This year, April 11 marks the 28th World Parkinson's Disease Day, and this year's theme is "Harmonious Coexistence for a Better Life". Parkinson's disease is a chronic neurodegenerative disease that occurs in older adults. Epidemiological statistics show that there are currently about 3.65 million Parkinson's disease patients in the mainland. The disease has become the "third largest health killer in middle-aged and elderly people" after cardiovascular and cerebrovascular diseases and tumors.
Overcome the pitfalls
Detect early signs of concealment as early as possible
Grandma Wang, who is in her 70s, lives not far from Beijing's Ditan Park, and after retirement, she likes to walk in the park. A few years ago, she felt like she was walking more and more slowly. At first, I didn't take it seriously, thinking that it was a normal phenomenon of aging when I was older, but I didn't expect the symptoms to get worse and worse, and soon she couldn't even walk to the park. Her family sent her to the China-Japan Friendship Hospital for medical treatment, and she was diagnosed with Parkinson's disease. Grandma Wang and her family are very strange, their hands are not shaking at all, how can it be Parkinson's disease?
The main pathological change of Parkinson's disease is the degeneration and death of dopaminergic neurons in the substantia nigra of the midbrain, which leads to a significant decrease in the dopamine content of the striatum. Aging, environmental factors, and genetic factors may all be involved in the degenerative death of dopaminergic neurons in Parkinson's disease. At the same time, more than 80% of dopaminergic neurons in the midbrain have been lost by the time the patient develops clinical symptoms. Therefore, early detection, early diagnosis, and then early treatment are important factors in delaying the progression of Parkinson's disease. However, at present, many patients only realize that they are not going to seek medical attention one year after the onset of the disease, because the early symptoms of Parkinson's disease are very "hidden".
When it comes to Parkinson's disease, many people's first impression is the classic scene of boxing champion Ali holding the torch high with trembling hands at the 1996 Atlanta Olympics. Since then, "hand tremors" have become one of the symbols of Parkinson's disease in the hearts of the public.
However, this is a big cognitive misunderstanding. Jin Miao, deputy chief physician of the Department of Neurology of China-Japan Friendship Hospital, said that hand tremor is not necessarily Parkinson's disease, for example, benign essential tremor can also cause hand tremor, and its incidence is higher than that of Parkinson's disease, that is to say, most of the symptoms of hand tremor are not Parkinson's disease;
Grandma Wang is like that. The illusion of "normal aging" made her sick for a year before she went to the hospital. Fortunately, she had good medication compliance and actively cooperated with the treatment, and her symptoms were effectively alleviated. Now, Grandma Wang can go for a walk in the park again.
There are many early signs of Parkinson's disease, but these signs are often misjudged by patients to be caused by other causes, resulting in a delay in the disease. "The average person may not think that frequent constipation can also be Parkinson's disease. Zhu Xiaodong, chief physician of the Department of Neurology of Tianjin Medical University General Hospital, introduced that the typical clinical manifestations of Parkinson's disease are motor symptoms, mainly including resting tremor, bradykinesis, muscle rigidity, etc., but there are many hidden non-motor symptoms, including constipation, decreased sense of smell, night sleep disorders, as well as neuropsychiatric symptoms, autonomic symptoms, etc.
"In fact, constipation is a symptom that many people with Parkinson's disease have before they develop bradykinesia and resting tremor, and nighttime sleep disturbances are more likely to occur years or even more than a decade before Parkinson's disease. Sadly, these early signs are often overlooked. ”
Experts suggest that in the case of long-term constipation and decreased sense of smell, and there are sleep disorders such as shouting and kicking, we should be especially vigilant about whether it is an early warning indication of Parkinson's disease, and should be closely observed and go to the hospital in time.
Don't be afraid of Pa
Clinical treatment methods have been abundant
The cause of Parkinson's disease is unknown, so there is no evidence-based prevention method. There is no cure for Parkinson's disease, and once diagnosed, it means lifelong companionship, and existing treatments can only slow the progression of the disease. The efficacy of the drug decreases, and as the dose increases, the side effects of the drug will gradually appear. As the disease progresses, patients with advanced Parkinson's disease will lose their ability to take care of themselves, their quality of life will be greatly reduced, and long-term bed rest may lead to various serious complications.
Almost every patient with Parkinson's disease who is diagnosed with Parkinson's disease will be "bombarded" by this series of bad news, and thus fall into negative emotions such as fear. Clinical findings show that more than 50% of patients with Parkinson's disease may have psychological problems such as depression and anxiety. Especially after the emergence of problems such as "switch phenomenon" and dyskinesia, many patients are greatly affected and depressed all day long.
Experts say that these psychological problems not only accelerate the progression of the disease, but also seriously affect the patient's treatment compliance and aggravate the patient's motor symptoms. Patients should have a correct view and understanding of the disease, and if they actively cooperate with the treatment, they can still effectively delay the progression of the disease, maximize the quality of life, and still have a good life.
Jin Miao said that although there is no cure, Parkinson's disease has a long course and does not have much impact on life expectancy. If the treatment and nursing are done well, most patients can maintain good physical function for more than 10 years, and some patients can even maintain it for 20 years. The long course of the disease gives patients the opportunity to wait for the advancement of technology, and hope is always there.
In recent years, mainland scholars have made significant progress in understanding the pathogenesis of Parkinson's disease, discovering biomarkers for early diagnosis, updating treatment concepts, and exploring treatment methods and means. In 2006, 2009, 2014 and 2020, the Parkinson's Disease and Movement Disorders Group of the Chinese Society of Neurology formulated four editions of the Chinese Parkinson's Disease Treatment Guidelines, which played an important role in standardizing and optimizing the treatment behavior and improving the treatment effect of Parkinson's disease in mainland China.
Jin Miao introduced that when it was found that therapeutic drugs would cause problems such as "switching phenomenon" and dyskinesia, the academic community tended to administer them as late as possible. Later, some studies found that it should be treated as soon as possible, adhere to the "dose titration" to avoid acute adverse drug reactions, and strive to achieve the drug principle of "achieving satisfactory clinical effects in as small doses as possible", which can avoid or reduce the incidence of motor complications, especially dyskinesia. Facts have proved that the incidence of dyskinesia in mainland Parkinson's disease patients is significantly lower than that in Parkinson's disease patients abroad.
After the onset of the patient, Ah Liang (pseudonym), the course of the disease progressed rapidly, the dosage of medication increased greatly, and the movement disorder intensified. Jin Miao performed deep brain stimulation surgery for him based on clinical judgment. After the operation, Ah Liang's physical function was significantly improved, and the dosage of medication was also greatly reduced.
It is understood that after years of practice, the continental deep brain stimulation therapy has gradually matured, and it is used when the drug efficacy is significantly reduced, and has significant curative effects on tremor, rigidity, bradykinesia and dyskinesia, which has become the main surgical choice because of its relative non-invasiveness, safety and controllability, and is one of the effective ways to delay the progression of the disease.
New therapeutic drugs and treatment modalities are still being explored. Recently, the New England Journal of Medicine published the results of an interim clinical trial. The results suggest that a drug may have a potential effect on early Parkinson's disease. "At present, there are also studies on stem cell therapy, gene therapy and other treatment methods, which are expected to be applied to clinical practice when the research matures. Zhu Xiaodong said.
Zhu Xiaodong said that with the advancement of science and technology and in-depth research on Parkinson's disease, he believes that there will be more new treatment methods to serve the majority of patients and strive to defeat Parkinson's disease as soon as possible.
Boost capacity
Empower more doctors to fight Parkinson's disease
The treatment of Parkinson's disease is not an easy task, and the treatment plan for progressive disease is very complex, and the proportion and dose of medication need to be adjusted according to the patient's condition at any time. Although there are treatment guidelines, they vary greatly from person to person in clinical practice, and treatment guidelines cannot be applied to all conditions, which is a great test of doctors' professional ability.
When talking about the treatment of Parkinson's disease, Jin Miao repeatedly emphasizes caution, meticulousness, and consideration. Whether it is a drug or a surgery, it must not be abused. This is because improper medication or wrong treatment options will accelerate the progression of the patient's disease and directly affect the patient's quality of life.
There are also some details that are easy to overlook in the guide. These details require doctors to fully understand the mechanism and proactively remind patients. Jin Miao introduced that in clinical practice, patients often encounter the problem of poor drug effect, and when asked, they found out that the patient took the medicine at the wrong time.
At present, the number of doctors capable of treating Parkinson's disease is far from enough, and Jin Miao called for strengthening the training of primary neurologists to improve their ability to diagnose and treat Parkinson's disease, so as to meet the needs of more and more patients.
Parkinson's disease is more difficult to diagnose than it is to treat. Zhu Xiaodong has seen patients with Parkinson's disease who have been diagnosed with a variety of diseases such as cervical spondylosis, cerebrovascular disease, osteoarthrosis, and hemiplegia. He said that the publicity and popularization of Parkinson's disease should not only be aimed at the middle-aged and elderly people, but also for the medical personnel of relevant departments. In fact, many professional doctors are trying to educate about Parkinson's disease in various ways. Mei Shanshan, deputy chief physician of the Department of Neurology of Xuanwu Hospital of Capital Medical University, posted hundreds of Parkinson's disease-related knowledge promotion videos on her video account. However, at present, the understanding of Parkinson's disease among the middle-aged and elderly people and even relevant medical and health practitioners is still insufficient, and there is a lack of unified standards for the rehabilitation and treatment of Parkinson's disease.
In response to these circumstances, in January this year, the Institute of Science and Technology of the National Health Commission, the Institute of Sports Medicine of the General Administration of Sports of the People's Republic of China and the China Technology Entrepreneurship Association edited the "Comprehensive Evaluation and Guidance System for Rehabilitation of People with Functional Impairment Caused by Parkinson's Disease". As the first group standard in the field of Parkinson's disease rehabilitation in China, the main goal of this standard is to provide a standardized rehabilitation framework to help Parkinson's disease patients obtain more effective and systematic treatment and rehabilitation services. Mei Shanshan is a participant in the group standard. She said that by setting clear rehabilitation standards, medical professionals can be helped to assess patients' conditions more accurately, formulate personalized rehabilitation plans, improve the quality and efficiency of rehabilitation treatment, and prolong the development cycle of the disease.
It is understood that in recent years, more and more doctors have taken the initiative to study Parkinson's disease, and the team against Parkinson's disease is growing day by day. A good life, hope is always there.
Source: Chinese Oral Daily
Text: Reporter Wang Yang
Curator: Li Bing
Editor: Yan Shaowei and Qin Mingrui
Proofreading: Ma Yang
Review: Guan Zhongyao, Xu Bingnan
