the 4th stage symptoms of parkinsonism severely limit motor activity;
at the 5th stage as a result of further progression of the disease, the patient is bedridden.

There are three options for the rate of progression of the disease:

With fast the change of stages of the disease from the first to the third takes 2 years or less.
With moderate- from 2 to 5 years.
With slow- more than 5 years.

Complications of Parkinson's disease

Parkinson's disease is not a fatal disease. Man dies with it, not from it. However, as the symptoms worsen, they can cause incidents that result in death. For example, in difficult cases, difficulty swallowing can cause patients to aspirate food into the lungs, leading to pneumonia or other pulmonary complications. Loss of balance can result in a fall, which in turn can result in serious injury or death. The severity of these incidents largely depends on the age of the patient, general condition health and stage of disease.

In the later stages of the disease, more pronounced symptoms of Parkinson's disease appear: dyskinesia (involuntary movements or twitches of body parts that may result from prolonged use of levodopa, congestion (sudden inability to move), or mincing gait (short, almost running steps that seem to accelerate on their own).

It should be remembered that Parkinson's disease is very individual in its course and everyone has their own scenario.

Diagnosis of Parkinson's disease

Parkinsonism is one of those disorders that can be diagnosed at a distance, especially with a detailed picture of the disease. However, diagnosing Parkinson's disease at an early stage is difficult. Early and accurate diagnosis of the disease is essential to develop the best treatment and maintenance strategies. High Quality life for as long as possible. In practice, it is possible to underestimate or overestimate Parkinson's disease. A neurologist who specializes in movement disorders will be able to make the most accurate diagnosis. The initial evaluation is based on the history, neurological examination using special tests to assess the symptoms of the disease. Neurological examination includes assessment of coordination, walking and fine motor tasks, assessment of neuropsychological status.

The practice of obtaining a second opinion largely depends on the personal choice of the patient. But keep in mind that Parkinson's disease is often difficult to diagnose accurately, especially when the symptoms are mild. There is no simple diagnostic test, and approximately 25% of Parkinson's disease diagnoses are wrong. Parkinson's disease starts with few visible symptoms, so many doctors who are not trained in movement disorders cannot make an accurate diagnosis. In fact, even the best neurologists can make mistakes. If the doctor does not have special experience in this area, then a specialist in movement disorders should be consulted. A good neurologist will understand your desire to confirm the diagnosis. A second opinion can help to take a timely right decisions regarding diagnosis and therapy.

Treatment of Parkinson's disease

Although there is no cure for Parkinson's disease, there are many methods that can allow you to lead a full and productive life for many years to come. Many symptoms can be relieved by medications, although over time they may lose their effectiveness and cause unwanted side effects. side effects(eg, involuntary movements known as dyskinesia).

There are several treatments available to slow the onset of motor symptoms and improve motor function. All of these treatments are designed to increase the amount of dopamine in the brain, either by replacing it or by prolonging the effect of dopamine by inhibiting its breakdown. Studies have shown that early therapy can delay the development of motor symptoms, thereby improving quality of life.

The nature and effectiveness of treatment is influenced by a number of factors:

severity of functional deficiency;
patient's age;
cognitive and other non-motor disorders;
individual sensitivity to drugs;
pharmacoeconomic considerations.

The goal of therapy in Parkinson's disease is to restore impaired motor functions and maintain optimal mobility for the longest possible period of time, minimizing the risk side effects drugs.

There are also surgical interventions, such as deep brain stimulation, which involves implanting electrodes into the brain. Because of the risks inherent in this type of treatment, most patients rule out this treatment until the medications they are taking no longer provide meaningful relief. Typically, this treatment is given to patients with a disease duration of four years or more who are responding to medications but have motor complications such as: significant blackouts (periods when the medication does not work well and symptoms return) and/or dyskinesias (uncontrolled, involuntary movements). Deep brain stimulation works best for symptoms such as stiffness, sluggishness, and tremors, but does not work for stability, stiffness when walking, and non-motor symptoms. This treatment may even exacerbate memory problems, which is why surgery is not recommended for people with cognitive impairments.

Various new ways of administering levodopa open up additional therapeutic possibilities. Today, an intestinal (intestinal) duodopa gel is used that reduces daily "off" periods and dyskinesia in patients with advanced Parkinson's disease due to a constant non-pulse regimen of drug administration.

Investigated alternative approach, the use of dopamine-producing cells derived from stem cells. Although stem cell therapy has great potential, more research is needed before stem cells can become a tool in the treatment of Parkinson's disease.

As Parkinson's disease progresses, the brain's dopamine storage and buffering capabilities become increasingly compromised, narrowing the therapeutic window for therapy and leading to fluctuations in the human motor system. Apomorphine pump delivers a subcutaneous infusion throughout the day to treat fluctuations ("ON-OFF" phenomena) in patients with Parkinson's disease who are not well controlled with oral anti-Parkinsonian drugs. This system is used constantly to provide the brain with continuous stimulation.

Forecast. Prevention

Parkinson's disease is unique to each person, no one can predict what symptoms will appear and when exactly. There is a general similarity in the pattern of disease progression, but there is no guarantee that what is observed in one will be in all with a similar diagnosis. Some people end up in wheelchairs; others still run marathons. Some people cannot fasten the necklace, while others make the necklaces by hand.

The patient can do anything to actively influence the course of Parkinson's disease and at least one very good reason: worsening of symptoms is often much slower in those who are positive and proactive about their condition than those who are not. does. First of all, it is recommended to find a doctor who will be trusted by the patient and who will cooperate with the developing treatment plan. Stress reduction is a must - stress worsens every symptom of Parkinson's disease. Educational classes are recommended: drawing, singing, reading poetry, needlework, learning languages, traveling, working in a team, social activities.

Unfortunately, even if drug therapy is adequately selected, this does not guarantee that cells will stop dying in Parkinson's disease. Therapy should be aimed at creating favorable conditions for motor activity taking into account the individual characteristics of the clinical picture of the disease. As the results of numerous studies show, professional motor rehabilitation is necessary condition to slow the progression of the disease and improve its prognosis. To date, clinical trials have shown efficacy rehabilitation program protocols LSVT LOUD, LSVT BIG, theoretical background which is reduced to the development of neuroplasticity of the substance of the brain. It is aimed at correcting trembling, walking, posture, balance, muscle tone and speech.

Rehabilitation methods should be aimed not only at maintaining the preserved motor abilities, but also developing new skills that would help a person with Parkinson's disease overcome their physical limitations, which is facilitated by the dance movement therapy program for Parkinson's disease, which works in more than 100 communities around the world. around the world, including Russia. Dance therapy can partially address the specific problems of Parkinson's disease: loss of balance, poor coordination, shuffling gait, tremors, freezing, social isolation, depression, and elevated level anxiety.

According to a US study of 52 Parkinson's patients, regular practice of Argentinean dance reduces the symptoms of the disease, improves balance, and improves the performance of complex movements in Parkinson's disease.

Pathology caused by the slow progressive death in humans of nerve cells that are responsible for motor functions is called Parkinson's disease. The first symptoms of the disease are trembling (tremor) of the muscles and an unstable position at rest of individual parts of the body (head, fingers and hands). Most often they appear at the age of 55-60, but in some cases, the early onset of Parkinson's disease was recorded in people under 40 years of age. In the future, as the pathology develops, the person completely loses physical activity, mental abilities, which leads to the inevitable attenuation of all vital functions and death. This is one of the most difficult diseases in terms of treatment. How long can people with Parkinson's disease live with the current level of medicine?

Etiology of Parkinson's disease

Physiology of the nervous system.

All human movements are controlled by the central nervous system, which includes the brain and spinal cord. One has only to think about any intentional movement, the cerebral cortex already alerts all departments nervous system responsible for this movement. One of these departments is the so-called basal ganglia. It's ancillary propulsion system, which is responsible for how quickly the movement is carried out, as well as for the accuracy and quality of these movements.

Information about the movement comes from the cerebral cortex to the basal ganglia, which determine which muscles will participate in it, and how much each muscle must be tense in order for the movements to be as precise and purposeful as possible.

The basal ganglia transmit their impulses with the help of special chemical compounds- neurotransmitters. How the muscles will work depends on their number and mechanism of action (excitatory or inhibitory). The main neurotransmitter is dopamine, which inhibits excess impulses, and thereby controls the accuracy of movements and the degree of muscle contraction.

black substance(Substantia nigra) is involved in complex motor coordination by supplying dopamine to the striatum and transmitting signals from the basal ganglia to other brain structures. The substantia nigra is so named because this area of the brain has a dark color: the neurons there contain a certain amount of melanin, a by-product of dopamine synthesis. It is the lack of dopamine in the substantia nigra of the brain that leads to Parkinson's disease.

Parkinson's disease - what is it?

Parkinson's disease is a neurodegenerative disease of the brain that progresses slowly in most patients. Symptoms of the disease may gradually appear over several years.

The disease occurs against the background of the death of a large number of neurons in certain areas of the basal ganglia and the destruction of nerve fibers. In order for the symptoms of Parkinson's disease to begin to appear, about 80% of neurons must lose their function. In this case, it is incurable and progresses over the years, even despite the treatment being undertaken.

Neurodegenerative diseases are a group of slowly progressive, hereditary or acquired diseases of the nervous system.

Also hallmark of this disease is a decrease in the amount of dopamine. It becomes insufficient to inhibit the constant excitatory signals of the cerebral cortex. Impulses are able to pass directly to the muscles and stimulate their contraction. This explains the main symptoms of Parkinson's disease: constant muscle contractions (tremor, trembling), muscle stiffness due to excessively increased tone (rigidity), impaired voluntary body movements.

Parkinsonism and Parkinson's disease, differences

Distinguish:

primary parkinsonism or Parkinson's disease, it is more common and is irreversible;
secondary parkinsonism - this pathology is caused by infectious, traumatic and other brain lesions, as a rule, is reversible.

Secondary parkinsonism can occur at absolutely any age under the influence of external factors.

encephalitis;
brain injury;
poisoning with toxic substances;
vascular diseases in particular, atherosclerosis, stroke, ischemic attack, etc.

Symptoms and signs

How does Parkinson's disease manifest itself?

rest tremor;
stiffness and reduced muscle mobility (rigidity);
limited volume and speed of movements;
decreased ability to maintain balance (postural instability).

Resting tremor is a tremor that occurs at rest and disappears with movement. The most characteristic examples of a resting tremor can be sharp tremulous movements of the hands and oscillatory movements of the head such as “yes-no”.

depression;
pathological fatigue;
loss of smell;
increased salivation;
excessive sweating;
metabolic disease;
problems with the gastrointestinal tract;
mental disorders and psychoses;
violation of mental activity;
cognitive impairment.

memory impairment;
slow thinking;
violations of visual-spatial orientation.

Young people

Sometimes Parkinson's disease occurs in young people between the ages of 20 and 40, which is called early parkinsonism. According to statistics, there are few such patients - 10-20%. Parkinson's disease in young people has the same symptoms, but is milder and slower progressing than in older patients.

In half of patients, the disease begins with painful muscle contractions in the limbs (more often in the feet or shoulders). This symptom can make it difficult to diagnose early parkinsonism because it is similar to arthritis.
Involuntary movements in the body and limbs (which often occur during dopamine therapy).

In the future, signs characteristic of the classic course of Parkinson's disease at any age become noticeable.

Among women

Symptoms and signs of Parkinson's disease in women do not differ from the general symptoms.

In men

Similarly, the symptoms and signs of the disease in men are not distinguished by anything. Is that men get sick a little more often than women.

Diagnostics

There are currently no laboratory tests that can be used to diagnose Parkinson's disease.

Diagnosis is based on the history of the disease, the results of a physical examination and tests. Your doctor may order certain tests to look for or rule out other possible diseases that cause similar symptoms.

One of the signs of Parkinson's disease is the presence of improvements after starting anti-Parkinsonian drugs.

There is also another diagnostic examination method called PET (positron emission tomography). In some cases, PET can detect low levels of dopamine in the brain, which is the main symptom of Parkinson's disease. But PET scans are generally not used to diagnose Parkinson's because it is very expensive and many hospitals are not equipped with the necessary equipment.

Stages of development of Parkinson's disease according to Hoehn-Yar

This system was proposed by English doctors Melvin Yar and Margaret Hehn in 1967.

0 stage.
The person is healthy, there are no signs of illness.

1 stage.
Slight movement problems in one hand. Nonspecific symptoms appear: impaired sense of smell, unmotivated fatigue, sleep and mood disorders. Further, the fingers of the hand begin to tremble with excitement. Later, the tremor intensifies, trembling appears at rest.

intermediate stage("one and a half").
Localization of symptoms in one limb or part of the trunk. Constant tremor that disappears in sleep. The whole hand may tremble. Difficulty fine motor skills and ruined handwriting. There are some stiffness of the neck and upper back, limitation of hand swings when walking.

2 stage.
Movement disorders apply to both sides. Tremor of the tongue and lower jaw is likely. Possible salivation. Difficulties in moving in the joints, deterioration of facial expressions, slowing down of speech. Sweating disorders; the skin can be dry or, on the contrary, oily (dry palms are typical). The patient is sometimes able to restrain involuntary movements. A person copes with simple actions, although they slow down noticeably.

3 stage.
Increased hypokinesia and rigidity. The gait acquires a "doll" character, which is expressed in small steps with parallel feet. The face becomes mask-like. There may be a tremor of the head according to the type of nodding movements ("yes-yes" or "no-no"). Characteristic is the formation of the "pose of the supplicant" - a head bent forward, a stooped back, pressed to the body and arms bent at the elbows, half-bent at the hips and knee joints legs. Movements in the joints - according to the type of "gear mechanism". Speech disorders progress - the patient "fixes" on the repetition of the same words. Man serves himself, but with sufficient difficulty. It is not always possible to fasten buttons and get into the sleeve (when dressing, help is desirable). Hygiene procedures take several times longer.

4 stage.
Pronounced postural instability - it is difficult for the patient to maintain balance when getting out of bed (may fall forward). If a standing or moving person is given a slight push, they continue to move by inertia in a "given" direction (forward, backward, or sideways) until they encounter an obstacle. Falls that are fraught with fractures are not uncommon. It is difficult to change the position of the body during sleep. Speech becomes quiet, nasal, slurred. Depression develops, suicidal attempts are possible. Dementia may develop. In most cases, outside help is required to perform simple daily tasks.

5 stage.
The last stage of Parkinson's disease is characterized by the progression of all motor disorders. The patient cannot stand up or sit down, does not walk. She cannot eat on her own, not only because of tremors or stiffness of movements, but also because of swallowing disorders. Impaired urinary and stool control. A person is completely dependent on others, his speech is difficult to understand. Often complicated by severe depression and dementia.

Dementia is a syndrome in which there is a degradation of cognitive function (that is, the ability to think) to a greater extent than is expected with normal aging. It is expressed in a persistent decrease in cognitive activity with the loss of previously acquired knowledge and practical skills.

Causes

failed to identify the exact cause

Aging- with age, the number of nerve cells decreases, this leads to a decrease in the amount of dopamine in the basal ganglia, which in turn can provoke Parkinson's disease.
Heredity- the gene for Parkinson's disease has not yet been identified, but 20% of patients have relatives with signs of parkinsonism.
environmental factors- various pesticides, toxins, toxic substances, heavy metals, free radicals can provoke the death of nerve cells and lead to the development of the disease.
Medications - Some neuroleptic drugs (for example, antidepressants) interfere with dopamine metabolism in the central nervous system and cause side effects similar to the symptoms of Parkinson's disease.
Injuries and diseases of the brain- bruises, concussions, as well as encephalitis of bacterial or viral origin can damage the structures of the basal ganglia and provoke the disease.
Wrong way of life- risk factors such as lack of sleep, constant stress, malnutrition, beriberi, etc. can lead to pathology.
Other diseases- atherosclerosis, malignant tumors, diseases of the endocrine glands can lead to complications such as Parkinson's disease.

How to Treat Parkinson's Disease

Parkinson's disease in the initial stages is treated with medication, by introducing the missing substance. The substantia nigra is the main target of chemotherapy. With this treatment, almost all patients experience a decrease in symptoms, it becomes possible to lead a lifestyle close to normal and return to their previous lifestyle.
However, if after several years the patients do not improve (despite the increase in the dose and frequency of taking the drugs), or complications appear, a variant of the operation is used, during which a brain stimulator is implanted.

Under local anesthesia, two electrodes are sequentially inserted (along a path predetermined by the computer) for deep brain stimulation.
Under general anesthesia in the area chest an electrostimulator is sewn subcutaneously, to which electrodes are connected.

Treatment of parkinsonism, drugs

Levodopa. Levodopa has long been considered the best medicine for Parkinson's disease. This drug is the chemical precursor of dopamine. However, it is characterized by a large number of serious side effects, including mental disorders. It is best to prescribe levodopa in combination with inhibitors of peripheral decarboxylase (carbidopa or benserazide). They increase the amount of levodopa reaching the brain and at the same time reduce the severity of side effects.

Madopar- one of these combination drugs. Madopar capsule contains levodopa and benserazide. Madopar is produced in different forms. So, Madopar GSS is in a special capsule, the density of which is less than the density of gastric juice. Such a capsule is in the stomach from 5 to 12 hours, and the release of levodopa is gradual. And dispersible madopar has a liquid consistency, acts faster and is more preferable for patients with swallowing disorders.

Amantadine. One of medicines with which treatment is usually started - amantadine (midantan). This drug promotes the formation of dopamine, reduces its reuptake, protects neurons in the substantia nigra by blocking glutamate receptors, and has other positive properties. Amantadine well reduces rigidity and hypokinesia, it affects tremor less. The drug is well tolerated, side effects with monotherapy are rare.

Miralex. Miralex tablets for Parkinson's disease are used as monotherapy in early stages, and in combination with levodopa in later stages. Miralex has fewer side effects than non-selective agonists, but more than amantadine: nausea, pressure instability, drowsiness, swelling of the legs, increased levels of liver enzymes are possible, hallucinations may develop in patients with dementia.

(Newpro). Another modern representative dopamine receptor agonists - rotigotine. The drug is made in the form of a patch applied to the skin. The patch, called a transdermal therapeutic system (TTS), measures between 10 and 40 cm² and is applied once a day. Neupro is a prescription monotherapy for early-stage idiopathic Parkinson's disease (without levodopa).

This form has advantages over traditional agonists: the effective dose is less, the side effects are much less pronounced.

MAO inhibitors. Monoamine oxidase inhibitors inhibit the oxidation of dopamine in the striatum, thereby increasing its concentration in the synapses. Most often, selegiline is used in the treatment of Parkinson's disease. In the early stages, selegiline is used as monotherapy, and half of the patients report significant improvement with treatment. Side effects selegiline are not frequent and not pronounced.

Therapy with selegiline allows you to delay the appointment of levodopa for 9-12 months. In the later stages, selegiline can be used in combination with levodopa - it allows you to increase the effectiveness of levodopa by 30%.

Mydocalm reduces muscle tone. This property is based on its use in parkinsonism as an auxiliary medicine. Mydocalm is taken both inside (tablets) and intramuscularly or intravenously.

B vitamins actively used in the treatment of most diseases of the nervous system. For the transformation of L-Dopa into dopamine, vitamin B₆ and nicotinic acid are required. Thiamine (vitamin B₁) also helps increase dopamine in the brain.

How long do people live with Parkinson's disease?

research by British scientists

people who have the disease onset between the ages of 25-39 live an average of 38 years;
at the age of onset 40-65 years, they live about 21 years;
and those who become ill over the age of 65 live for about 5 years.

Prevention of Parkinson's disease

general tips

to eat well;
lead a healthy and fulfilling life;
protect yourself from unnecessary worries and stress;
do not abuse alcohol;
move more often
train memory;
engage in active mental activity.

Author of the article: Sergey Vladimirovich, an adherent of reasonable biohacking and an opponent of modern diets and fast weight loss. I will tell you how a man aged 50+ to remain fashionable, handsome and healthy, how to feel 30 at his fifty. about the author.

About existence Parkinson's disease (PD) Mankind has known for about 200 years. And although the features, the therapeutic effect and the mechanisms of its course have been studied in sufficient detail, the “blank spots” - regarding the prevention of a serious illness, the clear causes of its inception - are not getting smaller.

What it is

The disease "inherited" its name from the name of the doctor who first described it in detail - the Englishman James Parkinson, who described the disorder as "shaking" paralysis. This neurological pathology is multifactorial (affects various body systems) and extensive damage to the central nervous system.

PD progresses slowly and steadily, interferes with the functioning of the human brain, leading to the death of dopaminergic neurons of the substantia nigra (located in the midbrain), which is responsible for regulating the motor function of the body, muscle tone, and is involved in the implementation of many autonomic functions.

In addition, the disease initiates a number of disorders non-motor character:

sensory (pain, burning, numbness, tingling, impaired sense of smell);
mental (apathy, depression);
vegetative (tonus blood vessels, breathing, heart activity).

BP is characterized age characteristics. As a rule, the first signs of the disease may have individual manifestations already at 50-55 years old. In the age group up to 65 years the prevalence of the disease rises to 1%; at 65-75 years old– already up to 2%; and the frequency of the disease from 3 to 4% is observed at the age 75+ .

WHO fixes a digital indicator of patients with PD in the amount of 3.7 million, each year there is an "increase" of cases by 300 thousand people. The incidence of Parkinson's disease per 100,000 population, according to various studies, averages from 60 to 180 cases.

ICD-10

Parkinson's disease has a separate ICD10 code. In this classifier, the disease is assigned to the class G20 (primary parkinsonism), consisting of:

hemiparkinsonism- unilateral parkinsonian syndrome (a consequence of trauma, brain damage);
shaking paralysis- chronic and progressive tremor (trembling) against the background of damage to the cortical nodes of the brain;
parkinson's disease- a general disease, accompanied by degenerative processes in certain parts of the brain, which are accompanied by slowness in movements, muscle rigidity, tremor at rest, impaired reflexes when taking a pose.

There is also secondary parkinsonism (class G21) - the cause is environmental factors (drugs, inflammation of the brain, its toxicity, tumors, strokes) and diseases with symptoms of PD, but which are disorders of the nervous system of a degenerative type against the background of another disease (class G22 , 23).

should be shared parkinsonism And Parkinson's disease- their difference is that the first term characterizes a complex series of irreversible changes in the activity of the human nervous system in general. BP is individual disease with its symptoms, which should be affected in the course of treatment.

Symptoms and signs

The characteristic parkinsonian symptoms are combined by experts into a triad:

Violation of initial motor functions and slow pace of movements - akinesia . There is also a decrease in the amplitude and speed of repetitive actions, although muscle strength is not lost. Akinesia manifests itself:

in facial expressions (immobility of the face),
in speech disorders (monotonity, mumbling, slowness),
in respiratory disorders (discontinuity, acceleration),
in the deterioration of elementary actions (turning in bed, shuffling with short steps and stooping gait).

Feeling of tightness (throughout the body, muscles) and general stiffness - rigidity . For BP, a certain kind of muscle tone is characteristic - viscous, monotonous, its strengthening is observed during the repetition of a passive movement. Typical is the asymmetry of muscle tone (increased in the limbs).
Trembling of limbs at rest tremor . A decrease in trembling is observed in the case of stretching the arm, with an increase in motor activity.

Symptoms and signs: photo

Characteristic for PD and non-motor manifestations:

mental and neuropsychic nature (panic attacks and increased anxiety, depression, lethargy and indifference, obsessive-compulsive states, in rare cases - psychoses);
deterioration of autonomic functions (experience of suffocation, dry mouth, impaired excretory functions - difficulty urinating and constipation, excessive sweating);
deterioration in the quality of sleep and its regime (drowsiness during the day, inability to fall asleep at night, excessive brightness of dreams);
sensory system disorders (increased / decreased sense of smell, pain in the limbs or throughout the body, experiencing paresthesia - numbness, burning, crawling, tingling).

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Causes

There is still no unambiguity about the causes contributing to the onset of PD among researchers and medical specialists. The most common factors that determine the disease include:

family predisposition - genetic factors contributing to the development of PD (although the gene responsible for the onset of symptoms has not yet been identified);
external influence - the influence of toxins (including various medications), the transfer of acute and chronic infections of the nervous system, tumors and injuries of the nervous system / brain.
the process of aging of the body - the acceleration of the death of nerve cells responsible for the implementation of motor functions, the deterioration of blood circulation in the brain.

Young people

Symptoms and signs in young or young patients with PD in most cases are similar to the classic variant of the disease.

Early (juvenile) parkinsonism tends to appear in age period 20-40 years old . In the course of the disease, secondary signs begin to appear that are not associated with motor activity - the disease does not affect the substantia nigra (as in elderly patients), but other parts of the brain.
Motor manifestations are reduced to involuntary and painful contraction of the muscles of the shoulder girdle and feet, as well as involuntary motor activity in the limbs or the body in general.

In general, the disease young age proceeds in a mild form, because there is no presence of many violations of the physiology of the organism inherent in age-related patients.

Treatment

Traditional approaches to the treatment of PD are reduced to the implementation of such methods:

maximum slowdown or complete stop of death of brain neurons ( neuroprotective therapy) - through taking medications that stimulate the reduction of degenerative processes;

reduction of the harmful effects of the main symptoms of PD ( symptomatic therapy) - timely response to their most acute manifestations through the correction of the imbalance of neurochemical and neurophysiological processes in the brain;
restoration of physical and socio-psychological functions - by physiotherapy exercises and psychotherapeutic influence.

During treatment, special attention should be paid to dosages drugs - a positive effect should be provided by minimal but effective doses that contribute to the restoration of motor functions affected by the disease.

Lifespan

When characterizing Parkinson's disease, how long patients live with it, and how long it can last, several points should be noted:

the life expectancy of a patient depends on the specific form of PD and the stage of its development, but the general data are as follows: from 5 to 7 years, patients in whom PD manifested itself after 65 years live; 20-21 years - life expectancy at the age of onset of the disease at 40-64 years; 37-39 years old, if the disease began in the period of 20-39 years of age;
although in most cases patients with PD can live for a significant period of time in the fight against the disease, adaptation to it is significantly more difficult, while the quality of life is significantly reduced;
The most difficult factors experienced by patients are: loss of dexterity of the upper limbs; the inability to adequately show one's feelings, overcoming apathy and external indifference; a significant loss of working capacity and motivation for activity in general.

The specificity of BP is such that it is not tied either to the sphere of habitation (manifested on all continents, in all countries), or to the financial situation or social status - both "average" people and people with wealth and fame are affected by it.

One of the picturesque examples is Vyacheslav Zaitsev, who announced his own struggle with the disease on one of the central TV channels. The famous couturier had to undergo a series of medical procedures, including both drug and movement therapy. A positive attitude and maintenance of motivation for vigorous activity allowed coexisting relatively well with parkinsonism.

Despite the status of an incurable disease, one can successfully live with PD if efforts are made to adapt the patient to new living conditions as effectively as possible, the necessary healing therapeutic procedures are implemented, and there is support from the immediate social environment.

Parkinson's disease refers to neurological diseases, when, against the background of degeneration of the extrapyramidal system, destruction of brain cells occurs. An exciting issue is the initial stage of Parkinson's, the symptoms of which are important not to miss. Pathogenetic therapy has been developed using conservative and surgical techniques that can improve the quality of human life and stop the development of pathology.

Causal factors for the onset of Parkinson's

Symptoms of the onset of Parkinson's are associated with several factors: aging, genetic determinism and environmental influences. The onset is accompanied by changes in the substantia nigra and the appearance of Lewy bodies. The level of dopamine, which is considered the hormone of pleasure and joy, decreases. In addition, the number of dopamine receptors sensitive to the hormone of the same name is reduced.

Main hypotheses for the onset of Parkinson's disease

Etiology	Description
Genetic conditioning	According to statistics, about 14-15% of patients with Parkinson's have a burdened hereditary history. Scientists have not established the genes responsible for the onset and development of the idiopathic syndrome of parkinsonism.
environmental reason	The impact of pesticides and herbicides on the human body has been proven in laboratory conditions. Inhibition of the respiratory chain complex in cell organelles, mitochondria, was found. Risk factors and the initial stage of Parkinson's disease may be associated with long-term residence in rural areas and around industrial enterprises.
Oxidative hypothesis	Assumptions have been put forward regarding free radicals that can enter into a biochemical reaction with unsaturated fatty acids of cell membranes, thereby destroying their structure.
Cerebrovascular insufficiency	Chronic circulatory disorders of the brain leads to insufficient intake useful substances to neurocytes. The impoverishment of microcirculation slows down metabolic processes and contributes to the extinction of the work of brain regions.

As a rule, the initial signs of Parkinson's disease occur against the background of a combination of several etiological factors. In the case of a genetic predisposition, additional factors may contribute to the early onset of neurological degenerative pathology.

Important! According to statistics, people who regularly take caffeine have a lower risk of developing Parkinson's disease - the substance has a dopamine-stimulating effect.

Cardinal initial symptoms

Parkinson's disease is manifested at the initial stage by motor, vegetative and mental changes. Patients do not notice how appetite decreases and body weight decreases. The onset is accompanied by metabolic disruptions and a change in food cravings. The work of the sebaceous and sweat glands increases, the face acquires shine, regardless of the intensity of physical activity.

signs of the onset of psychosis: anxiety, fear, absent-mindedness;
hallucinatory and paranoid states;
depression;
insomnia;
fast fatigue and lack of initiative.

The initial motor signs of Parkinson's include several conditions: tremor, hypokinesia, muscle rigidity, and postural unsteadiness. Violations of the sphere of movement tend to increase and intensify.

Shaking or tremor

The onset of Parkinson's disease is accompanied by trembling of the limbs, and then of its individual parts. The syndrome refers to the most obvious and quickly noticeable symptom to the environment. It is noteworthy that the onset is due to the occurrence of a tremor of the fingers on one hand, then gradually passes to the opposite side and legs. Increases at rest, and disappears during dynamic movement.

The multidirectional movements of the fingers of the upper limbs can resemble counting coins or rolling capsules, similar to the pill-forming technique in the pharmaceutical industry. The onset of Parkinson's may be characterized by head trembling in the vertical or horizontal axis, in a yes-yes or no-no pattern, respectively.

Important! In differential diagnosis with cerebellar tremor, when tremor always haunts the patient, Parkinson's tremor is characteristic only in a calm state and disappears when movements are performed.

Hypokinesia

The definition of hypokinesia means a decrease in active movements. When Parkinson's disease develops, the initial symptoms in the form of hypokinesia or bradykinesia look frightening. Relatives notice that a sick person freezes and stays in one position for a long time. The beginning of the pathology is characterized by stiffness of the whole body. Movements are performed as if "reluctantly" with some delay.

Signs of the onset of Parkinson's disease: walking with a shallow step, feet parallel to each other, lack of facial expressions, a feeling of a frozen look, rare blinking of the upper eyelid. Mimic muscles tense with a slowdown, the reaction to the news and conversation is slow. The beginning is accompanied by the appearance of a frozen grimace of joy, happiness, grief or crying.

Speech function is disturbed, loses expressiveness and emotionality. The handwriting and the peculiarity of writing words on paper are changing - small letters with torn movements in places where smooth lines are supposed.

Muscle rigidity

Muscles lose plasticity, after giving a certain position, the limbs are difficult to bend and unbend. The onset is accompanied by a stoop, forward tilt of the head, legs and arms half-bent at large joints. Upper limbs along the body, no sweeping movements. There is a symptom of a gear wheel, when, if you want to straighten the patient's arm, there is an intermittency in muscle contraction.

The onset of the development of the pathology is combined with the Westphal phenomenon, when, with a passive impact on the foot of a patient with Parkinson's with dorsiflexion and muscle tension, the foot retains its position for some time. The onset is characterized by the appearance of waxy plasticity of the skeletal muscles.

Postural instability

The initial stage of Parkinson's is rarely accompanied by postural instability, the symptom is more characteristic of the late stage, when it is difficult to overcome the inertia of active movement or the inertia of absolute rest. The torso, as it were, is ahead of the movement of the legs. The center of gravity and stability are lost. Falls with injury to soft tissues and bones are inevitable.

The onset of the disease is determined by the appearance of paradoxical kinesias. Due to emotional stress, anxiety, stress or tension, instability, muscle rigidity, hypokinesia and tremor are eliminated. A person easily moves for 1-3 hours, after which pathognomonic symptoms return.

Additional features

Indirect symptoms of the onset of Parkinson's disease indicate the onset of the disease and its further progression. Each of the signs separately can be present in other diseases, but the combination of several suggests a neurological degenerative pathology.

Additional signs:

Change in olfactory perceptions - the obvious smell of products with a pronounced aroma is lost. The exceptions are colds and chronic respiratory pathologies.
Violation of taste buds - the usual and favorite food does not bring pleasure, the taste is perverted. It is caused by a violation of the synthesis and metabolism of dopamine.
A change in handwriting without the appearance of micrography - if you notice a change in the amplitude of the written letters and numbers, the smoothness of the lines, you should contact a neurologist.
Restlessness during a night's sleep - twitching of the limbs, shuddering and other sudden movements may indicate the onset of Parkinson's.
Fading voice - the timbre becomes quieter, the person speaks almost in a whisper. Beginning with a speech disorder - trembling voice and lack of intonation.
Slowness of movements - not only gait becomes slow, but also speech, reading speed.
Constipation and a feeling of incomplete emptying of the bowel - such symptoms of Parkinson's disease in the initial stage may not be perceived as leading due to medication, dietary changes, diseases gastrointestinal tract or decreased activity.
The impression of a mask on the face is created - a person loses the speed of reaction to the information he hears, sees or reads. A mournful or crying facial expression, even if the mood is good.

As additional initial symptoms of Parkinson's, profuse sweating and soreness in cervical region spine. Hyperhidrosis is caused by affecting the autonomic nervous system, and therefore, against the background of complete well-being and the absence of heat, a patient with Parkinson's may sweat. Pain in the neck appears with an uncomfortable posture during rest and compression of the vertebral artery.

Treatment methods

Pathogenetic treatment at the initial stage of Parkinson's disease is divided into conservative and surgical. Conservative therapy includes medications that can eliminate hypokinesia, rigidity, tremor and dysphagia. The onset is accompanied by the drugs of choice: Levodopa, Bromocriptine, Amantadine, Selegiline.

Surgical destructive therapy is represented by thalamotomy (destruction of the ventral nucleus of the thalamus) and pallidotomy (partial destruction of the globus pallidus). They are prescribed for the ineffectiveness of conservative treatment of the onset of the disease.

The onset of the disease can be halted by neurosurgical stimulation therapy. An innovative stereotaxic frame is used with fixation of the head and installation of the subcutaneous parts of the system - connectors and a pulse generator.