Parkinson’s disease and the Parkinsonisms (ISSN 2753-8176 (online))

1.Ana Pedro

1.Gwyntwr1386 Health & Social Care, Regus Chester Business Park, Heronsway, Chester, CH49QR, UK. info@gwyntwr1386.com

Parkinson’s Disease was first described by James Parkinson in 1817. Idiopathic Parkinson's disease is caused by a loss of nerve cells in the part of the brain called the substantia nigra which produce dopamine. Dopamine acts as a messenger between the parts of the brain and nervous system that help control and co-ordinate body movements. The loss of these nerve cells is a slow process and Parkinson's disease symptoms' usually start to develop when around 50% of the nerve cell activity in the substantia nigra have been lost (1).

Parkinson's disease is a common condition in elderly people. About 137,000 people were living with Parkinson's disease in the UK. The prevalence rate was 286.5 per 100,000 person-years (2).

The symptoms of Parkinson's disease usually develop gradually being mild in the beginning (3). The order in which these symptom's develop and their severity is different for each individua and is also unlikely that a person with Parkinson's disease would experience all or most of these symptom(3). The main symptoms of Parkinson’s disease are tremor, slowness of movement (bradykinesia) and muscle stiffness (rigidity). Other symptoms can include balance problems, loss of sense of smell (anosmia), nerve pain, nocturia and urinary incontinence, constipation, erectile dysfunction, sexual dysfunction in women, orthostasis, excessive sweating, dysphagia, drooling and insomnia (3)

Among neuropsychiatric and cognitive symptoms we can find depression and anxiety, mild cognitive impairment and dementia (3)

Moreover, “Parkinsonism” is the umbrella term used to describe the symptoms of tremors, muscle rigidity and slowness of movement. Parkinson's disease is the most common type of parkinsonism, but there can be other causes as well such as drug-induced parkinsonism (for example after taking antipsychotic medication), other progressive brain conditions (Progressive supranuclear palsy, multiple system atrophy and corticobasal degeneration, dementia with Lewy bodies) and cerebrovascular disease (3, 4).

Parkinson’s plus syndromes

Parkinson-plus syndromes are a group of neurodegenerative diseases which feature the classical features of Parkinson's disease with additional features that distinguish them from simple idiopathic Parkinson's disease (5). Parkinson-plus syndromes are often difficult to differentiate from Parkinson’s disease and each other. They include multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration. Dementia with Lewy bodies, may or may not be part of the Parkinson’s spectrum. These disorders are currently divided into two groups, the synucleinopathies (characterised by the abnormal accumulation of aggregates of alpha-synuclein protein in neurons) and the tauopathies (characterized by the aggregation of abnormal tau protein) and may coexist with other pathologies (6-8). Clinical features which can distinguish Parkinson-plus syndromes from idiopathic Parkinson’s disease include symmetrical onset, a lack of or irregular resting tremor, and a reduced response to dopaminergic drugs (including levodopa). Other features include bradykinesia, early-onset postural instability, increased rigidity in axial muscles, dysautonomia, alien limb syndrome, supranuclear gaze palsy, apraxia, involvement of the cerebellum including the pyramidal cells, and in some cases significant cognitive impairment (9).

Parkinson-plus syndromes usually progress more rapidly and are less likely to respond to antiparkinsonian medication than Parkinson’s disease. Nevertheless, the additional features of these diseases may respond to medications not used in Parkinson’s disease (10,11)

Current therapy for Parkinson-plus syndromes is centered around a multidisciplinary treatment of symptoms.

References:

(1) Parkinson's disease - Causes - NHS (www.nhs.uk)

(2) Prevalence | Background information | Parkinson's disease | CKS | NICE

(3) Parkinson's disease - Symptoms - NHS (www.nhs.uk)

(4) Types of Parkinson's | Parkinson's UK (parkinsons.org.uk)

(5) Bensimon G, Ludolph A, Agid Y, Vidailhet M, Payan C, Leigh PN (January 2009). "Riluzole treatment, survival and diagnostic criteria in Parkinson plus disorders: the NNIPPS study". Brain. 132 (Pt 1): 156–71.

(6) Mark, M. H. (2001). "Lumping and splitting the Parkinson Plus syndromes: dementia with Lewy bodies, multiple system atrophy, progressive supranuclear palsy, and cortical-basal ganglionic degeneration". Neurologic Clinics. 19 (3): 607–27

(7) Levin J, Kurz A, Arzberger T, Giese A, Höglinger GU (February 5, 2016). "The Differential Diagnosis and Treatment of Atypical Parkinsonism". Dtsch Ärztebl Int. 113 (5): 61–9.

(8) Brittany N. Dugger; Charles H. Adler; Holly A. Shill; John Caviness; Sandra Jacobson; Erika Driver-Dunckley; Thomas G. Beach & the Arizona Parkinson’s Disease Consortium (May 2014). "Concomitant pathologies among a spectrum of parkinsonian disorders". Parkinsonism Relat Disord. 20 (5): 525–9.

(9) Mitra K.; Gangopadhaya P. K.; Das S. K. (2003). "Parkinsonism plus syndrome—a review". Neurol India. 51 (2): 183–188.

(10) Litvan I, Campbell G, Mangone CA, Verny M, McKee A, Chaudhuri KR, Jellinger K, Pearce RK, D'Olhaberriague L (Jan 1997). "Which clinical features differentiate progressive supranuclear palsy (Steele-Richardson-Olzewski syndrome) from related disorders". Brain. 120 (1): 65–74

(11)David R. Williams & Irene Litvan (October 2013). "Parkinsonian syndromes". Continuum (Minneap Minn). 19 (5 Movement Disorders): 1189–212.