Causes, symptoms and stages of Parkinson's disease. Parkinson's disease: symptoms and signs in women and men What is a parkinson's mask

Parkinson's disease is a neurodegenerative disease common among adults, the first signs and symptoms of which can occur in adults, in adolescence, if there are causes, and treatment helps to slow the progression of the syndrome, but not get rid of it.

Parkinson's syndrome develops as a result of degenerative changes in the substantia nigra of the brain. Due to the fact that dopamine-producing neurons begin to die.

The debut of Parkinson's disease usually occurs after 50 years, although in recent decades it is not uncommon for the first symptoms to be observed in young (from 16 years old) people. This is due to environmental degradation, genetic congenital problems and an unhealthy lifestyle.

It is rather difficult to tell everything about Parkinson's disease, symptoms and treatment in simple words, but the causes of the onset and development of parkinsonism are sufficiently clear to doctors.

Parkinson's disease or shaking paralysis (why it is called so is clear from the main manifestations even at the initial stage) is one of the most common degenerative brain diseases that affects thousands of people every year.

But you can live with such a pathology for decades.

Scientists are still not able to determine exactly what exactly provokes the development of the disease. However, the factors accelerating degradation are well established:

the gradual aging of the body, in which the number of neurons that produce dopamine naturally decreases;
genetic predisposition, inherited;
living in areas with a polluted atmosphere, it is especially dangerous to live near large industries, highways, railways;
massive or chronic poisoning with certain chemical compounds;
persistent vitamin D deficiency - depletion of its reserves in the body can cause Parkinson's disease even in early age, which is characterized by slow development;
brain injury, tumors;
neuroinfections, tick-borne encephalitis is especially dangerous.

Also, the progression of pathology is affected by the use of certain medications, narcotic substances.

Scientists believe that the signal for the development of the disease is the impact of several adverse factors at the same time.

Symptoms of Parkinson's Disease

The symptoms of Parkinson's disease are quite diverse, sometimes it is difficult to understand when it starts, how exactly this disease manifests itself for the first time. But the occurrence of one or more of them, even at a young age, is a signal for concern.

The main signs are associated with loss of control over movements:

stiffness, muscle rigidity;
tremor that manifests itself during movement, at rest;
decreased ability to maintain balance;
decrease in speed, range of motion.

The disease can be determined not only by the symptoms associated with impaired mobility of the body, but also by other characteristic signs:

pathological fatigue;
metabolic disorders, problems with the gastrointestinal tract;
increased sweating;
decreased sharpness of smell;

increased salivation;
depression;
development of mental deviations, disorders;
decrease in the level of mental activity;
violation of cognitive functions - thinking slows down, memory is greatly weakened, it becomes difficult to navigate in space.

If suspicious symptoms are detected, a full diagnosis must be made. Necessarily, taking into account the characteristics of the organism of an individual patient.

This is the only way to establish the root cause and choose a treatment that is suitable for a particular patient, based on the characteristics of his body.

Classification and stages of development

There are several developed scales for determining the stage of development of parkinsonism. Demanded, which neurologists rely on, and are also used as a scale when passing the ITU for disability assignment, were developed by English doctors Margaret Hehn and Melvin Yar.

Stages are distinguished depending on the strength of the manifestation of symptoms:

0 (zero). There are no external signs.
1 (first) - characterized by slight twitches of one hand. Gradually, the tremor will spread further. Increased fatigue, sleep disorders, sudden mood swings, decreased sense of smell.

2 (sometimes it is called not the second, but one and a half or intermediate). Tremor is concentrated in one limb, disappears only during sleep. Handwriting deteriorates, with activities that require fine motor skills, the patient copes worse. There are restrictions in the swinging movements of the hands, stiffness in the neck.
3 (third). There is a limitation of mobility. The gait is replaced by a "doll": the steps are short, the feet are set in parallel. The person moves in a hunched state, leaning slightly forward. Speech is disturbed, obsession with certain words appears. It becomes more difficult to take care of yourself.
4 (fourth). Increased postural instability. A patient with Parkinson's balance is unsatisfactory. May fall when trying to get up from a chair or bed. Movements are constrained. Speech worsens, it becomes quiet, unintelligible, the voice changes. Depression develops.
5 (fifth), last stage. It is characterized by a sharp deterioration in the condition. The patient cannot move independently, swallowing function is lost, incontinence appears. Speech is usually lost. The person needs constant supervision. dementia develops.

The examination must be carried out comprehensively in order to establish all the factors affecting the patient's condition, to determine the characteristics of the organism, psychology. Only in this case, the doctor will be able to develop a comprehensive treatment designed to stop the development of the syndrome.

For the treatment of parkinsonism, complex treatment is used:

TMS (transcranial magnetic stimulation);
method of vortex fields;
bioresonance therapy;
EHF (extremely high frequencies);
physiotherapy exercises (exercise therapy) according to a program compiled by a doctor with a trainer;
massages;
regular work with a psychologist;
drugs that stimulate the production of dopamine;
mobile lifestyle.

Timely detected at the initial stage, according to the first symptoms and signs of Parkinson's disease, helps to prescribe an effective treatment that can stop the disease in development for many years, and sometimes decades.

One of the neurological pathologies is Parkinson's disease. It is characterized by disturbances in the pyramidal system, which is responsible for stereotyped human movements. Signs of Parkinson's disease indicate that severe damage to brain structures has already developed. Pathology refers to chronic and progressive lesions. However, in the initial stages, it can be treated with medications.

In order not to miss the first signs of the disease, one should pay attention to changes in a person's behavior, his facial expressions, and movements. Only a doctor can recognize a pathological condition after carrying out special diagnostic procedures.

Symptoms of the disease at an early stage

The first signs of Parkinson's disease are often invisible to the patient himself. Therefore, they are discovered by relatives of the patient. Symptoms of the pathological condition develop gradually over several years. At the beginning of the disease, signs of damage nervous system insignificantly expressed.

A person may be disturbed by unexpressed movement disorders. Most patients change speech. The thought process is also disturbed, but this is not always noticed.

The first signs of pathology include:

Tremor. The fingers of the upper limbs begin to tremble when performing accurate work. Fine tremor may not always appear. Characteristic of Parkinson's disease is the increase and worsening of symptoms.
Change gait. Steps become slow, the patient begins to “short” his feet.
Violation handwriting. Because of the tremor of the fingers, the letters become sloppy, different in size. People who do clerical work often notice this symptom first.
emergence nasality and speech delay. The change in voice is gradual.
Lability emotional background. At the initial stage of Parkinson's disease, depression and anxiety appear. Some people become irritable.

Change emotional background may be the only sign of an incipient pathology for several months or years. It is connected with the fact that a person feels the changes happening to him, but so far he cannot determine exactly what they are expressed in.

The subjective initial symptoms of the disease include a feeling of “falling out” of thoughts. A person can think about something specific, and after a short period of time forget about the subject of reflection. Gradually, this sign begins to appear in speech. When talking, the patient's words "fall out" of the context. As a result, speech becomes monotonous, poor.

The progression of the pathology leads to the fact that the patient cannot perform the usual actions. To a greater extent, this applies to "small" work. An example is tying shoelaces, lighting a cigarette, threading a needle. The impossibility of performing such movements is associated with a tremor of the hands, as well as with the stiffness of movements that occurs subsequently.

Initial symptoms develop mainly in the elderly, but may also appear in middle age. Pathology is noted in both women and men.

Diagnostics

Diagnosis of the pathological condition is performed by a neurologist. Parkinson's disease can be recognized by the characteristic clinical symptoms, as well as by a special examination.

The first signs should include not only the subjective sensations of the patient, but also changes that are noted from the outside. Often the patient himself does not pay attention to the change in gait, facial expressions, voice.

Initial signs that are noted during a neurological examination:

Speech sick. Patients suffering from Parkinson's disease complain of weakness, unwillingness to get out of bed, apathy. If these symptoms come first, then a person often goes to a psychologist before visiting a neurologist. However, any doctor must take into account the characteristic speech of the patient. It is distinguished by the absence of emotional coloring, poverty, monotony.
Mimic. No matter what the patient says, his face remains calm. This is due to amemia. It is difficult for a person to change facial expressions, smile, cry.
State skin cover. At the initial stages of the pathological condition, the work of the sweat glands changes. In most patients, the skin becomes dry, in some cases it becomes oily. The intensity of perspiration is reduced.
Motor changes. During a neurological examination, the patient is asked to touch the tip of the nose with their fingers. This must be done with your eyes closed. During this test, a small tremor of the fingers is noted. The eyelids may also tremble.
Tremor tongue and lips. It is noted with the progression of neurological disorders. In the initial stages, this symptom does not prevent a person from eating and talking. However, if you ask the patient to move the tongue first to the right and then to the left, a tremor can be noticed.
Change gait. The patient is asked to walk a few steps in a straight line. The floor surface must be level. If the patient's gait is slow, shuffling, then this indicates the initial stage of Parkinson's disease.
stiffness in joints. Occurs when performing movements of the arms and legs. Also, stiffness can be in the cervical spine and resemble the symptoms of osteochondrosis.
Change handwriting. It becomes sloppy, illegible.
"Dropping out" words from the offer. In ordinary speech, this feature may be absent at the initial stage. It is possible to recognize this symptom if you ask the patient to pronounce a tongue twister.
slowdown thinking. Diagnosed by performing special psychological tests. An example is the quick selection of associations to words.

Parkinson's disease develops due to a lack of dopamine, a neurotransmitter. The deficiency of this substance occurs due to the degeneration of cellular structures. Due to the lack of dopamine, nerve impulses slow down, leading to pyramidal disorders.

Diagnosis of pathology is based on a stress test. The patient needs to take a medication containing dopamine. If the initial symptoms of the disease stop as a result of the use of the drug, the test is considered positive.

The first signs of pathology should serve as a signal for contacting a neurologist. In some cases, they appear after suffering vascular diseases, in particular - a stroke. In this case, the symptoms occur due to ischemia of the brain structures responsible for the functioning of the pyramidal system.

In this case, Parkinson's syndrome is noted. The initial manifestations of this condition are the same, however, the symptoms develop faster than in Parkinson's disease.

The appearance of the first signs of this pathology does not always indicate that a person will develop pyramidal insufficiency. In some cases, the symptoms indicate other disorders of the nervous system or psyche. However, the initial symptoms should not be ignored, as timely treatment can slow down the progression of Parkinson's disease.

Parkinson's disease (shaking paralysis) is a fairly common degenerative disease of the central nervous system, which is manifested by a complex of motor disorders in the form of trembling, slowness of movement, rigidity (inelasticity) of muscles and body instability.

The disease is accompanied by mental and autonomic disorders, personality changes. To establish the diagnosis, the presence of clinical symptoms and data from instrumental methods of research is required. To slow the progression of the disease and the deterioration of the condition, a patient with Parkinson's disease must constantly take medications.

Shaking paralysis develops in 1% of the population under the age of 60 years. The onset of the disease most often falls on the age of 55-60 years, occasionally it is detected in people younger than 40 years old, and very rarely - up to 20 years old. In the latter case, this is a special form: juvenile parkinsonism.

The incidence rate is 60-140 cases per 100,000 population. Men get sick more often than women, the ratio is approximately 3:2.

What it is?

Parkinson's disease is one of the most common neurodegenerative diseases. Symptoms and signs of Parkinson's disease are very characteristic: decreased motor activity, slowness in walking and movements, trembling of the extremities at rest.

This is due to the defeat of certain brain structures (substance black, red nucleus), which are responsible for the production of the dopamine mediator.

Causes

The basis of Parkinson's disease and parkinsonism is a decrease in the number of neurons of the substantia nigra and the formation of inclusions in them - Lewy bodies. Its development is facilitated by hereditary predisposition, elderly and senile age, and exposure to exogenous factors. In the occurrence of an akinetic-rigid syndrome, a hereditary disorder of the metabolism of catecholamines in the brain or the inferiority of the enzyme systems that control this exchange may be of importance. Often a family burden for this disease is detected with an autosomal dominant type of inheritance. Such cases are referred to as Parkinson's disease. Various exogenous and endogenous factors (atherosclerosis, infections, intoxication, trauma) contribute to the manifestation of genuine defects in the mechanisms of catecholamine metabolism in the subcortical nuclei and the onset of the disease.

Parkinsonism syndrome occurs as a result of acute and chronic infections of the nervous system (tick-borne and other types of encephalitis). The causes of Parkinson's disease and parkinsonism can be acute and chronic disorders of cerebral circulation, cerebral atherosclerosis, vascular diseases of the brain, tumors, injuries and tumors of the nervous system. Perhaps the development of parkinsonism due to drug intoxication with prolonged use of drugs of the phenothiazine series (aminazine, triftazin), methyldopa, some drugs - drug parkinsonism. Parkinsonism can develop with acute or chronic carbon monoxide and manganese monoxide intoxication.

The main pathogenetic link of tremor paralysis and parkinsonism syndrome is a violation of the exchange of catecholamines (dopamine, norepinephrine) in the extrapyramidal system. Dopamine performs an independent mediator function in the implementation of motor acts. Normally, the concentration of dopamine in the basal ganglia is many times higher than its content in other structures of the nervous system. Acetylcholine is an excitatory mediator between the striatum, globus pallidus, and substantia nigra. Dopamine is its antagonist, acting inhibitory. With the defeat of the substantia nigra and the globus pallidus, the level of dopamine in the caudate nucleus and putamen decreases, the ratio between dopamine and noradrenaline is disturbed, and a disorder in the functions of the extrapyramidal system occurs. Normally, the impulse is modulated towards the suppression of the caudate nucleus, putamen, substantia nigra and stimulation of the globus pallidus.

When the function of the substantia nigra is turned off, there is a blockade of impulses coming from the extrapyramidal zones of the cerebral cortex and the striatum to the anterior horns of the spinal cord. At the same time, the cells of the anterior horns receive pathological impulses from the globus pallidus and the substantia nigra. As a result, the circulation of impulses in the system of alpha and gamma motor neurons of the spinal cord with a predominance of alpha activity increases, which leads to the appearance of pallidar-nigral rigidity of muscle fibers and tremor - the main signs of parkinsonism.

What's happening?

The process of degeneration occurs in the so-called black substance - a group of brain cells related to subcortical formations. The destruction of these cells leads to a decrease in the content of dopamine. Dopamine is a substance with the help of which information is transmitted between subcortical formations about programmed movement. That is, all motor acts are, as it were, planned in the cerebral cortex, but are implemented with the help of subcortical formations.

A decrease in the concentration of dopamine leads to a disruption in the connections between neurons responsible for movement, and contributes to an increase in inhibitory effects. That is, the implementation of the motor program becomes difficult, slows down. In addition to dopamine, acetylcholine, norepinephrine, and serotonin influence the formation of a motor act. These substances (mediators) also play a role in the transmission of nerve impulses between neurons. An imbalance of mediators leads to the formation of an incorrect program of movements, and the motor act is not implemented as the situation requires. Movements become slow, limbs tremble at rest, muscle tone is disturbed.

The process of destruction of neurons in Parkinson's disease does not stop. Progression leads to the appearance of more and more new symptoms, to the strengthening of existing ones. Degeneration captures other structures of the brain, mental and psychic, vegetative disorders join.

Classification

When formulating the diagnosis, the predominant symptom is taken into account. Based on this, there are several forms:

Rigid-bradykinetic a variant for which an increase in muscle tone and a violation of motor activity are most characteristic. While walking, it is easy to recognize such patients by the “beggar’s position”, however, they quickly lose the ability to actively move, stop standing and sitting down, and instead acquire disability with an immobilized state for the rest of their lives;
tremor-rigid a form, the main features of which are trembling and stiffness of movements;
trembling shape. Its leading symptom is, of course, tremor. Rigidity is expressed slightly, physical activity does not particularly suffer.

It is widely used to assess the stages of Parkonson's disease. modified scale according to Hyun and Yahr(Hoehn & Yahr), which takes into account the prevalence of the process and the severity of manifestations:

stage 0 - there are no signs of the disease;
stage 1 - unilateral process (only limbs are involved);
stage 1.5 - unilateral process involving the trunk;
stage 2 is a two-way process without breaking the balance;
stage 2.5 - the initial manifestations of a bilateral process with slight imbalances (during the push test, the patient takes several steps, but returns to the starting position);
stage 3 - from initial to moderate manifestations of a bilateral process with postural instability, self-care is preserved, the patient is physically independent;
stage 4 - severe disability, the ability to stand, walk without support, the ability to walk, elements of self-service are preserved;
stage 5 - complete disability, helplessness.

The ability to work and the assignment of a disability group depend on how pronounced the movement disorders are, as well as on the patient's professional activity (mental or physical work, does the work require precise movements or not?). Meanwhile, with all the efforts of doctors and the patient, disability does not pass by, the difference is only in the timing of its onset. Treatment started at an early stage can reduce the severity of clinical manifestations, but you should not think that the patient has recovered - just the pathological process has slowed down for a while.

When a person is almost bedridden, therapeutic measures, even the most intense ones, do not give the desired effect. The famous levodopa is not particularly encouraging in terms of improving the condition, it only slows down the progression of the disease for a short time, and then everything returns to normal. It will not work for a long time to contain the disease at the stage of severe symptoms, the patient will no longer leave the bed, and will not learn to serve himself, therefore, he will need constant outside help until the end of his days.

Symptoms of Parkinson's disease

In the early stages of development, Parkinson's disease is difficult to diagnose due to the slow development of clinical symptoms. It can manifest with pain in the extremities, which can be mistakenly associated with diseases of the spine. Depressive states can often occur.

The main manifestation of parkinsonism is akinetic-rigid syndrome, which is characterized by the following symptoms:

Tremor

It is a fairly dynamic symptom. Its appearance can be associated with both the emotional state of the patient and his movements. For example, a tremor in the hand may decrease during conscious movement, and increase with walking or moving the other hand. Sometimes it may not be. The frequency of oscillatory movements is small - 4-7 Hz. They can be observed in the hand, foot, individual fingers. In addition to the extremities, "trembling" can be noted in the lower jaw, lips and tongue. The characteristic parkinsonian tremor in the thumb and forefinger is reminiscent of "pill rolling" or "counting coins." In some patients, it can occur not only at rest, but also when moving, causing additional difficulties with eating or writing.

Rigidity

Movement disorders caused by akinesia are aggravated by rigidity - an increase in muscle tone. During an external examination of the patient, it is manifested by increased resistance to passive movements. Most often, it is uneven, which causes the appearance of the phenomenon of "gear wheel" (there is a feeling that the joint consists of gears). Normally, the tone of the flexor muscles prevails over the tone of the extensor muscles, so the rigidity in them is more pronounced. As a result, characteristic changes in posture and gait are noted: the torso and head of such patients are tilted forward, the arms are bent at the elbows and brought to the body, the legs are slightly bent at the knees (“beggar's position”).

Bradykinesia (akinesia)

It is a significant slowdown and depletion of motor activity, and is the main symptom of Parkinson's disease. It manifests itself in all muscle groups, but is most noticeable on the face due to the weakening of the mimic activity of the muscles (hypomimia). Due to the rare blinking of the eyes, the look seems heavy, piercing. With bradykinesia, speech becomes monotonous, muffled. Due to impaired swallowing movements, salivation may occur. Fine motor skills of the fingers are also depleted: patients can hardly perform habitual movements, such as fastening buttons. When writing, transient micrography is observed: by the end of the line, the letters become small, illegible.

Postural instability

It is a special violation of the coordination of movements when walking, due to the loss of postural reflexes involved in maintaining balance. This symptom appears at a late stage of the disease. Such patients experience some difficulty in changing posture, changing direction and starting to walk. If the patient is unbalanced with a small push, he will be forced to take several quick short steps forward or backward (propulsion or retropulsion) in order to “catch up” with the center of gravity of the body and not lose balance. The gait at the same time becomes mincing, "shuffling". The consequence of these changes are frequent falls. Postural instability is difficult to treat and is often the reason why a patient with Parkinson's disease is bedridden. Movement disorders in parkinsonism are often combined with other disorders:

Mental disorders:

Cognitive disorders (dementia) - memory is disturbed, slowness of sight appears. With a severe course of the disease, serious cognitive problems arise - dementia, a decrease in cognitive activity, the ability to reason sensibly, express thoughts. effective way there is no slowdown in the development of dementia, but clinical studies prove that the use of Rivastigmine, Donepezil somewhat reduces such symptoms.
Emotional changes - depression, it is the very first symptom of Parkinson's disease. Patients lose self-confidence, are afraid of new situations, avoid communication even with friends, pessimism and irritability appear. There is increased drowsiness during the daytime, sleep is disturbed at night, nightmares, too emotional dreams. It is unacceptable to use any drugs to improve sleep without the advice of a doctor.

Vegetative disorders:

Orthostatic hypotension - a decrease in blood pressure when changing body position (when a person stands up abruptly), this leads to a decrease in blood supply to the brain, dizziness and sometimes fainting.
Increased urination or vice versa difficulty with the process of emptying the bladder.
Gastrointestinal disorders are associated with impaired intestinal motility - constipation associated with inertia, poor nutrition, limited drinking. Another cause of constipation is the use of drugs for parkinsonism.
Reduced sweating and increased greasiness of the skin - the skin on the face becomes oily, especially in the nose, forehead, head (provokes dandruff). In some cases, it may be the other way around, the skin becomes too dry. Conventional dermatological treatments improve the condition of the skin.

Other characteristic symptoms:

Muscle spasms - due to lack of movement in patients (muscle stiffness), muscle spasms occur, more often in the lower extremities, massage, warming up, stretching helps to reduce the frequency of seizures.
Speech problems - difficulty starting a conversation, monotony of speech, repetition of words, too fast or slurred speech is observed in 50% of patients.
Difficulties with eating - this is due to the limitation of motor activity of the muscles responsible for chewing, swallowing, there is increased salivation. Retention of saliva in the mouth can lead to suffocation.
Sexual dysfunction - depression, taking antidepressants, worsening blood circulation lead to erectile dysfunction, decreased sexual desire.
Fatigue, weakness - increased fatigue usually increases in the evening and is associated with problems starting and ending movements, it can also be associated with depression, insomnia. Establishing a clear regimen of sleep, rest, reduction physical activity help reduce fatigue.
Muscle pain - aching joints, muscles caused by poor posture and muscle stiffness, the use of levodopa reduces such pain, and some types of exercise also help.

Diagnostics

In order to diagnose the described ailment, unified criteria have been developed today that have divided the diagnostic process into stages. The initial stage is to recognize the syndrome, the next is to look for manifestations that exclude this disease, the third is to identify symptoms that confirm the disease in question. Practice shows that the proposed diagnostic criteria are highly sensitive and quite specific.

The first step in diagnosing Parkinson's disease is the recognition of the syndrome in order to distinguish it from neurological symptoms and psychopathological manifestations, similar in a number of manifestations to true parkinsonism. In other words, the initial stage is characterized by differential diagnosis. True parkinsonism is when hypokinesia is detected in combination with at least one of the following manifestations: muscle rigidity, rest trembling, postural instability, not due to primary vestibular, visual, proprioceptive and cerebellar disorders.

The next step in diagnosing Parkinson's disease involves the exclusion of other ailments that are manifested by parkinsonism syndrome (the so-called negative criteria for the diagnosis of parkinsonism).

The following criteria for excluding the disease in question are distinguished:

anamnestic evidence of repeated strokes with a stepwise progression of parkinsonian symptoms, repeated brain injury or significant encephalitis;
the use of antipsychotics before the onset of the disease;
oculogyric crises; prolonged remission;
supranuclear progressive gaze paresis;
unilateral symptoms lasting more than a three-year period;
cerebellar manifestations;
early onset of symptoms of severe autonomic dysfunction;
Babinsky's symptom (abnormal response to mechanical irritation of the foot);
the presence of a tumor process in the brain;
early onset of severe dementia;
lack of result from the use of large dosages of Levodopa;
the presence of open hydrocephalus;
methyl-phenyl-tetrahydropyridine poisoning.

Diagnosis of Parkinson's disease last step- this is a search for symptoms confirming the pathology in question. In order to reliably diagnose the described disorder, it is necessary to identify at least three criteria from the following:

the presence of a resting jitter;
debut of the disease with unilateral symptoms;
stable asymmetry, characterized by more pronounced manifestations on the half of the body, with which the disease debuted;
good response to the use of Levodopa;
the presence of severe dyskinesia caused by taking Levodopa;
progressive course of the disease;
maintaining the effectiveness of Levodopa for at least 5 years; prolonged course of illness.

Anamnesis and examination by a neurologist play an important role in diagnosing Parkinson's disease.

First of all, the neurologist finds out the patient's habitat, at what age the disease debuted and what manifestations, whether there are known cases of the disease in question in the family, whether the pathology was preceded by various brain injuries, intoxications, whether the trembling subsides at rest, what motor disorders appeared, are they symmetrical manifestations, whether he can take care of himself independently, copes with daily activities, whether there are sweating disorders, shifts in emotional mood, dream disorders, what drugs he took, whether there is a result of their influence, whether he took Levodopa.

After collecting the anamnesis data, the neurologist evaluates the patient's gait and posture of his body, as well as the freedom of motor acts in the limbs, facial expressions, the presence of trembling at rest and during exercise, reveals the presence of symmetry of manifestations, determines speech disorders and handwriting defects.

In addition to data collection and inspection, the survey should also include instrumental examination. Analyzes in the diagnosis of the disease in question are not specific. They are more of an ancillary value. In order to exclude other ailments that occur with symptoms of parkinsonism, they determine the level of glucose concentration, cholesterol, liver enzymes, the amount of thyroid hormones, and take kidney samples. Instrumental diagnosis of Parkinson's disease helps to identify a number of changes characteristic of parkinsonism or other ailments.

With the help of electroencephalography, a decrease in electrical activity in the brain can be detected. Electromyography displays the frequency of trembling. This method contributes to the early detection of the described pathology. Positron emission tomography is also indispensable at the debut stages of the disease even before the onset of typical symptoms. A study is also underway to detect a decrease in dopamine production.

It must be remembered that any clinical diagnosis is only possible or probable. To reliably determine the disease, it is necessary to conduct a pathomorphological study.

Possible parkinsonism is characterized by the presence of at least two defining manifestations - this is akinesia and trembling or rigidity, a progressive course, and the absence of atypical symptoms.

Probable parkinsonism is characterized by the presence of the same criteria as possible, plus the presence of at least two of the following manifestations: a clear improvement from Levodopa, the occurrence of fluctuations in motor functions or dyskinesia, provoked by Levodopa, asymmetry of manifestations.

Significant parkinsonism is characterized by the presence of similar criteria as in probable parkinsonism, as well as the absence of oligodendroglial inclusions, the presence of destruction of pigmented neurons, revealed by pathological examination, the presence of Lewy bodies in neurons.

What do people with Parkinson's disease look like?

For people suffering from Parkinson's disease (see photo), the stiffness of the whole body is characteristic, the arms are usually pressed to the body and bent at the elbows, the legs are parallel to each other, the body is slightly tilted forward, the head is extended, as if supported by a pillow.

Sometimes you can notice a slight trembling of the whole body, especially the limbs, head, lower jaw, eyelids. Due to paralysis of facial muscles, the face acquires the expression of a “mask”, that is, it does not express emotions, it is calm, the person rarely blinks or smiles, the gaze lingers at one point for a long time.

The gait of those suffering from Parkinson's disease is very slow, clumsy, the steps are small, unsteady, the arms do not move when walking, but remain pressed to the body. General weakness, malaise, depression are also noted.

Effects

The consequences of Parkinson's disease are very serious, and they come the faster the later treatment begins:

Akinesia, that is, the inability to move. But, it is worth noting that complete immobility occurs rarely and in the most advanced cases.
More often, people are faced with a deterioration in the functioning of the motor apparatus of varying severity.
Constipation, which sometimes even leads to death. This is due to the fact that patients become unable to consume food and water in the proper amount to stimulate normal bowel function.
Irritation of the visual apparatus, which is associated with a reduction in the number of blinking movements of the eyelids up to 4 times per minute. Against this background, conjunctivitis often appears, the eyelids become inflamed.
Seborrhea is another complication that often plagues people with Parkinson's disease.
. It is expressed in the fact that a person becomes withdrawn, inactive, prone to depression and emotional poverty. If dementia joins, then the prognosis of the course of the disease worsens significantly.

How to treat Parkinson's disease?

A patient who has the initial symptoms of Parkinson's disease requires careful treatment with an individual course, this is due to the fact that missed treatment leads to serious consequences.

The main goals of treatment are:

as long as possible to maintain motor activity in the patient;
development special program physical exercise;
drug therapy.

When a disease and its stage are detected, the doctor prescribes drugs for Parkinson's disease that correspond to the stage of development of the syndrome:

Initially, amantadine tablets are effective, which stimulates the production of dopamine.
At the first stage, dopamine receptor agonists (mirapex, pramipexole) are also effective.
The drug levodopa in combination with other drugs is prescribed in complex therapy at later stages of the development of the syndrome.

The basic drug that can slow down the development of Parkinson's syndrome is Levodopa. It should be noted that the drug has a number of side effects. Prior to the introduction of this drug into clinical practice, the only significant method of treatment was the destruction of the basal ganglia.

Symptomatic treatment:

Hallucinations, psychoses - psychoanaleptics (Exelon, Reminil), neuroleptics (Seroquel, Clozapine, Azaleptin, Leponex)
Autonomic disorders - laxatives for constipation, gastrointestinal motility stimulants (Motilium), antispasmodics (Detrusitol), antidepressants (Amitriptyline)
Sleep disturbance, pain, depression, anxiety - antidepressants (Cipramil, Xel, Amitriptyline, Paxil) Zolpidem, sedatives
Decreased concentration, memory impairment - Exelon, Memantine-akatinol, Reminil

The choice of treatment method depends on the severity of the disease and the state of health, and is carried out only by a doctor after a complete diagnosis of Parkinson's disease has been made.

Surgery

The successes of conservative methods of treatment are undoubtedly significant and obvious, but their possibilities, as practice shows, are not unlimited. The need to find something new in the treatment of Parkinson's disease made me think about this issue not only for neurologists, but also for surgical doctors. The results achieved, although they cannot be considered final, are already beginning to encourage and please.

At present, destructive operations are already well mastered. These include interventions such as thalamotomy, effective in cases where the main symptom is tremor, and pallidotomy, the main indication of which is movement disorders. Unfortunately, the presence of contraindications and a high risk of complications does not allow the wide use of these operations.

The introduction of radiosurgical methods of treatment into practice led to a breakthrough in the fight against parkinsonism.

Neurostimulation, which is a minimally invasive surgical intervention - the implantation of a stimulator (neurostimulator), similar to an artificial pacemaker (heart pacemaker, but only for the brain), which is so familiar to some patients, is performed under the control of MRI (magnetic resonance imaging). Electrical stimulation of the deep brain structures responsible for motor activity gives hope and reason to expect the effectiveness of such treatment. However, it also has its pros and cons.

The benefits of neurostimulation include:

Safety;
Quite high efficiency;
Reversibility (as opposed to destructive operations, which are irreversible);
Good tolerance by patients.

The disadvantages include:

Large material costs for the patient's family (not everyone can afford the operation);
Breakdown of electrodes, replacement of the generator after several years of operation;
The risk of infection (small - up to 5%).

Neurostimulation of the brain

This is a new and rather encouraging method of treatment not only for Parkinson's disease, but also for epilepsy. The essence of this technique is that electrodes are implanted into the patient's brain, which are connected to a neurostimulator installed subcutaneously in the chest area.

The neurostimulator sends impulses to the electrodes, which leads to the normalization of brain activity, in particular, those structures that are responsible for the appearance of symptoms of Parkinson's disease. In developed countries, the neurostimulation technique is actively used and gives excellent results.

Treatment with stem cells

The results of the first trials on the use of stem cells in Parkinson's disease were published in 2009.

According to the data obtained, 36 months after the introduction of stem cells, a positive effect was noted in 80% of patients. Treatment consists of transplanting neurons derived from stem cell differentiation into the brain. Theoretically, they should replace dead dopamine-secreting cells. The method for the second half of 2011 has not been sufficiently studied and does not have a wide clinical application.

In 2003, for the first time, genetic vectors containing the gene responsible for the synthesis of glutamate decarboxylase were introduced into the subthalamic nucleus of a person with Parkinson's disease. This enzyme reduces the activity of the subthalamic nucleus. As a result, it has a positive therapeutic effect. Despite the good results of treatment, in the first half of 2011 the technique is practically not used and is at the stage of clinical trials.

Prospects for the dissolution of Lewy bodies

Many researchers believe that Lewy bodies are not just a marker of Parkinson's disease, but also one of the pathogenetic links, that is, aggravate symptoms.

A 2015 study by Assia Shisheva showed that the aggregation of α-synuclein with the formation of Lewy bodies is prevented by a complex of ArPIKfyve and Sac3 proteins, which can even contribute to the melting of these pathological inclusions. Based on this mechanism, the prospect of creating a drug capable of dissolving Lewy bodies and treating dementias associated with them appears.

What determines the life expectancy of people with Parkinson's disease?

The life expectancy of people with Parkinson's disease depends on timely diagnosis and the effectiveness of treatment. If the disease is detected in the early stages, effective drug treatment, diet and proper lifestyle, as well as with the regular implementation of various physiotherapy procedures (massage, gymnastics), life expectancy practically does not change.

Prevention

People whose relatives suffered from this disease need prevention. It consists of the following measures.

It is necessary to avoid and promptly treat ailments that contribute to the development of parkinsonism (intoxication, brain diseases, head injuries).
It is recommended to refuse extreme sports altogether.
Professional activity should not be associated with hazardous production.
Women should monitor the content of estrogen in the body, as it decreases over time or after gynecological operations.
Finally, hemocysteine can contribute to the development of pathology - high level amino acids in the body. To reduce its content, a person should take vitamin B12 and folic acid.
A person needs to exercise moderately (swim, run, dance).

As a result, we note that one cup of coffee daily can also help protect against the development of pathology, which was recently discovered by researchers. The fact is that under the influence of caffeine, dopamine is produced in neurons, which strengthens the defense mechanism.

Forecast - how long do they live with her?

Sometimes you can hear such a question: "Parkinson's disease, the last stage - how long do they live?". In this disease, death is observed from intercurrent diseases. Let's explain with an example. There are diseases, the very course of which leads to death, for example, peritonitis, or hemorrhage in the brain stem. And there are diseases that lead to deep disability, but do not lead to death. With proper care, a patient can live for years, even when switching to tube feeding.

The causes of death are the following conditions:

Hypostatic pneumonia with the development of acute respiratory and then cardiovascular failure;
The appearance of bedsores with the addition of a secondary infection and sepsis;
Habitual constipation, intestinal paresis, autointoxication, vascular collapse.

If the patient is properly cared for, then he can live for years, even being bedridden. Consider the example of Prime Minister Ariel Sharon, who suffered a severe stroke in 2006 and died without regaining consciousness 8 years later in January 2014. He was in a coma for 8 years and treatment was discontinued at the request of his relatives when he was 86 years old. Therefore, the issue of maintaining the life of a patient with parkinsonism is solved simply - this is care and support, since the disease does not lead to the immediate death of the patient.

It is a chronic process with damage to the nervous tissue. As a result, a person ceases to control his movements and becomes disabled. The danger is that the symptoms and signs of Parkinson's disease appear slowly. They are steadily progressing and lead to the loss of social and labor functions.

The mechanism of development of pathology is associated with a violation of the production of dopamine. This substance serves to transmit a signal between nerve endings. A part of the brain called substancia nigra (“black substance”) suffers. It is responsible for the smoothness and coordination of movements, the preservation of muscle tone.

Briefly about the manifestations of the disease

When Parkinson's disease appears: The first symptoms and signs may become noticeable by the age of 55-60. But in modern world there is a tendency to rejuvenate the disease.

The clinic starts with the following manifestations:

slowness of actions and movements;
lack of coordination;
unsteadiness when walking;
stride shortening.

What functions are broken?

Symptoms affect every system:

Statodynamic function suffers (gait is disturbed, walking slows down);
The mental sphere is disturbed (patients suffer from depression, mood swings, suicidal thoughts appear);
With the growth of the clinic, the function of self-service is lost (hand tremor makes it difficult to eat, muscle stiffness does not allow you to get out of bed);

Intelligence declines and dementia develops.

At-risk groups

The disease affects certain categories of people. Who is at risk?

The elderly;
People with burdened heredity;
Patients after a viral infection of the nervous system;
Persons after strokes;
Patients with severe atherosclerosis of the arteries of the head and neck;
Patients after major operations and brain injuries.

The role of vitamin D deficiency in the development of the disease and exposure to toxic substances (alcohol, carbon monoxide, pesticides, salts of heavy metals) are actively discussed.

Various forms of the disease

Most often found idiopathic type of illness. The cause of the disease cannot be established. Family Parkinson's syndrome is inherited. It is caused by the manifestation of a pathological gene.

Secondary Parkinson's is formed against the background of concomitant diseases of the brain:

Injury;
vascular disorders;
Taking medicines, etc.

Atypical forms

After the epidemic of encephalitis in the United States, the term "atypical Parkinson's" appeared. This type of disease progresses rapidly. Patients do not respond well to the standard treatment of the disease (Levodopa drugs). In this case, the clinical picture is characterized by the absence of tremor and early falls.

Essential tremor

Benign or familial tremors are often mistaken for parkinsonism. At the same time, hands, head, fingers are involved in trembling. Tremor appears only with deliberate movements. And in Parkinson's disease, trembling is present at rest.

What is the difference between Parkinson's disease and parkinsonism?

Parkinsonism is a complex of symptoms. It includes reduced muscle mobility (hypokinesia) in combination with other clinical signs (tremor at rest, rigidity, or postural instability).

Parkinson's disease is a chronic disease. It slowly progresses and is characterized by stages. It is characterized by symptoms of parkinsonism in combination with conduct disorder (depression, dementia, psychosis).

Pathogenesis

There are two dopamine systems in the brain. The "black substance" and the extrapyramidal system are responsible for the coordination of movements and muscle tone, the readiness of the muscles to respond to an impulse from the brain. When dopamine is depleted, the signal is not transmitted along the nerve endings. Walking, stability are disturbed, it is difficult to perform complex coordinated actions.

The second dopamine system is the mesolimbic one. She is responsible for mood and emotions. Behavioral disorders are formed in the patient in the later stages.

How is the disease progressing?

The first symptom of the disease is trembling. It is typical for the initial stages of the disease. Tremor appears at rest. It covers one limb, then the trunk or head is involved.

Later, hypokinesia and muscle rigidity appear. The patient can “freeze” in certain positions, facial expressions change (rare blinks, mask-like expression). Steps become short and shuffling. Handwriting loses smooth lines.

In the later stages, postural instability develops. The patient cannot move independently due to unsteady gait and loss of control over movement.

Detailed information about symptoms

Four clinical signs dominate:

Tremor;
Hypokinesia;
Muscle stiffness;
postural instability.

In the later stages they are joined by:

Depression;
dementia;
Psychosis.

Symptoms can progress over years. Their severity depends on the severity of the disease, the response to treatment and the implementation of a rehabilitation set of exercises.

Tremor occurs before other manifestations. One limb is involved in trembling, later two, the head and torso. Tremor is characterized by a frequency of 4-6 Hz. It only appears at rest.

Hypokinesia is a decrease in the number of movements. It is formed in a shortening of the step, a decrease in facial expressions, "freezing". Bradykinesia is slow motion. With repetition of actions, the symptoms intensify.

Rigidity is an increase in muscle tone. Movements lose their fluidity. The handwriting becomes sharpened, and with passive flexion and extension of the limbs, a "gear wheel phenomenon" is observed. The limb seems to “stick” and cannot smoothly unbend.

Postural instability appears at the end of the disease. The patient cannot maintain a position, start moving. Often stability is lost. As a result, falls and injuries occur.

The patient's urination functions are disturbed, the voice disappears, the sense of smell worsens. Men suffer from sexual dysfunction.

The character of the patient changes. He becomes touchy, suspicious, apathetic. The progression of the disease leads to bradyphrenia. The patient does not absorb information well, thinks slowly and makes decisions. Over time, dementia (dementia) develops.

Taking medications for Parkinson's disease aggravates the patient's well-being. Levodopa preparations are difficult to tolerate. They cause low blood pressure, constipation, and in some cases even hallucinations.

Early symptoms of Parkinson's

First Manifestation diseases are tremor. If a limb, head or tongue trembles, you should contact a neurologist for further additional examination.

Second Manifestation- clumsiness, loss of dexterity when working with small objects and details. It is necessary to be alert if the usual work (fastening buttons, tightening screws) has become extremely difficult.

Age features of Parkinson's disease

Juvenile parkinsonism appears before the age of 25. It is caused by a mutation of certain groups of genes. The disease begins with atypical symptoms: muscle pain, spontaneous falls, psychoses and delusional disorders. Later tremor joins. Patients respond well to treatment. But without therapy, the disease progresses rapidly.

Early-onset parkinsonism is rare in people 25 to 45 years of age. Usually we are talking about secondary forms of the disease. They developed against the background of concomitant pathology of the brain. Middle-aged patients often complain of side effects from taking drugs. This reduces compliance - the patient's desire to comply with the doctor's recommendations.

At this age, surgical methods of the disease are recommended. Neurosurgical operations significantly reduce tremor and restore the patient's activity. In addition, patients often have symptoms of depression and suicidal thoughts. They require pharmacological correction. The assistance of a clinical psychologist is essential.

Usually the disease appears after 55-60 years. But against the background of vascular pathology of the brain, the first symptoms of Parkinson's disease can be detected at the age of 75-85. In the elderly, the progression of the clinical picture is slow. Standard symptoms are combined with the manifestation of senile changes.

Features of the course of the disease in men

Men suffer from Parkinson's more often than women;
Male patients tolerate movement disorders worse;
With the development of the disease, the male patient becomes aggressive and irritable.

Features of the course of the disease in women

The first signs of the disease may appear as pain in the neck or shoulder;
Muscle tension in this zone is taken for periarthritis or osteochondrosis of the SHOP;
Then depressive symptoms, sleep disturbance come to the fore;
Women with Parkinson's disease are more likely to suffer from dementia and decreased intelligence;
Women often have trouble putting on clothes;
Early manifestation of personality disorders;

Female patients are more depressed and express suicidal thoughts.

Stages of Parkinson according to Hen-Yar

The Clinical Symptoms Severity Scale was introduced in 1967. Later it underwent minor modifications.

Stage zero. The patient has no signs of illness;
First stage. The clinical picture affects one limb. More often the disease is manifested by tremor. But in some cases there is pain, rigidity;
1.5 stage. In the period, the clinical picture passes from the limb to the trunk;
Second stage. Trembling, rigidity or hypokinesia is manifested from two sides. The arms or legs are symmetrically affected. The muscles of the body are affected. But the patient remains stable;
2.5 stage. Beginning of postural instability. Shaky, frequent falls. But the patient is able to move independently;
Third stage. Clinic covers important features(disturbed walking, tremor), but the patient is able to take care of himself;
Fourth stage. Outside help is needed in everyday life. It is impossible to carry out simple actions. With support, the patient is able to get up, walk, turn in bed;
Fifth stage. Complete disability. The patient is bedridden.

Diagnosis of the disease

Complaints are a key point for diagnosis. Diagnostic criteria is a set of signs by which a diagnosis can be made. At the same time, their combination indicates pathology, but requires the exclusion of parkinsonism.

The main indicators by which the diagnosis is made are hypokinesia + one of the accompanying symptoms (tremor, rigidity, postural disorders). Also, the patient should respond positively to taking antiparkinsonian drugs (Levadopa).

In the diagnosis of pathology in the early stages, the phenomena of postural reflexes help.

Westphal's phenomenon (when the foot is dorsiflexed, it maintains such a position for a long time);
The Foix-Thevenard phenomenon (when lying on the stomach, the doctor bends the knee and releases the limb, while the lower leg slowly unbends).

MRI and CT necessary to exclude concomitant pathology in diseases of the brain. For diagnosis, they are required in rare cases. By using PAT cell dopaminergic activity can be assessed. This type of diagnostics is used for scientific research and clinical trials of new drugs.

Differential Diagnosis

Sometimes parkinsonism appears in other diseases. They can be suspected in the following cases:

The disease progresses rapidly;
The patient does not respond to standard therapy;
The patient has a concomitant neurological pathology.

In this case, the pathology is referred to as atypical Parkinson's or Parkinson's plus syndrome.

Diagnostic steps

On the first stage cerebellar, vestibular and visual disorders should be excluded. A symptom complex should be present: hypokinesis + postural disorders or tremor or muscle rigidity.

On the second stage the doctor monitors the course of the disease and looks for pathology that can mimic the symptoms of parkinsonism. In favor of Parkinson's is a good response to treatment, the slow progression of the disease. Diagnosis exclusion criteria: