Parkinson’s disease is a disorder of central nervous system that directly affects motor skills of an individual. The cause of this disease is still unknown but various researchers believe that it is due to the combination of genetic and environmental factors (Allen, Schwarzel and Canning, 2013). The report discusses regarding aetiology and pathogenesis of Parkinson’s. It will also discuss regarding stage 1 to 5 of the disease and prevalence of symptoms in same. A comprehensive discussion will also be made on diagnostic process and treatment aspect of this disease. At the end, it can be stated that deep brain surgery is performed to bring condition under control at the last stage of Parkinson’s disease.
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Aetiology and pathogenesis
Parkinson’s disease is a neurodegenerative disorder which has an ability to deteriorate motor functions of the body. The condition is initiated due to loss of dopamine producing brain cells. The cause is still unknown to the disease but researcher have been able to speculate that there is adequate involvement of both genetic and environmental factors in its initiation. Primary symptoms of this disease are, stiffness, tremors and impaired balance. Other secondary symptoms of this disease are, depression, anxiety and dementia (Kelly, Eusterbrock and Shumway-Cook, 2012). Majority of the individuals are diagnosed with this disease after the age of 60 years or older than it. However, it early onset of Parkinson’s disease can be found in youngsters as well.
Exposure to certain type of pesticides and any type of history of head injury have direct link to Parkinson’s disease. If the individual has never smoked cigarettes or any type caffeinated beverage also increases the risk of Parkinson’s disease to some extent. Lack of concentration of urate in blood serum can also result in this disease. Researchers have indicated that complex interaction between genetic and environmental factors can lead to this disease (King and et.al., 2012). There are various Parkinson’s related genes that are involved in direct function of lysosomes which are responsible for digestion of cellular wastes. In certain cases, Parkinson’s disease can also be the result of dysfunction of lysosomes that ultimately reduced the ability of cells to breakdown alpha- synuclein. Age id considered to be the greatest factor of development of Parkinson’s disease, where men tend to get affected by it by about 1.5 to 2 times more often in comparison to that of a woman. An increased risk of this disease is present in the patients who have its family history (Litvan and et.al., 2012).
The disease is not curable yet adequate steps can be adopted by patients and its family members to reduce its impact on normal functions of life. The disease tends to progress with its functions from the form it usually occurs at its first stage and may overlap as well and occurring at another stage as well. As the stage of Parkinson’s disease progresses, a advancement in severity of disease can also be noticed in it. The main stages of Parkinson disease are:
- Stage 1: Mind symptoms can be noticed at this stage with tremors or movement in hands and legs and swing arm while walking. These do not generally interfere in the daily activities of individual and generally occur in one side of the body (Bonnet and et.al., 2012).
- Stage 2: At the stage 2 of Parkinson’s disease, the symptoms generally worsen up and patient may face problems in walking. At this stage, both parts of the body get affected.
- Stage 3: At this stage, the patient star facing issues in movement which get slowdown. He / she also loss balance in the body and increased the tendency and probability of falling and getting injured.
- Stage 4: At this stage, it becomes difficult for the patient to live his life alone and require help in each and every common activity conducted in life (Pringsheim and et.al., 2014).
- Stage 5: It is the last and fifth step of Parkinson’s disease where caregiver is required to be present for all the activities of the patient. It becomes difficult for the patient to walk or stand and may be left bedridden. Patient may also face hallucinations and delusional activities as well.
A physician can, at initial level, can find out the presence of Parkinson’s disease with careful examination of medical history and neurological examination. An autopsy is generally conducted in the mid brain, which is usually considered as the final proof that the individual is suffering from Parkinson’s disease. The clinical course overtime may ascertain that it is not Parkinson’s disease. It generates the requirement of reviewing the condition so as to confirm the accuracy of diagnosis performed. Physical and neurological examinations are conducted to assess changes taking place in patient’s reflexes, muscle strength, coordination and mental function (Plotnik, Giladi and Hausdorff, 2012). Certain imaging tests are also conducted on patient’s brain, such as, MRI and CT Scan. Some common blood tests are also conducted by the doctor in order to rule out other illness that the patient must be suffering from.
Physicians are also involved in giving carbidopa- levodopa, which is Parkinson disease medications to its patients. Significant improvement in the condition of the symptoms generally confirm the diagnosis. The four main motor symptoms of Parkinson’s disease are, bradykinesia (slowness in movements), tremors, muscle rigidity and postural instabilities in the form of falls. However, researchers have stated that in almost 30% of the cases, tremors are not present in the patient. There are other range of symptoms as well which can generally be experience by the patient. These are, freezing of movements, cognitive changes, mood disorder in the form of anxiety and depression, fatigue, speech and sensory changes and sleep disorder (Diagnosis, 2015). These symptoms can also help the physicians in ascertaining that whether the patient is suffering from Parkinson’s disease or not. Assessing the symptoms along with clinical examination can help in diagnosing the disease.
It is sometimes hard for the professional to diagnose Parkinson’s, especially when the early symptoms are not related to its primary symptoms, such as, tremors, one side swing of hands and legs, slowness, etc. Since, there is no specific tests that are related to Parkinson’s disease, it is generally diagnosed at its third or fourth stage. The disease may show its symptoms in years or months in vague manner due to which it is generally misinterpreted by the health care professionals. It can be stated that it can only be diagnosed by the patient itself in its initial stage and if it went unnoticed then the period of overall treatment goes on long as it directly reaches to an irrecoverable state.
Computed Tomography scans usually appears to be normal in case of Parkinson’s disease. MRI, in such cases is able to make rather more accurate diagnosis of the disease overtime (Odekerken and et.al., 2013). Hence, in such cases of doubt, MRI and CT scan both are generally performed by the health care professional on Parkinson’s disease. It can be stated that it is important to rule out the disease in specific duration so that treatment for the same can be started at initial phase only.
Parkinson’s disease cannot be treated or cured, yet certain medications can be given to the patient that can help in controlling symptoms of the disease. In later stages of Parkinson’s disease, health care professionals generally advice for surgery. Doctors also recommend lifestyle change where aerobic exercise is generally advised. In extreme cases, physical therapy which focus upon balance and stretching also becomes important for the patient. It can also be asked to hire a speech-language pathologist that can help in improving speech issues of the patient as well (Postuma and et.al., 2015).
Medication can help the patient with walking, tremors and movement issues. It increases the substitute of dopamine which is a specific signalling chemical of neurotransmitter in the brain. Since, people with Parkinson’s disease tend to face issues due to low dopamine concentration in the body. A significant improvement can be felt in the symptoms after taking treatment fort Parkinson’s disease. However, benefits of the drugs tend to decrease and become less consistent. Certain medications that are generally prescribed to the Parkinson’s disease patients are:
- Carbidopa -levodopa: Levodopa is considered to be the most effective drug for Parkinson’s patients. It is a natural chemical that can be passed into the patient’s brain and the same is converted into dopamine. Some side effects of this medicine include, light headedness or nausea.
- Dopamine agonists: This medication does not convert into dopamine for the brain. Rather it mimics its effects in the patient’s brain. The impact of this drug generally lasts for longer duration. However, its side effects generally quite similar to that of Carbidopa -levodopa (Kordower and et.al., 2013).
- Amantadine: Doctors generally prescribe this medicine in the early stage of Parkinson’s so as to provide short term relief from the symptoms to patient. It is also given at the last stage of Parkinson’s with the aim to control involuntary movements. Common side effects of this medication are, ankle swelling, hallucinations or purple mottling of skin.
There are certain surgical procedures as well which are advised to the patients at the last stage of Parkinson’s and there is no other option as the body become resistant to medications at this stage. One kind of surgery is Deep Brain Stimulation, in which surgeons tend to implant electrodes into specific parts of the brain whose generator is implanted in chest of the patient near collarbone which is responsible for sending electric pulses to the brain and can help in reducing the symptoms of Parkinson’s disease. This procedure is generally offered to the people who have been facing advanced level Parkinson’s disease. It helps in reducing halt or involuntary movement, tremors and rigidity.
Certain lifestyle changes are also initiated by the doctors, such as increase in intake of food with high fibre content, drinking adequate fluids. Moreover, a balanced diet with Omega 3 fatty acids can be quite helpful for the patients with Parkinson’