All About Parkinson’s Disease: Clinical Features, Management And Future Research - Dr Rahul Chawla

Parkinson's disease (PD) is considered as the second most common neurodegenerative disorder in adults over the age of 60 years.

Parkinson's disease is an idiopathic movement disorder that limits the body's ability to control movement. It mostly affects people over 60 years and is progressive in nature.

Parkinson's disease was first described as shaking palsy is a first research paper published by James Parkinson in 1817, which was later named as the Parkinson's disease (PD) to honour James Parkinson's contributions.

With time, the term Parkinsonism began to be used as a broader spectrum of movement disorders with similar clinical manifestations with some atypical findings not commonly seen in idiopathic PD.

Pathophysiology

The loss of dopamine and its related neurotransmitter, norepinephrine, leads to the development of different sign and symptoms of PD.

Parkinson's disease is characterized by death of dopaminergic neurons in the substantia nigra. The pathologic hallmark of Parkinson's disease is the Lewy body, a neuronal inclusion consisting largely of α-synuclein protein aggregations.

These symptoms are observed after loss in 60–80% or more of the dopamine producing cells in the brain of substantia nigra.

Clinical Features

Parkinson's disease is a clinical diagnosis, and the patient presents with characteristics of Motor and Non-Motor symptoms.

Motor Symptoms:

• Rest Tremor (trembling in head, hands, legs, arms and jaw)
• Rigidity (stiffness of the trunk and limbs)
• Bradykinesia (slowness of movement), Postural Instability (impaired balance)

Non-Motor Symptoms:

• Cognitive changes (memory problems, executive dysfunction)
• Mood disturbances (depression, anxiety)
• Sleep disturbances (insomnia, REM sleep behaviour disorder)
• Autonomic dysfunction (constipation, orthostatic hypotension)

Diagnosis and Evaluation

Diagnosing Parkinson's disease involves a thorough clinical assessment, including medical history, physical examination, and neurological tests.

Key diagnostic criteria include the presence of bradykinesia along with at least one other motor symptom.

Neuroimaging studies like MRI or DaTscan may be used to support diagnosis and rule out other conditions such ad drug induced parkinsonism or Atypical Parkinsonism.

Treatment

Medications such as levodopa, dopamine agonists, MAO-B inhibitors, and COMT inhibitors help alleviate motor symptoms and improve quality of life.

Individuals with mild motor-predominant Parkinson disease (49%-53% of individuals with Parkinson disease) have mild symptoms, a good response to dopaminergic medications (e.g., carbidopa-levodopa, dopamine agonists), and slower disease progression.

Surgical Interventions: The advent of Deep Brain Stimulation (DBS) marked a milestone in surgical interventions for Parkinsonism.

DBS targets specific brain regions like the Sub Pathological Thalamic Nucleus or Globus Pallidus and has proved to be effective in alleviating motor symptoms and reducing medication-related complications in advanced Parkinson's disease cases.

Physical Therapy: Exercise programs, physical therapy, and occupational therapy are vital for maintaining mobility, improving muscle strength, and enhancing overall functional abilities.

Speech and Swallowing Therapy: Speech therapy can address speech difficulties (dysarthria) and swallowing problems (dysphagia) commonly seen in PD.

Psychological Support: Managing psychological aspects such as depression, anxiety, and cognitive changes is crucial. Counselling, support groups, and cognitive behavioural therapy can provide emotional support and coping strategies.

Healthy Diet: Consume a nutritious diet with plenty of fruits, vegetables, whole grains, lean proteins, and adequate hydration. Limiting processed foods, sugar, and saturated fats can promote overall health.

Sleep Hygiene: Establish a regular sleep schedule, create a relaxing bedtime routine, and create a comfortable sleep environment.

Safety Measures: Make home modifications to enhance safety and reduce fall risks. Use assistive devices such as handrails, grab bars, and mobility aids as needed.

The Role of a Multidisciplinary Team Managing Parkinson's disease effectively requires neurologists, movement disorder specialists, physical therapists, occupational therapists, speech therapists, nutritionists, social workers, and mental health professionals.

Genetic Insights and Research Advances in genetics and molecular biology have deepened our understanding of Parkinsonism's genetic underpinnings. Genes such as SNCA, LRRK2, PARKIN, and PINK1 have been implicated in familial forms of PD.

Future Perspectives

A lot of research is happening in Parkinsonism with key focus on disease-modifying therapies, biomarkers for early diagnosis, personalized medicine approaches, and non-motor symptom management.