Introduction-
Parkinsons is a common neurodegenerative disorder. The diagnosis of PD is clinical. It is important to recognize the early symptoms and signs suggestive of parkinsonism.
Pathology-
The pathological hallmark of parkinsons is cell loss within the substantia nigra. The earliest changes occur in the medulla oblongata/pontine tegmentum and olfactory bulb. In these early stages, however, patients are pre-symptomatic. As the disease advances, areas of the midbrain and basal forebrain and finally the neo-cortex become involved.
Lewy bodies are the pathological hallmark of PD. They are made up of multiple proteins together and are therefore responsible for proteolysis. These also include ubiquitin,which is a heat shock protein and it plays an important role in targeting other proteins for breakdown.
Mutations are also responsible for some familial forms of PD.
Environmental factors-
A few environmental factors that predispose to the development of PD-
- Exposure to pesticide use
- wood preservatives
- exposure to environmental toxins.
Symptoms-
The main clinical features of PD are bradykinesia, rigidity and rest tremor. However, not all of these may be present. Postural instability may also be involved in a few cases. There are a number of other clinical signs such as A change of handwriting with micrographia, reduced facial expression, A loss of arm swing on one side and gait disturbances.
As the disease becomes more advanced, hypophonia, drooling of saliva and impairment of postural reflexes may also develop.
Diagnosis-
Diagnosis of a parkinsonian syndrome-
- Bradykinesia along with at least one of the following-
- muscular rigidity
- rest tremor and
- postural instability
Supportive criteria for PD-
Three or more of the following is required for diagnosis of definite PD
- Unilateral onset
- Rest tremor present
- Progressive disorder
- Persistent asymmetry
- Excellent response to levodopa
- Severe levodopa-induced chorea
- Levodopa response for 5 years or more
- Clinical course of 10 years or more
Non motor complications-
- Sleep issues- Sleep disorders are frequent in PD. There is disturbed nocturnal sleep and excessive daytime somnolence. sleep disturbance occurs in 60–98% of patients and correlates with disease severity. Daytime sleep events are also more common
- Cognition in PD- Many patients with PD develop dementia, typically about 10 years or more after the onset of motor symptoms.
- Mood disturbance and PD- Depression is the most common mood disturbance occurring at any stage of the illness. Fluctuations are commoner in more advanced stage of disease.
- Psychosis and confusion – Psychosis can occur in up to 30% of PD patients. It often presents with hallucinations, agitation or also sometimes aggression. Psychosis is also possibly mediated by loss of dopaminergic neurones.
Conclusion-
PD is a common neurodegenerative illness. A combination of genetic and also environmental factors is responsible for producing abnormal protein aggregation. This leads to cell dysfunction and then cell death. The diagnosis remains a clinical one and it is thus important to exclude other causes of parkinsonism. A large number of pharmacological agents with surgical interventions can help treat complications of PD.Also, Physiotherapy plays an important role to manage symptoms, retrain balance, develop strength and improve posture.
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