Approaching Parkinson’s Disease

  Parkinson’s disease, also known as “tremor palsy,” was first described systematically by the British internist James Parkinson, and most often develops after age 50. Parkinson’s disease is the fourth most common neurodegenerative disease in older adults, affecting 1% of those aged ≥65 years and 0.4% of those aged >40 years. The disease can also develop in childhood or adolescence. With the increase in the number of aging people in China, the number of Parkinson’s disease patients has reached about 2 million, accounting for about 1% of the elderly population, which means that 1 in 100 elderly people is a Parkinson’s patient. It is expected that 100,000 new patients will be diagnosed each year.  Because Parkinson’s disease affects the patient’s ability to move, as the disease slowly progresses, the vast majority of Parkinson’s patients will end up confined to their homes and couch, adding a heavy burden to their families and society. For people with Parkinson’s disease, both the loss of motor function and non-motor symptoms can have a serious impact on their quality of life. Caregivers of people with Parkinson’s disease suffer from the same diminished quality of life. This is often overlooked in the treatment of Parkinson’s disease. Changes in the caregiver’s lifestyle cause physical and mental exhaustion, mental anxiety and depression. The decline in quality of life for caregivers also further increases the financial burden of Parkinson’s disease treatment. Parkinson’s disease also places a significant economic burden on society. Therefore, aggressive treatment and effective management of Parkinson’s disease, especially slowing disease progression and the development of medications, will both reduce the direct and indirect health care costs of Parkinson’s disease.  To date, the etiology of Parkinson’s disease remains unclear. Current research favors a combination of factors related to aging, genetic susceptibility and exposure to environmental toxins. The reduction of dopamine neurons in the striatum of the substantia nigra of the brain is closely related to the development of the disease.  The etiology can be summarized as follows: 1. Ageing: Parkinson’s patients are mainly seen in middle-aged and elderly people over 50 years of age, and show a tendency to have a higher incidence the older they are.  2, environmental factors: epidemiological findings found that there are regional differences in the prevalence of Parkinson’s disease, so it is suspected that there may be some toxic substances in the environment that damage the brain’s dopamine neurons.  3, familial heredity: Medical doctors have found in their long practice that Parkinson’s disease seems to have a tendency to gather in families, and families with familial onset of Parkinson’s disease have relatives with a somewhat higher incidence than the normal population.  4. Genetic susceptibility: Although the occurrence of Parkinson’s disease is associated with aging and environmental toxins, not all older adults or people exposed to the same environment develop Parkinson’s disease.  Although there is also a family clustering of Parkinson’s disease patients, most patients are sporadic and to date, no clear causative gene has been found in disseminated Parkinson’s disease patients.  In 50% to 80% of cases, the onset is insidious, and the first symptom is usually a resting “pill-twisting” tremor of 4 to 8 Hz in one hand. The tremor is most prominent when the limb is at rest, decreases when the limb is active, and disappears during sleep; emotional stress or fatigue can aggravate the tremor, which is usually most severe in both hands, arms and legs. A small number of elderly patients may have no tremor. In addition to tremor, the more common symptoms are myotonia, bradykinesia and abnormal posture and gait. Early on, myotonicity begins unilaterally in the limbs, with stiffness and tightness of the muscles. When the facial muscles are affected, a “mask face” with a dull expression may appear; when the trunk, limbs and hip and knee joints are affected, they may be in a special flexed position. Motor retardation is manifested in the early stage of the patient’s upper limbs, fine movements such as tying shoelaces, buttoning, etc. are much slower than before, and even cannot be completed successfully. Writing also gradually becomes difficult, and the handwriting becomes curved and smaller and smaller, which is called “microcapitalism”. In addition, due to the ankylosis of the limbs, trunk and neck muscles, the patient has a special flexed posture when standing, with the head tilted forward, the trunk flexed ventrally, the elbow joints flexed, the wrist joints straightened, the anterior part inward, and the hip and knee joints slightly bent. When walking, it is difficult to start, once the step is started, the body leans forward, the pace is small and faster, and cannot stop in time, that is, “panic gait”. During walking, the synergistic swing of the affected upper limb is reduced or even disappears; it is difficult to turn around, so that several successive small broken steps are required.  There is no treatment that can stop or reverse the pathophysiological process of neurodegeneration in Parkinson’s disease, so the goal of Parkinson’s disease treatment is to reduce symptoms, slow down the process and improve quality of life. Different treatment options should be selected according to the individual patient’s condition, such as age, severity of the disease and response to drugs. At present, the treatment of Parkinson’s disease is mainly based on drugs. With the clinical application of many new anti-Parkinsonian drugs, levodopa is no longer the only therapeutic drug, and complementary therapy can reduce the motor symptoms of Parkinson’s disease patients, however, after 3-5 years of using these drugs, some of their own limitations will appear, which will bring motor complications to patients, manifested as “end-of-dose phenomenon “, “switch phenomenon”, heterokinesia, etc. Meanwhile, levodopa treatment can also produce neuropsychiatric symptoms, which manifest in various forms, such as depression, anxiety, hallucinations, euphoria, psychosis, mild mania, etc. Therefore, patients with Parkinson’s disease should avoid blind medication, and should visit a specialist to receive scientific and effective early treatment to slow down the disease process and reduce the occurrence of complications, improve the patient’s life treatment and reduce medical costs.