Parkinson’s disease is a disorder of the brain that leads to shaking and difficulty in movement and in-coordination. Parkinson’s disease most often develops after age 50. It is one of the most common nervous system disorders of the elderly.
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Causes of Parkinson’s disease
Impaired release of dopamine
- Idiopathic
- Drugs depleting dopamines stores(reserpine, tetrabenazine)
- Toxins damaging dopaminergic neurons
- Viral infections (Encephalitis lethargica, Japanese B encephalitis)
- Trauma (Repeated head injuries )
Blockade of striatal dopamine receptors
- Phenothiazines
- Butyrophenones
Damage to striatal neurons
- Viral infection
- Multi-system atrophy
Miscellaneous
- Wilson’s disease
- Huntington’s disease
- Cerebral tumour
- Neurosyphilis
Symptoms and signs
General
- Expressionless face(mask-like appearance)
- Greasy skin
- Soft, rapid, indistinct speech
- Flexed posture
Specific
Gait
- Slow to start walking
- Shortened stride
- Rapid small steps, tendency to run
- Reduced arm swinging
- Impaired balance on turning
Tremors
Resting
- Usually first in fingers/thumb
- Coarse, complex movements, flexion/extension of fingers
- Abduction/adduction of the thumb
- Supination/pronation of forearm
- May affect arms, legs, feet, jaw, tongue
- Intermittent, resting, on distracted
- Diminishes on action
Postural
- Less obvious, faster, finer amplitude
- Present on action or posture persists with movement
Rigidity
- Cogwheel type, mostly upper limbs, phasic element to stiffness in all directions of movements
- Plastic (lead pipe)type, mostly legs and trunk
- Trunk flexed, stooped posture
Hypokinesis
- Slowness initiating movements
- Impaired fine movements, especially fingers(micrographic
- Poor precision of repetitive movements
Psychic
- Anxiety
- confusion
- constipation
- dementia
- difficulty swallowing
- excessive salivation
- a diminished sense of smell
- increased sweating
- Insecurity
- male erectile dysfunction
- stress
- urinary frequency/urgency
Investigations
- Serological tests for syphilis
- SPECT (single photon emission computed tomography) scan
- MRI scan
Treatment
- Ayurvedic Medicines
- Lifestyle changes-
- Good nutrition
- Suitable exercise
- Regular rest periods and avoiding stress
- Physical therapy, speech therapy, and occupational therapy
- Railings or bannisters placed in commonly used areas of the house
- Special eating utensils
- Surgery
Complications
- Disability (differs from person to person)
- Injuries from falls
- Pneumonia (from aspirating saliva)