Parkinson’s Paradigm: the Uncharted Neurological Syndrome

HEIV
Jun 3, 2024
4 min read

Parkinson's Disease renders the brain in a harrowing state. Characterized as a disorder of the Central Nervous System (CNS), it adversely affects close to 10 million people annually. Making it one of the most formidable medical conditions. Due to its sheer consequences on brain functioning, it naturally resolves the complexity of the human brain in multidimensional ways. Leading to severe symptoms such as tremors, stiffness, and difficulty with balance and coordination. First described by James Parkinson in 1817 and further characterized by Jean-Martin Charcot, our knowledge of PD is developing. The disease's root cause is still unknown to date, though it can be a cumulative effect of multiple reasons. Many genetic mutations as well as several genes can cause rare familial forms of Parkinson’s disease. External factors including smoking, caffeine consumption, and pesticide exposure have been postulated to alter the risk of its development, although these roles remain unclear. It is the second most prevalent neurodegenerative disorder preceded only by Alzheimer's disease. People aged 50-65 years commonly fall prey to the disease; rarely, cases below the age of 50 are also seen in some regions of Africa and South America.

What are its underlying physiological mechanisms?

The disorder arises due to the loss of dopaminergic neurons of the substantia nigra pars, the hallmark being an aggregation of alpha-synuclein, in the form of Lewy bodies and Lewy neurites. Several processes have been implicated in Parkinson's Disease, including mitochondrial dysfunction, defective protein clearance mechanisms, and neuroinflammation, but how these factors interact is not understood completely yet.

Neuropathology: Computerized cognitive testing

Digital computerized cognitive testing, which can be carried out remotely from patients’ homes, has become an interesting alternative to traditional pen-and-paper testing. The benefits of computerized testing include the extended accessibility for frequent testing with less learning effects, which increases the sensitivity to detect decline, cost-efficiency, and the availability of large normative databases. Technology is being developed for conducting both remote functional assessments, and digital interventions (such as cognitive training) on the same online platform.

Clinical Symptoms that diagnose Parkinson's

The disease may begin in the peripheral autonomic nervous system or olfactory bulb, with the pathology then spreading through the central nervous system affecting the lower brainstem structures before affecting the substantia nigra. This may thus explain the presence of hyposmia, constipation, and rapid eye movement sleep disorders in Parkinson's patients before motor symptoms begin. Patients showing symptoms like tremors, balance problems, depression, constipation, fatigue, and urinary dysfunction in the last 5 years before diagnosis are more likely to have this disease.

Though symptoms develop slowly over the years. The progression of symptoms is often a bit different from one person to another due to the diversity of the disease. The most common symptoms are:

· Tremor, mainly at rest and described as pill rolling tremor in hands; and other forms

· Slowness and paucity of movement (called bradykinesia and hypokinesia)

· Limb stiffness (rigidity)

· Gait and balance problems (postural instability)

Relief Treatments

Most individuals with Parkinson’s disease are managed with drugs that alleviate the disease’s symptoms. These drugs mainly function in two ways: (1) they encourage the residual cells in the substantia nigra to generate more dopamine (this is the action of levodopa medications), or (2) they suppress the production of some of the acetylcholine (these are the anticholinergic medications), thereby re-establishing the equilibrium between the brain’s chemicals.

Treatments such as deep brain stimulation, along with other therapies, can aid in managing tremors and lessen the dependency on medications. Rehabilitation including physiotherapy can offer relief from Parkinson's disease and other degenerative neurologic disorders. Therapies include:

· Strength Training

· Gait and Balance Training

· Hydrotherapy

Such treatments can enhance the functionality and life quality for individuals battling Parkinson’s disease. This can also alleviate the burden on their caregivers.

Complications that are experienced commonly by people:

Parkinson’s disease frequently comes with other issues that may be manageable:

· Thinking difficulties. Cognitive challenges, such as dementia and difficulties in thinking, may be encountered. These typically manifest in the advanced stages of Parkinson’s disease. Such cognitive problems aren't usually helped by medicines.

· Depression and emotional changes. Depression may be experienced, occasionally even in the initial stages. Undergoing treatment for depression can facilitate managing the other difficulties associated with Parkinson’s disease. Some additional emotional changes include fear, anxiety, or loss of motivation. Symptom-specific treatment maybe given.

· Swallowing problems. As your condition advances, you might encounter problems with swallowing. Due to the slowing down of the swallowing process, saliva may build up in your mouth, resulting in drooling.

· Chewing and eating problems. In the late stages of Parkinson’s disease, the muscles in the mouth are affected, which can make chewing a challenge. This could result in choking and inadequate nutrition.

· Sleep problems and sleep disorders. Individuals with Parkinson’s disease frequently experience sleep disturbances, which may include waking up multiple times during the night, rising early, or experiencing daytime sleepiness. People also may experience rapid eye movement sleep behaviour disorder, which involves acting out dreams. Medicines may improve your sleep.