Today is the 28th World Parkinson's Disease Day, and this year's theme is "Harmonious Symbiosis, 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.
In this issue of "Please Big Doctor", Dr. Chunyu CEO Wang Yuxiao
It will join hands with the First Medical Center of the General Hospital of the Chinese People's Liberation Army
Chief Physician of Neurosurgery Mao Zhiqi
Bring a live broadcast of Parkinson's features
You can make an appointment by stamping the picture
See you in the live broadcast room at 19 o'clock tonight
Early signs of Parkinson's
The clinical manifestations of Parkinson's disease include motor and non-motor symptoms, the symptoms are diverse, the onset is insidious, and it is not easy to detect, and many patients usually find their motor symptoms only after being reminded by family members or friends, while non-motor symptoms can only be detected by themselves and are detected later.
Non-motor symptoms
1) Olfactory disorders: Hyposmia or absence is present in more than 90% of patients, usually bilateral, and may precede the onset of motor symptoms caused by dopamine deficiency.
Although hyposmia is not present in every patient with Parkinson's disease, its presence or development may be a specific marker in patients with early Parkinson's disease prior to the onset of motor symptoms, especially when hyposmia is associated with other early clinical manifestations, radiographic evidence, or biomarkers, such as resting tremor and cognitive dysfunction.
2) Anxiety and depression: Anxiety affects 60% of patients with PD, including generalized anxiety (anxiety, fear, and annoyance), panic disorder, and social phobia, which are often accompanied by depression.
Anxiety may precede motor symptoms in Parkinson's disease, suggesting that it may be associated with abnormalities in the substantia-striatum nigra pathway. Depression is also prevalent clinically, affecting 35% of patients with PD. Depression is less aware of depression than in patients with non-Parkinson's disease. In addition, cognitive decline and dementia, psychotic episodes, anxiety, sleep disturbances, and autonomic symptoms have also been associated with an increased risk of depression in Parkinson's disease.
3) Sleep disorders: Sleep and wake disorders affect most patients with Parkinson's disease, and their severity increases with the duration of the disease. Daytime sleepiness can be distinguished from nocturnal sleep disorders, which include illness or drug-related insomnia such as choppy sleep, prolonged wakefulness, REM sleep behavior disorder, periodic limb movements, restless legs syndrome, and akathisia.
At night, when the effect of the drug wears off, motor symptoms will reappear, and dystonia, nightmares, hallucinations, and nocturia can exacerbate sleep disorders. Insomnia symptoms in patients with Parkinson's disease may be related to the pathology of the disease, but the therapeutic effect of dopaminergic drugs is minimal.
4) Autonomic dysfunction: Autonomic dysfunction symptoms are common in patients with Parkinson's disease, which may precede motor symptoms, including bladder sphincter dysfunction, gastrointestinal dysfunction, cardiovascular dysfunction, hyperhidrosis, constipation, etc.
The pathological basis of autonomic dysfunction is the loss of neurons and the formation of Lewy bodies in its regulatory areas, including the distribution of nerve plexuses such as hypothalamus, sympathetic and parasympathetic nervous systems, digestive system, heart and urinary system.
Motor symptoms
Motor symptoms of Parkinson's disease are typical, but they appear later than nonmotor symptoms, possibly due to neuroprotective or autocompensatory mechanisms, such as collateral axon regeneration of residual dopamine neurons. There are 4 main types of motor symptoms:
1) Tremor: The tremor in the early stage of Parkinson's disease is not typical, most of them are only manifested as small tremors during excitement or nervousness, without typical "pill-rubbing" movements, and are related to mood and attention, and need to be distinguished from other tremor-causing diseases, such as essential tremor, anxiety and depression, tremor caused by psychotropic drugs, and alcoholism.
2) Muscle rigidity: the patient has limb stiffness in the early stage, that is, the patient puts both elbows on the table, so that the forearms are perpendicular to the table, and the wrist joint is relaxed. In normal people, the forearm and wrist joints are about 90° flexed, while the wrist joints in early Parkinson's disease are still more or less straight, like road signs, which is called the "road sign phenomenon".
Shoulder discomfort and pain are most common in the early stages of Parkinson's disease, which can be misdiagnosed as bursitis, arthritis, or injury to the rotator muscles.
3) Slow movement: patients show a decrease in voluntary movements, slow and clumsy movements, such as slow movements such as dressing and buttoning, tying shoelaces, etc., reduced facial expressions and blinking, staring into both eyes, writing is getting smaller and smaller, broken steps when walking, arm swinging movements and amplitude are reduced, the speed of speech slows down, the pitch becomes lower, and the speed and amplitude decrease when doing rapid repetitive movements (thumb and index finger to finger).
4) Postural balance disorder: In the early stage of the disease, patients with Parkinson's disease show a decrease in the amplitude and frequency of swinging of the upper limbs when walking, dragging the lower limbs, and sometimes the whole body freezes during walking, which is called the phenomenon of "freezing". At the same time, it is difficult to start and turn, the pace is getting smaller and smaller, walking faster and faster, in a state of forward rush, and can not stop in time, which is called "panic gait".
When you find yourself or your family members have the above symptoms, you should seek medical attention in time to avoid missing the best time for treatment.
Prevention and treatment of Parkinson's
Although Parkinson's disease is more common in the elderly, there is a trend of younger development in recent years, and studies have shown that some patients have an onset age earlier than 50 years old, accounting for 5%~10% of Parkinson's disease.
Although the cause of primary Parkinson's disease is not fully understood, it is generally believed to be mainly related to a combination of factors such as aging, genetics, and environment. Secondary Parkinson's disease is mostly caused by encephalitis, cerebral arteriosclerosis, or manganese and carbon monoxide poisoning.
Therefore, early prevention, early detection, early diagnosis, and early treatment of Parkinson's disease may be achieved by intervening from the following aspects.
5 tips to prevent Parkinson's
1. Prevention and treatment of cerebral arteriosclerosis is the fundamental measure to prevent Parkinson's disease, and hypertension, diabetes and hyperlipidemia should be seriously treated clinically;
2. Avoid or reduce exposure to substances toxic to the human nervous system, such as carbon monoxide, carbon dioxide, manganese, mercury, etc.;
3. Avoid or reduce the use of perphenazine, reserpine, chlorpromazine and other drugs that induce tremor paralysis;
4. Strengthen physical exercise and mental activities to delay the aging of cranial nerve tissue;
5. When it is found that the elderly have early signs of Parkinson's disease such as smell disorders, sleep disorders, anxiety and depression, upper limb tremors, hand tremors, and slow movements, they should go to the hospital for treatment in time to strive for early diagnosis and treatment.
If Parkinson's disease is diagnosed, do not be too pessimistic and nervous, although the disease cannot be cured at present, but through drug treatment, surgical treatment, exercise therapy, psychological intervention, nursing care, etc., it can effectively improve or delay symptoms, avoid or reduce adverse reactions, and improve work ability and quality of life.
Among the many treatments, drug therapy is the first choice and the main treatment method in the whole treatment process, surgical treatment is an effective supplement when the drug treatment is not good, botulinum toxin injection is an effective method for the treatment of local spasticity and dystonia, and exercise and rehabilitation therapy, psychological intervention and nursing care are suitable for the whole treatment of Parkinson's disease.
Drug treatment process for Parkinson's disease / Source: Chinese Parkinson's Disease Treatment Guidelines (Fourth Edition)
It should be noted that Parkinson's disease is susceptible to the disturbance of the internal environment, and if infection, ion disorder, mental and emotional stimulation occur, it will aggravate the symptoms of Parkinson's disease itself, such as tremor, rigidity, and aggravation of mobility difficulties. Therefore, it is important to take the drug according to the doctor's instructions during the drug treatment, and do not change or delete the drug at will.
Source: Yitu.com
Editor: Chunyujun
Bibliography:
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