Parkinson’s stages

Introduction

Parkinson’s is a disease that affects the central nervous system of the body and it results from the loss of certain cells in the brain that produces dopamine. Even though the exact cause of the disease is not known, the current research on the subject suggests that the condition is triggered by a combination of genetic and environmental factors. It is not clear how a few selected individuals are affected by this condition. This neurodegenerative disorder develops slowly with time and the effects can vary from one patient to the other. At present, the disease has no specific cure and the methods of treatment include medications and surgery. The disease may start with some barely noticeable symptoms like a small tremor, which may develop into stiffness or slowing of movement with time. The parts of the brain that control the movements of the body cannot function normally and result in these types of complications.

At present, Parkinson’s is the most common neurodegenerative disorder after Alzheimer’s disease. It generally causes the degeneration of nerve cells in one area of the brain called the substantia nigra. In most cases, the symptoms of Parkinson’s develop when around 80% of the nerve cells in this area have been lost. While the disease can be transmitted through genes, it is rarely the main cause that causes the symptoms to develop. The various environmental factors that include the intake of toxins through food and air are assumed as another reason behind this disease. The present therapies for Parkinson’s reduce the symptoms of the patient, without slowing down the progress of the disease. Apart from the movement-related symptoms, the disease can also give rise to other symptoms like apathy, depression, constipation, sleep disorders and loss of sense of smell, and cognitive impairment.

Symptoms of Parkinson’s

The signs and symptoms of the disease can vary from one person to another and it can appear on one side of the body or both. The following symptoms can be considered as a sign of Parkinson’s disease.

• Tremors or shaking in the finger, thumb, hand, or chin can be an early sign of Parkinson’s. The hands can also experience tremors when they are at rest. Tremors are usually very subtle when they first occur and remain noticeable only to the patient. Shaking is often normal after a session of strenuous exercise or when there is a lot of stress in the body and this should not be confused with Parkinson’s.
• With time Parkinson’s can slow down simple physical movements like walking and sitting. Increased difficulty in movements is termed bradykinesia and the symptoms include shorter steps and dragging of feet. There is also a decreased ability to perform some normal movements like including blinking, smiling, or swinging the arms while walking.
• Another symptom of the disease is the handwriting getting smaller with time and the words coming closer than normal. This symptom of Parkinson’s is called micrographia.
• In some cases, muscle stiffness may occur in any part of the body frequently, especially in the areas like shoulders and the hips. The stiff muscles can be painful and limit the normal range of motion.
• In some cases, the patient can also lose the sense of smell for some items that were smelled distinctly in normal conditions. There can also be difficulty in distinguishing between two different odours.
• Parkinson’s disease also leads to impaired posture and balance and a person may have to stoop forward to balance the body.
• Sleep-related problems like insomnia, excessive fatigue during daytime, frequent sporadic movements during sleep, and sleep apnea can also be initial symptoms of the disease.
• There can be speech changes that can impact the normal pattern of speaking. Speech patterns can become faster or there might be some slurring while speaking. There is also a tendency to talk more softly.
• Facial masking or reduced ability to make facial expressions is another symptom that can occur in the early stages. It causes the patient to wear a depressed or serious look quite often, even when they are not so serious. This happens due to the loss of control over the subtle, complex muscle movements, even though the ability to experience emotions is not diminished.

Factors leading to Parkinson’s disease

Even though genetic factors are a part of the disease, people with a family history of the disease have only a 3 percent risk of developing it. Certain mutations in the genes can be inherited and can lead to the disease, even though such cases are rare. Research has found protein deposits called Lewy bodies in the dead and dying nerve cells, even though their role in nerve cell damage is not yet clear. Some mutations can also cause protein degradation in the brain cells and an accumulation of toxic proteins that can lead to cell damage. There is a lot of research that is being conducted at present to understand the genetic causes of Parkinson’s. Exposure to environmental toxins is also considered as a reason behind the disease and the following factors are considered significant.

Age

Parkinson’s disease usually occurs in the middle or in the late phase of life and the risks increase with age. Around 1 % of people above the age of 60 are affected by the disease and it hardly affects individuals below the age of 45.

Gender

The disease is more common in men and the exact reasons behind this are not yet clear to the researchers.

Head injury

This has been established as a major cause of the disease. Traumatic brain injury that causes amnesia or loss of consciousness can trigger Parkinson’s even years after the injury. Studies suggest that such injuries cause inflammation in the brain, which could lead to the onset of neural damage. In some cases, mental trauma or anxiety associated with other factors can also increase the risks.

Exposure to toxins

Exposure to industrial pollution, herbicides, fungicides, and insecticides can increase the risk of the disease. In 2009, the U.S. Department of Veteran Affairs associated Parkinson’s disease with exposure to Agent Orange, which is a special herbicide used during the Vietnam War.

Occupation

Certain occupations are believed to increase the risks of Parkinson’s even though much research needs to be conducted in this regard. Welding is considered a profession that can lead to the development of Parkinson’s. The current research on the subject has delivered inconsistent results.

The mechanism of Parkinson’s disease

There is a lot that is not known about the exact process of specific molecular events that provoke neurodegeneration in the disease. The mean age or the onset of the disease is 55 and in 95% of the cases, the genetic linkage is not responsible for the disease. It has been estimated that around 15 to 25 percent of patients will have a family history of the disease. Electrical impulses pass between the neurons through the process of neurotransmission and it is dependent on a process called endocytosis. This is often caused by the overabundance of the chemical alpha-synuclein and when one signal is disrupted, there is a chain of disruption that takes place. Current research states that the inhibitory effect of alpha-synuclein is a major cause behind the early stages of Parkinson’s disease. Another reason behind Parkinson’s is the depletion of dopamine-producing cells. Dopamine plays a major role in transmitting nerve signals from one neuron to another in the brain. The loss of dopamine leads to abnormal muscle movements and cognitive impairment.

The stages of Parkinson’s disease

Even though the disease progresses at a different pace for each patient, the Hoehn and Yahr Scale classifies it into five different categories. This scale is commonly used by physicians to classify patients in various stages. The length of progress from one stage to another varies between patients and the symptoms can also vary. The stages are discussed below.

Stage one

The first stage involves mild symptoms that are seen only on one side of the body. This stage does not involve any significant functional impairment and does not affect daily tasks and the overall lifestyle. The symptoms can include intermittent tremor of one hand, rigidity, or one hand or leg may feel heavier than another. In most cases, such symptoms are left unattended and even for a physician, this stage is difficult to diagnose. However, the symptoms can be handled effectively with the right medication.

Stage two

This stage is still considered an early stage in the development of the disease and here, the symptoms affect both sides of the body. This is termed bilateral involvement and this may develop years after the first stage, even though the rate of progression can vary. The stiffness in the body, tremors, and trembling are more prominent in this stage and this may lead to neck or back pain, stooped posture, and general slowness in all daily activities. At this stage, the patient can perform the daily tasks and continue to live alone if needed.

Stage three

This is the middle stage in the progression of the disease and is marked by a general loss of balance and more slowness of movements. The patient also fails to make the rapid, involuntary adjustments that can prevent falling, and hence falls are common in this stage.  Even though this impairs daily activities in a major way, the patient is still able to perform activities like dressing, hygiene, and eating. The diagnosis of the ailment can be made easily in this stage and medication along with therapy is used to neutralize the symptoms.

Stage four

In this stage, Parkinson’s has turned into a severely disabling disease and patients have a high level of difficulty in performing daily tasks. While some can still walk or stand unassisted, others may need the support of a walker. There is also a significant decrease in reaction time and more slowness in movements. Living alone at this stage of the disease can be difficult and even dangerous. Hence the patients will need support for performing many of the daily activities.

Stage five

Stage five is the most advanced stage of the disease and due to advanced impairment in the legs, it is extremely difficult to stand or walk in this stage. Inability to rise from a chair or get out of bed, along with stumbling while walking is a common symptom. The patients usually need wheelchairs in this stage along with round-the-clock support and care. Around 30 percent of patients at an advanced level of stage 4 and in stage 5 experience confusion, hallucinations, and delusions. A large section of the patients also suffers from dementia in this stage. In some cases, the medications do not prove to be effective in this stage of the disease.

Conclusion

Living with Parkinson’s disease involves adopting the right techniques to manage the symptoms and make the necessary lifestyle changes. The proper use of medications and other treatments will also be necessary. Starting a regular exercise schedule can make a whole lot of a difference in the condition of the patient. In many cases, activities like swimming, cycling, dancing, and even non-contact boxing, tai-chi, etc., from an early stage have resulted in various positive effects that can counter the debilitating effects of the disease. While there is no specific diet recommended for Parkinson’s, a healthy diet that involves the consumption of plenty of fruits and vegetables is a good option. Adequate hydration can also reduce the chances of cramping of the muscles.

There are a variety of medications that can treat motor symptoms and connect with the right experts in the field that can help in the process of medical therapy. A patient can also find local resources and support groups that can help in dealing with the disease. It is also essential to maintain sound mental health as emotional well-being is directly connected with health. Any signs of anxiety, depression, and stress should be avoided to keep the system in a positive mode. Living with Parkinson’s disease can be challenging but with the right level of support and determination, there is no reason for not conducting life in the best possible manner.

References