Parkinson’s Disease

Parkinson’s disease together with parkinsonian syndrome affect about 1% of world’s population older than 60. This disease is present in every country and statistics show that there are 18-234 cases of this disease in a population of 100 000 individuals.

Risk factors and etiologic hypotheses

PD’s real etiology is still not clear. There are many hypotheses that will be only mentioned without elaboration of their pathophysiological mechanisms.

First etiologic factor is the environment with its microclimate, pollution, the way of life and unhealthy eating habits. There are many neurotoxic chemicals, such as: organophosphates insecticides, pesticides, herbicides, as well as heroin-illegal narcotic. There is also a link between PD and smoking, especially for adults. The risk of PD rises from 0.7% to 1% for long-term smokers. On the other hand, drinking too much coffee (more than 3 cups per day) can affect people and increase the risk of suffering from PD. The risk increases to 0,7% because of the estrogens and testosterone, which is similar to smokers.

Etiopathogenesis

Certain neurons in the brain slowly break down or die. There is a loss of neurons that produce a chemical messenger in the brain known as dopamine. A lack of dopamine causes abnormal brain activity.

The cause for PD is unknown, nevertheless there are some factors: the risk of this disease increases with age, people who have relatives with PD are more prone to it, and men are more prone to this disease.

Molecular Mechanisms Provoking the Neurodegenerative Disease

The mechanisms have effect on the death of the nigal dopaminergic cell, as well as oxidative stress, altered protein, and inflammation. On the other hand, there isn’t any knowledge of whether the mechanisms provoke neuronal loss.

There are two hypotheses that lead to contradiction.

The first hypothesis is on genetic basis, the protein aggregates in neuronal pathology , especially  α-synuclein- protein involved in the neurological degeneration.

The second hypothesis is linked to the oxidative stress (imbalance between the free radicals and the antioxidants), as well as mitochondrial dysfunction.

Genes

In 1900, Gowers stated that this disease is under the influence of the genes. 15% of people with Parkinson’s disease have family history with this condition. Over the last 10 years, there were many experiments and analysis on the genes-cause of this disease. The newest research has shown that the genes as well as environment play a big part. Researchers assure that there are 5 genes that are associated with the PD (alpha synuclein, dardarin, parkin, PINK1 and DJ-1).

Clinical Manifestations of PD

Early symptoms of PD that most of the patients are not aware of: the substantial reduction in olfactory function, rapid eye movement (during REM sleep), constipation and daytime sleepiness. In the later stages, patients feel anxiety, depression, as well as hallucinations, apathy, confusion, and psychotic disorder.

Diagnostics

The purpose of neuroimaging diagnostics and paraclinical examinations is to differentiate PD from other Parkinson’s degenerative syndromes using computed tomography, magnetic resonance, and imaging test known as PET.

Treatments

PD cannot be cured, nevertheless it can be controlled. Change of life style is always suggested (aerobic exercises). There are medications that used for treatment:

  • Dopamine Agonists used in early stages to reduce the symptoms
  • MAO-B inhibitors prevent the breakdown of brain dopamine
  • Anticholinergics used to control the tremor caused by PD
  • Carbidopa-levodopa is the most effective- the natural chemical is converted to dopamine
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