Parkinson’s Disease: Symptoms, Progression, and Management

Parkinson’s disease (PD) is one of the most common chronic progressive diseases of the nervous system in the elderly. Since the main symptoms of PD are caused by dopamine deficiency, drugs that increase the activity of dopaminergic brain systems are used for their correction. The treatment program for each patient is developed individually, taking into account the severity of the individual symptoms of the disease and the presence of side effects of therapy.

Parkinson’s disease (PD) is a chronic progressive disease of the nervous system. The clinical picture is primarily composed of motor disorders in the form of stiffness and slowness of movements (hypokinesia), muscle rigidity and tremor. Subsequently, they are joined by impaired balance (postural instability), cognitive disorders and autonomic insufficiency.

The disease was first described by James Parkinson in 1817 as “shaking palsy”. The prevalence of PD among the elderly is more than 1%. The average age of onset is 60-65 years, and 10-15% of cases may begin before the age of 40. The incidence of men and women is almost the same.

The disease is usually sporadic, but in the presence of PD in the closest relatives the risk of developing the disease increases twofold. Only a small number of cases (5-10%) of PD are associated with hereditary factors. The disease is based on degeneration of dopaminergic neurons in the substantia nigra and decreased dopamine levels in the basal ganglia, a relative excess of glutamate and acetylcholine; in later stages, norepinephrine and serotonin deficiency is associated with the disease. Patho-morphological studies in PD reveal degeneration and depigmentation of neurons of substantia nigra, as well as characteristic intracellular inclusions, which are products of protein decay – Levi’s corpuscles. Neuronal damage in PD occurs predominantly through the mechanism of apoptosis and is associated with disorders of intracellular metabolism. Nevertheless, the specific trigger mechanism, interaction and sequence of pathogenetic factors remain insufficiently clear.

PD treatment is aimed at correcting the symptoms of the disease and slowing the progression of the disease. The main method of PD treatment is pharmacotherapy. Neurosurgical methods are used relatively rarely if conservative treatment is ineffective in the late stages of the disease. At all stages of the disease, a significant role is played by rehabilitation measures, including psychosocial assistance, physical exercises and adequate nutrition. Neuroprotection

An important part of PD therapy is neuroprotection – protection of dopamine neurons from factors contributing to their further degeneration, i.e., slowing down the progression of the disease. Given the currently known pathogenetic mechanisms of PD development, the effect of drugs with presumed neuroprotective properties is aimed at reducing oxidative stress and leveling the influence of potential neurotoxins and excitatory neurotransmitters (mainly glutamate). According to experimental data, selegyline, dopamine receptor agonists (ADRs) and amantadine possess neuroprotective properties. Unfortunately, these data have not yet been conclusively confirmed in clinical trials.


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