What is Parkinson's

Parkinson's

What is Parkinson's?

Parkinson's: what happens in the body?

Parkinson's is one of the most common diseases of the nervous system and usually begins insidiously. The first signs of the disease do not always clearly indicate Parkinson's. It can therefore often take years for Parkinson's to be diagnosed.

Parkinson's disease is also called Parkinson's disease. It is a chronic, permanent disease of the nerve cells in the part of the brain that is responsible for controlling movements. The nerve cells affected there produce the messenger substance dopamine.

Dopamine is responsible for transmitting signals for controlling movement. If the nerve cells die, the dopamine level drops. In its course, the disease can therefore have an impact on the coordination and mobility of those affected.

Not curable, but easily treatable

In Germany there are an estimated 220,000 people diagnosed with Parkinson's. Since the disease can go undetected for many years, it is not possible to say exactly how many people are actually affected, especially if the symptoms are only mild.

Parkinson's is usually diagnosed between the ages of 50 and 60. However, around ten percent of those affected are younger than 40 years of age. Men are affected slightly more often than women. The specific cause of the breakdown of nerve cells in the brain is still unclear.

Parkinson's is a chronic disease. This means that it cannot be cured at this time. Thanks to effective therapies, however, the symptoms can be treated well and thus alleviated.

How does Parkinson's arise?

The cause of the symptoms of Parkinson's disease is a deficiency in the neurotransmitter dopamine. This substance is produced in the nerve cells of the substantia nigra (black substance). This region in the brain gets its name from its dark color. It is located in the basal ganglia, a network of nerve cells that is responsible for controlling movement. Basically, the number of nerve cells in the substantia nigra decreases in every person in the course of their life. In people with Parkinson's, however, this cell breakdown is accelerated. As a result, the substantia nigra loses its typical dark color, bleaches and produces less and less dopamine. When about 50 to 60 percent of the dopamine-producing cells have died, the typical motor symptoms appear.

Interplay of several factors

The exact cause of Parkinson's and which factor is responsible for the breakdown of nerve cells is not yet known. Evidence suggests that the interaction of several factors can promote the occurrence of the disease.

Age

An important factor that can be involved in the development of Parkinson's disease is age. In no case does this mean that every old person has an increased risk of Parkinson's. In every person, the number of nerve cells in the substantia nigra decreases in the course of their life. However, this process is usually so slow that it does not lead to symptoms within the average life expectancy. In the healthy aging process, around 5 percent of the dopamine-producing cells of the substantia nigra per decade. In Parkinson's patients it is ten times more. Then it can happen that at some point there are too few dopamine-producing cells and there is a shortage of dopamine.

Genetic cause

In very few cases, Parkinson's is hereditary. About 15 to 20 percent of those affected have a close relative with Parkinson's. The disease is usually not passed on directly from parents to children. Rather, it is believed that the interaction of different genetic predispositions makes some people more susceptible to Parkinson's than others.

Toxins

It appears that various pollutants can increase the risk of Parkinson's disease. These include hydrocarbon-based solvents, pesticides and neurotoxins, among others. Various observations have shown that people in rural, pesticide-contaminated areas who are not connected to the urban water supply, but are supplied with water from their own well, have an increased risk of Parkinson's.

Head injuries

Certain types of head injuries can increase the risk of developing secondary Parkinson's disease. The substantia nigra can be damaged by severe blows to the head, such as those that occur when boxing, strokes or brain tumors. If the cell loss in this region of the brain is too great, it can lead to a dopamine deficiency and thus to Parkinson's symptoms.

Classic symptoms as the disease progresses

Parkinson's usually begins insidiously and progresses slowly. In most cases, the first signs of Parkinson's disease appear years, sometimes even decades, before the classic motor symptoms. Motor symptoms are the symptoms that affect how the body moves, such as tremors. The first symptoms are mostly unspecific, which means that it is not immediately obvious that they are caused by Parkinson's. For many of those affected it only becomes clear after a later Parkinson's diagnosis that these were harbingers of the disease.

Four classic signs of illness


After rather unspecific initial symptoms, four signs are typical of Parkinson's disease during the course of the disease: muscle tremors (tremor), muscle stiffness (rigidity), slowing down of movement (bradykinesia) as well as gait and balance disorders (postural instability). They are known as cardinal symptoms. In many cases, rigor, tremor and bradykinesia are initially only noticeable on one side of the body. Only gradually do they spread to the other side. These symptoms can appear individually or in combination.

Muscle tremors (tremor)

The most noticeable sign of Parkinson's disease is muscle tremors, the so-called tremor. It is usually the first thing those affected notice. In many cases, this is a quiescent tremor. This means that the tremor is particularly pronounced in resting situations and disappears during movement. More rarely, the tremor manifests itself when holding things or in motion as so-called holding or action tremor. As a rule, it first shows up on the upper extremities, i.e. on the arms and head. It also affects the feet less often. Tremor doesn't have to occur. Only about half of all those affected notice muscle tremors right at the beginning of the disease. In around 10 percent, Parkinson's even runs completely without tremors.

Muscle stiffness (rigidity)

The so-called rigor or muscle stiffness occurs in most of those affected. When a healthy person tenses a muscle, the opposite muscle automatically relaxes. This response is limited by Parkinson's disease. Both the flexor and extensor muscles are permanently tense. This makes the whole body stiff. For example, if a second person tries to stretch the arm or leg of a person affected, this is difficult to do even though no active resistance is offered. As a result, movements are often only possible in stages or jerks.

Rigor is also involved in the development of misalignments. Affected people often bend forward or keep their shoulders pulled forward. Elbow and knee joints as well as flexed finger joints can also occur.

Slowing down of movement (bradykinesia)

The slowdown in movement is known as bradykinesia. An increase is the sedentary lifestyle, which is called akinesia. Those affected can often only initiate movements with a delay. This is particularly evident in spontaneous movements, for example when you get up to greet you or when you leave suddenly. Bradykinesia is also evident in the gait. Those affected often take small steps and shuffle. It is also possible that the arms do not or hardly vibrate at all. Usually sliding movements are difficult, they are jerky. Sometimes those affected remain in the middle of the movement. This is also known as "freezing". Movements then appear frozen. Such situations can also be triggered by emotional stress.

In addition, there may be other complaints. For example, facial expressions can be slowed down and appear rigid. The number of blinkers may decrease and eye movements may be reduced. This may make the expression appear less vivid. Since the muscles involved in voice and speech formation can also be affected by bradykinesia, some affected people speak more quietly than usual or more monotonously. Often times, people with Parkinson's also have difficulty swallowing. The saliva is then not optimally removed, resulting in increased salivation (hypersalivation). Fine motor skills can also be impaired, as shown in writing, for example. This becomes smaller towards the end of the line and moves upwards.

Gait and balance disorders (postural instability)

The symptoms mentioned above can lead to gait and balance disorders if they are severe, the so-called postural instability. Movements are then not compensated for quickly enough. Even minor external influences, such as jostling in a crowd, can in some cases lead to a fall.

Not motor complaints

In addition to the complaints that affect body movement, Parkinson's can also cause vegetative disorders - i.e. disorders that are not subject to the will or consciousness - as well as psychological changes. This can lead to disorders in the gastrointestinal tract, among other things. The gastric emptying is delayed by the disease and the intestinal muscles work more slowly. Possible consequences are premature satiety, a feeling of fullness or discomfort after meals. Bladder dysfunction occurs in around half of all those affected. They can manifest themselves as sudden incontinence or as a frequent need to urinate in small amounts. In addition, sexual disorders such as libido, potency or ejaculation disorders can also occur.

Some people with Parkinson's disease feel uncomfortable about being in public because of their condition. This social insecurity can lead to complete withdrawal, in the worst case to depressive states. In the further course of the disease, Parkinson's dementia can develop in rare cases.

First signs

The symptoms that Parkinson's is associated with and how severe they are is different for each person affected. In some cases the impairment in movement is still very minor after decades, in others it increases sharply within a few years. Since the disease usually occurs in old age, these symptoms are sometimes dismissed as normal old age.

If you have Parkinson's disease, it is very likely that you will not notice all of the symptoms mentioned here and that not all will occur equally in the future. It is also possible that some are less pronounced than others. In Parkinson's disease, almost no two disease courses are the same. Depending on which sign of the disease is in the foreground, there can be very different appearances and forms of development.

The first signs of Parkinson's disease can often be very unspecific. But the earlier Parkinson's is diagnosed, the sooner it is possible not to cure the disease, but to treat it effectively and thus maintain your quality of life for a long time. The following checklist is designed to help you identify early signs of illness. If you suspect you have Parkinson's, please contact your doctor. He will refer you to a neurologist if necessary.

Parkinson's Early Detection Checklist

Compare your symptoms with the listed early symptoms. Check the box in front of the symptoms that you have experienced in the past or are currently experiencing. Click Print to print a list of your symptoms. You can discuss this list with your doctor the next time you visit a doctor.

All early symptoms are only possible signs of illness. If you observe any of these symptoms, it does not necessarily mean that you have Parkinson's disease. Your doctor will carefully clarify your symptoms for a diagnosis.

  • Loss and disturbance of the sense of smell
  • Sleep disturbances, dreamed movements are lived out
  • Shoulder pain / joint pain
  • Constipation
  • Visual disturbances
  • Cramped and scaled-down handwriting
  • Facial features lose their expression
  • Difficulty walking, general slowing down
  • Slowed responsiveness
  • fatigue
  • Hallucinations, anxiety, irritability, apathy Loss of vitality




Parkinson's diagnosis

Possible investigations

There is no special Parkinson's test that could help make a quick and reliable diagnosis. However, an experienced doctor - with Parkinson's the neurologist is the specialist in charge - is able to put the results of various examinations together like a puzzle and thus arrive at the correct diagnosis. To do this, he must know the course of your illness well. The basis of the examination is a detailed discussion (anamnesis). Your neurologist will ask you about the type and duration of your symptoms and examine you for the main symptoms of the disease:
Muscle tremors (tremor), slowing down of movements (bradykinesia), stiffening of the muscles (rigor) as well as gait or balance disorders (postural instability).

Diagnosis by process of elimination

To rule out other conditions and to confirm the diagnosis of Parkinson's, your neurologist can also test whether you are responding to levodopa. If the symptoms improve under the active ingredient levodopa, this is another indication of Parkinson's disease. If the symptoms remain the same or if they worsen, this almost always indicates a different disease.

The use of imaging techniques can also help rule out other diseases and support the diagnosis of Parkinson's. These include computed tomography (CT), magnetic resonance tomography (MRT), ultrasound examination and single-photon emission computed tomography (SPECT).

If you suspect you may have Parkinson's, speak to your doctor about it. An experienced neurologist can perform any necessary examinations and make a diagnosis.

Concomitant therapies

Not only for people with Parkinson's disease: exercise is good for you. It strengthens the muscles and the musculoskeletal system and has a positive effect on the cardiovascular system. In addition, it also contributes to general well-being. Those who do sport usually feel better. Regular exercise is particularly important for people with Parkinson's disease. In addition to therapy concepts that are well suited as accompanying therapy for Parkinson's, there are also training systems that have been specially developed for people with Parkinson's.

physical therapy

Physiotherapy is an important part of Parkinson's therapy. It can help to strengthen and maintain mobility, coordination and a sense of balance. As a supplement to drug treatment, it can help alleviate symptoms and maintain quality of life.

When doing physiotherapy exercises, it is important to move the entire body. Individual illness-related restrictions are treated in a targeted manner. The goal is to use and train your own skills. Especially in the early stages of the disease or if it is milder, it is usually sufficient for a physiotherapist to instruct suitable exercises that you can then do regularly at home. Training in a group can be a good alternative. Perhaps you will find it easier to motivate yourself to train together. Movement in the group can also prevent possible withdrawal tendencies.

A rhythmic or musical background to the exercises is particularly suitable. If the movement disorders are more pronounced, permanent support from the physiotherapist may be necessary. In the individual gymnastics, he can address your individual complaints. Appropriate measures can then be balance exercises as well as special fall or dizziness training.
In general, people with Parkinson's can and should make an effort. However, you should refrain from excessive loads. The exercises should increase your well-being and not exhaust you excessively.

LSVT LOUD therapy

LSVT-LOUD therapy is a scientifically well-researched speech training specially developed for Parkinson's patients. LSVT-LOUD differs from other approaches in that the method aims to improve speaking skills solely through the speaker's loudness. Over a period of four weeks, you train four times a week for one hour each in intensive individual exercises. The exercises help you speak in a louder voice again. Overall, the therapy aims to ensure that the trainees make themselves understood in everyday life without exertion and can take part in conversations.At the same time, the exercises strengthen the muscles required for speaking, swallowing and breathing.

The success of LSVT-LOUD therapy for the treatment of speech and swallowing disorders in Parkinson's patients has been proven by various studies. Due to its good effectiveness, the LSVT-LOUD training is now one of the primarily recommended therapy concepts for Parkinson's patients.

LSVT-BIG therapy

The LSVT-BIG therapy, developed as a further development of the Lee Silverman Voice Treatment (LSVT), is a movement therapy that has been very successful in practice. The focus of this physiotherapy training is the regular practice of wide, powerful movements. This is intended to counteract the reduction in size and slowing down of movements that are typical for Parkinson's disease. With simple exercises, for example powerful pushing movements with the arms or large lunges, you can make optimal use of your reserves of movement under therapeutic supervision. The findings show that regular training can slow down the progression of restricted mobility. For you, this can mean maintaining quality of life and independence.

Speech therapy

Maintaining communication skills is particularly important in order to maintain social contacts and to be able to participate in social life as usual. For example, many people with Parkinson's have difficulty adjusting their speaking volume to their surroundings, i.e. speaking louder in a noisy environment. Some people stutter intermittently. Regular speech therapy training can help you strengthen your voice and speak loudly and clearly. Breathing and facial expression exercises are also part of the therapy. Good training can also be singing together in a group. Swallowing disorders, as they often occur in connection with Parkinson's, can also be treated as part of speech therapy. One of the best-known speech therapy approaches for people with Parkinson's is the so-called LSVT-LOUD therapy. Vocal function and speaking volume should be trained through various exercises. The improvement in intelligibility should only be achieved by increasing the speaking volume.

Occupational therapy

For most of those affected, maintaining independence plays an essential role. Occupational therapy can help keep it going for as long as possible. As part of the therapy, you can practice handling everyday objects or everyday tasks, among other things. If necessary, the therapist will provide you with aids that will make everyday life with Parkinson's easier and thus help you to maintain your independence. These can be aids for food intake, exercise, care, dressing and undressing or to support certain leisure activities. In addition, your occupational therapist can advise you on which changes in your living environment can help you continue to live a safe and independent life within your own four walls.

Movement - an important basis

Exercise is good for body and mind - Parkinson's disease doesn't change that either. The main thing here is that exercise and sporting activities should not overwhelm you, but should be fun!

Movement should be fun - whether walking, hiking, cycling, gymnastics, Pilates, yoga, swimming or dancing. Especially at the beginning of the illness there are no restrictions and you can be or become active to your heart's content. But also later: Even if some movements are more difficult than before, physical activity has a positive effect on various physical and mental aspects. Therefore, keep moving as much as possible in everyday life within the scope of your possibilities and adapted to your individual state of health.

Tai Chi therapeutic training

The Tai Chi therapeutic training "Keep Moving" promotes natural movements, improves posture and strengthens flexibility, balance and coordination. It may also work against an anxiety that is often associated with Parkinson's. The training is derived from the classic Tai-Chi, in which large, round movements are performed slowly. This makes it suitable for diseases that, like Parkinson's, are associated with movement disorders.

The exercises of Tai Chi therapeutic training were specially developed for people with movement disorders. A central component of the concept is walking training. Here safe and sufficiently large, but appropriate steps for the body size are practiced. In this way, the natural sequence of movements should be promoted. Broad steps are also trained, which ensure good balance and a firm stance. In addition, there are slow, almost meditative exercises while sitting, for example concentrated circling with the arms. The security of movement gained from the training is an important fall prevention in everyday life and can prevent or help to overcome a sudden "freezing" of movements. If you are interested in a Tai Chi therapeutic training, ask your doctor whether he can recommend such a training. In some cases, neurological clinics and self-help groups also provide contacts. Tai Chi therapeutic training is recognized as a prevention course and is supported by various health insurance companies.

Dance as movement training

Dancing strengthens flexibility, coordination and balance as the trainees take specific steps and turn. Having to balance yourself for a short moment while standing on one leg while your free foot performs a dance step trains your balance. Perception and thinking are promoted because both halves of the brain work together and certain sequences of movements have to be learned. Last but not least, dance training together with others can have a positive effect on the psyche.

In a study, people with Parkinson's disease and those not suffering from it completed dance training together in a group under supervision. Subsequently, several of the participants with Parkinson's disease said that the exercise improved their balance and made them feel more energetic and enterprising. If you are interested in dance as movement training, you can ask your doctor whether and, if so, which offers might be possible. Self-help groups can usually also arrange contacts. Parkinson's dance offers are not included in the benefits of the statutory health insurance.

Psychological counseling

A diagnosis of Parkinson's can be associated with many uncertainties and fears for those affected. This can become a great emotional burden. In addition, poor coping with illness can increasingly lead to psychological changes, in the worst case to anxiety and depression. Psychological counseling can help you deal with your illness and develop positive strategies for coping with it. This strengthens you in dealing with your illness and can thus prevent social withdrawal and the loss of quality of life.

How is Parkinson's disease treated?

Various therapy modules for optimal treatment success

The combination of different forms of therapy is very successful in treating Parkinson's disease. An important component of Parkinson's therapy is drug treatment. She is supported by various accompanying therapies.

Since the disease itself cannot be cured, Parkinson's therapy primarily aims to alleviate symptoms and side effects. Every course of Parkinson's is different, and the symptoms can be very different in nature and severity. What is particularly troubling for one person may not even appear for the other. In addition to the symptoms, medical history, age and living conditions also play an important role. It is therefore necessary to tailor the therapy to the individual. Your treating neurologist is an important point of contact for your Parkinson's therapy.

He knows you and your illness and can give you comprehensive advice on the various therapy options. You can also use it to set your personal therapy goals before starting treatment. In it you formulate together which aspects should be in the foreground in your treatment. Depending on the life situation, this can be, for example, the improvement of certain complaints and the maintenance of work or independence in daily life.

Medical therapy

Even if Parkinson's cannot be cured to this day, the symptoms are usually easy to treat. Various Parkinson's drugs are available for drug therapy, which can significantly alleviate the symptoms. Since every course of Parkinson's is different, it is important to tailor the drug therapy to you individually. The aim of drug therapy is to compensate for the lack of dopamine in the brain as early as possible and thus alleviate the symptoms. Your neurologist can give you comprehensive advice on this.

Levodopa (L-Dopa)

Levodopa, also called L-dopa, is considered the gold standard for treating Parkinson's disease. Parkinson's symptoms are triggered by a deficiency in the neurotransmitter dopamine. Dopamine cannot be supplied to the body from the outside because it cannot cross the blood-brain barrier, i.e. the border between blood vessels and nerve tissue. Therefore, in Parkinson's therapy, levodopa is used in combination with a decarboxylase inhibitor (carbidopa or benserazide). Decarboxylase inhibitors prevent levodopa from breaking down before it reaches the brain. So it is more effective. Levodopa is a precursor to dopamine and can be converted to dopamine in the brain. With levodopa, the symptoms can improve significantly, especially at the beginning of therapy. However, they can reappear as treatment progresses. In most cases, the levodopa dose then has to be increased.

Levodopa is often given orally, i.e. in the form of tablets or capsules. With long-term oral levodopa therapy, however, the effect may wear off or fluctuate (ON-OFF fluctuation). In this case, levodopa in combination with carbidopa can be given directly into the small intestine via a pump. The concentration of active substances in the blood can thus be kept constant. Levodopa therapy can lead to weight loss, nausea, constipation, anxiety, depression, insomnia, involuntary overmovement (dyskinesia), worsening or no improvement of the disease, fluctuations in blood pressure when standing up (orthostatic hypotension) or falling.

COMT inhibitors

If the duration of action of orally administered levodopa is shortened, the combination with a COMT inhibitor can be useful. COMT inhibitors are mostly used when there are so-called wearing-offs. With wearing-off, the levodopa will wear off before it is time for the next tablet. This group of drugs includes active ingredients that inhibit the breakdown of levodopa in the body and thus prevent it from being broken down in the bloodstream. As a result, a larger amount of levodopa arrives in the brain and it can therefore work longer and more effectively. However, this can also increase the side effects of levodopa. Other side effects can include nausea and vomiting, constipation, diarrhea, dry mouth, tiredness and headache.

MAO-B inhibitors

These active ingredients inhibit the breakdown of the released dopamine in the brain. This applies to the body's own dopamine as well as to dopamine, which is formed from the levodopa that is added. In doing so, they strengthen and prolong the effect of levodopa. Slight fluctuations in the effect can be balanced out in this way. Similar to COMT inhibitors, the side effects of levodopa can also occur more intensely during therapy with MAO-B inhibitors. Influenza-like conditions, joint pain, loss of appetite, dizziness and allergic reactions are known to be side effects of the MAO-B inhibitors.

Dopamine agonists

Along with levodopa, dopamine agonists are among the most important drugs in Parkinson's therapy. Chemically, they are very similar to dopamine and imitate its function in the brain. In this way, dopamine agonists can replace missing dopamine and weaken disorders that arise from the dopamine deficiency in the brain. The typical symptoms of Parkinson's disease can be positively influenced in this way and fluctuations in effects can be compensated for. The dopamine agonist rotigotine can be applied to the skin using a plaster to ensure a constant concentration of the active substance. As part of advanced Parkinson's therapy, the dopamine agonist apomorphine can also be continuously administered directly under the skin via a pump. A side effect of dopamine agonist therapy may be low blood pressure (hypotension) or fluctuations in blood pressure when sitting up (orthostatic hypotension), which can sometimes lead to fainting. In addition, nausea, weight loss, weight gain, daytime sleepiness, microsleep, edema and impulse control disorders such as buying, eating or gambling addiction can occur.

Glutamate antagonists (NMDA antagonists)

Cell death in the brain brings various messenger substances out of balance - including the messenger substance glutamate. Due to the dopamine deficiency, people with Parkinson's disease often have a relative excess of glutamate in the brain. Since glutamate has an activating effect, the excess can lead to involuntary overmovement, as often occurs in the later course of the disease. Glutamate antagonists inhibit the effect of the activating glutamate and can thus reduce excessive movements. In addition, they can improve the release of dopamine.

Side effects of NMDA (N-Methyl-D-Asparate) antagonists can include sleep disorders, edema in the legs, marbling of the skin, cardiac arrhythmias, inner restlessness, nightmares, hallucinations, confusion, daytime tiredness, dry mouth, visual disturbances, constipation, urinary retention, nausea Vomiting, or stomach discomfort occur.

Anticholinergics

These active ingredients are considered to be the oldest Parkinson's drugs, but play a rather subordinate role in modern therapy. They decrease the release of acetylcholine in the brain. This messenger substance is present in relative excess in people with Parkinson's disease and, in addition to dopamine deficiency, contributes to the typical movement disorders. Anticholinergics are sometimes used to treat tremors. They have little influence on other symptoms.

Anticholinergics can have a dementia-promoting effect. Other side effects are dry mouth, increased intraocular pressure, dilation of the pupils, constipation, urination disorders, reduced sweat, increased pulse rate, heartburn, nausea, vomiting, drowsiness, sleep disorders, inner restlessness, confusion, hallucinations, delirium and allergic reactions.