Parkinson's Disease: Understanding Diagnosis Symptoms and Stages

By Dr. Manoj Khanal in Neurosciences , Neurology

Apr 17 , 2024 | 2 min read

Parkinson's disease stands as the second most prevalent neurodegenerative disorder globally, following Alzheimer's disease. Initially, English physician James Parkinson defined its cardinal clinical features, which remain pivotal in diagnosis and management. With around 5 million people worldwide dealing with this disease, it's important to understand its symptoms and treatment modalities.

Parkinson's disease knows no bounds, affecting individuals irrespective of gender, race, occupation, or geographical location. While its mean onset typically occurs around the age of 60, there is a noticeable rise in cases of young onset Parkinson's disease (YOPD). The features include rest tremor, rigidity, bradykinesia (slowing), and gait impairment or postural instability. Additional motor and non-motor symptoms further complicate its clinical presentation, ranging from micrographia and masked facies to depression, cognitive impairment, and autonomic disturbances.

Pathologically, it is characterized by the degeneration of dopaminergic neurons in the brain, leading to reduced dopamine levels and the formation of Lewy bodies, primarily comprising the protein alpha-synuclein. Differential diagnosis encompasses a spectrum of Parkinsonism disorders, including atypical variants like multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal ganglionic degeneration (CBDG).

While the majority of Parkinson's disease cases are sporadic, with an unknown etiology, genetic predispositions are more prevalent in YOPD. Environmental factors such as pesticide exposure, rural living, and well water consumption have been implicated in increasing risk.

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Diagnostic imaging, including PET or SPECT scans, aids in understanding the degenerative changes in the brain's dopamine system, which are crucial for accurate diagnosis and treatment planning. The imaging of the brain's dopamine system in Parkinson's disease (PD) is conducted through PET or SPECT scans. Young-onset Parkinson's disease (YOPD), occurring before the age of 40, is often linked to mutations in the Parkin gene. Both MRI and PET scans serve as valuable tools to distinguish atypical Parkinsonism from other conditions. In Multiple System Atrophy (MSA), the characteristic "pontine hot cross buns sign" is observed. At the same time, Progressive Supranuclear Palsy (PSP) typically presents the "hummingbird sign," indicating midbrain atrophy with comparatively preserved pons. Additionally, secondary Parkinsonism can be induced by dopamine-blocking agents commonly used in psychiatric practice.

Treatment strategies for Parkinson's disease encompass a multifaceted approach, with levodopa serving as the cornerstone. Adjunctive therapies may include dopamine agonists, MAO-B inhibitors, and deep brain stimulation (DBS) for those in advanced stages. A comprehensive management plan often incorporates medication alongside neurorehabilitation, encompassing speech and occupational therapy, physiotherapy, and collaboration among multiple disciplines.

In essence, Parkinson's disease underscores the importance of a holistic approach to patient care, integrating medical interventions with rehabilitative measures like speech and occupational therapy along with physiotherapy. As research continues to elucidate the complexities of Parkinson's disease, fostering awareness and understanding remains paramount in enhancing patient outcomes.