Parkinson's Disease: Aetiology, Pathogenesis, Diagnosis, and Treatment

This report provides a comprehensive overview of Parkinson's disease, a neurodegenerative disorder affecting motor skills. It explores the aetiology and pathogenesis, discussing the potential involvement of genetic and environmental factors, as well as the loss of dopamine-producing brain cells. The report details the diagnostic process, including neurological examinations, imaging tests like MRI and CT scans, and the use of medications like Carbidopa-levodopa. It also outlines the five stages of the disease and the progression of symptoms, from tremors and stiffness to balance issues and the need for caregiver assistance. Furthermore, the report discusses various treatment options, including medications such as dopamine agonists and deep brain stimulation for advanced cases. The conclusion emphasizes that while Parkinson's disease is incurable, medications and surgical procedures can help manage symptoms, improving the patient's quality of life. The report also highlights the importance of lifestyle changes like exercise and a balanced diet.

Parkinson’s disease

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
Aetiology and pathogenesis.........................................................................................................1
Diagnostic process.......................................................................................................................2
Treatment.....................................................................................................................................3
CONCLUSION................................................................................................................................5
REFERENCES................................................................................................................................6

INTRODUCTION
Parkinson’s disease is a disorder of central nervous system that directly affects motor
skills of an individual. The cause of this disease is still unknown but various researchers believe
that it is due to the combination of genetic and environmental factors (Allen, Schwarzel and
Canning, 2013). The report discusses regarding aetiology and pathogenesis of Parkinson’s. It
will also discuss regarding stage 1 to 5 of the disease and prevalence of symptoms in same. A
comprehensive discussion will also be made on diagnostic process and treatment aspect of this
disease. At the end, it can be stated that deep brain surgery is performed to bring condition under
control at the last stage of Parkinson’s disease.
Aetiology and pathogenesis
Parkinson’s disease is a neurodegenerative disorder which has an ability to deteriorate
motor functions of the body. The condition is initiated due to loss of dopamine producing brain
cells. The cause is still unknown to the disease but researcher have been able to speculate that
there is adequate involvement of both genetic and environmental factors in its initiation. Primary
symptoms of this disease are, stiffness, tremors and impaired balance. Other secondary
symptoms of this disease are, depression, anxiety and dementia (Kelly, Eusterbrock and
Shumway-Cook, 2012). Majority of the individuals are diagnosed with this disease after the age
of 60 years or older than it. However, it early onset of Parkinson’s disease can be found in
youngsters as well.
Aetiology
Exposure to certain type of pesticides and any type of history of head injury have direct
link to Parkinson’s disease. If the individual has never smoked cigarettes or any type caffeinated
beverage also increases the risk of Parkinson’s disease to some extent. Lack of concentration of
urate in blood serum can also result in this disease. Researchers have indicated that complex
interaction between genetic and environmental factors can lead to this disease (King and et.al.,
2012). There are various Parkinson’s related genes that are involved in direct function of
lysosomes which are responsible for digestion of cellular wastes. In certain cases, Parkinson’s
disease can also be the result of dysfunction of lysosomes that ultimately reduced the ability of
cells to breakdown alpha- synuclein. Age id considered to be the greatest factor of development
of Parkinson’s disease, where men tend to get affected by it by about 1.5 to 2 times more often in
1

comparison to that of a woman. An increased risk of this disease is present in the patients who
have its family history (Litvan and et.al., 2012).
Pathogenesis
The disease is not curable yet adequate steps can be adopted by patients and its family
members to reduce its impact on normal functions of life. The disease tends to progress with its
functions from the form it usually occurs at its first stage and may overlap as well and occurring
at another stage as well. As the stage of Parkinson’s disease progresses, a advancement in
severity of disease can also be noticed in it. The main stages of Parkinson disease are: Stage 1: Mind symptoms can be noticed at this stage with tremors or movement in hands and
legs and swing arm while walking. These do not generally interfere in the daily activities of
individual and generally occur in one side of the body (Bonnet and et.al., 2012). Stage 2: At the stage 2 of Parkinson’s disease, the symptoms generally worsen up and patient
may face problems in walking. At this stage, both parts of the body get affected. Stage 3: At this stage, the patient star facing issues in movement which get slowdown. He /
she also loss balance in the body and increased the tendency and probability of falling and
getting injured. Stage 4: At this stage, it becomes difficult for the patient to live his life alone and require
help in each and every common activity conducted in life (Pringsheim and et.al., 2014). Stage 5: It is the last and fifth step of Parkinson’s disease where caregiver is required to be
present for all the activities of the patient. It becomes difficult for the patient to walk or stand
and may be left bedridden. Patient may also face hallucinations and delusional activities as
well.
Diagnostic process
A physician can, at initial level, can find out the presence of Parkinson’s disease with
careful examination of medical history and neurological examination. An autopsy is generally
conducted in the mid brain, which is usually considered as the final proof that the individual is
suffering from Parkinson’s disease. The clinical course overtime may ascertain that it is not
Parkinson’s disease. It generates the requirement of reviewing the condition so as to confirm the
accuracy of diagnosis performed. Physical and neurological examinations are conducted to
assess changes taking place in patient’s reflexes, muscle strength, coordination and mental
function (Plotnik, Giladi and Hausdorff, 2012). Certain imaging tests are also conducted on
2

patient’s brain, such as, MRI and CT Scan. Some common blood tests are also conducted by the
doctor in order to rule out other illness that the patient must be suffering from.
Physicians are also involved in giving carbidopa- levodopa, which is Parkinson disease
medications to its patients. Significant improvement in the condition of the symptoms generally
confirm the diagnosis. The four main motor symptoms of Parkinson’s disease are, bradykinesia
(slowness in movements), tremors, muscle rigidity and postural instabilities in the form of falls.
However, researchers have stated that in almost 30% of the cases, tremors are not present in the
patient. There are other range of symptoms as well which can generally be experience by the
patient. These are, freezing of movements, cognitive changes, mood disorder in the form of
anxiety and depression, fatigue, speech and sensory changes and sleep disorder (Diagnosis,
2015). These symptoms can also help the physicians in ascertaining that whether the patient is
suffering from Parkinson’s disease or not. Assessing the symptoms along with clinical
examination can help in diagnosing the disease.
It is sometimes hard for the professional to diagnose Parkinson’s, especially when the
early symptoms are not related to its primary symptoms, such as, tremors, one side swing of
hands and legs, slowness, etc. Since, there is no specific tests that are related to Parkinson’s
disease, it is generally diagnosed at its third or fourth stage. The disease may show its symptoms
in years or months in vague manner due to which it is generally misinterpreted by the health care
professionals. It can be stated that it can only be diagnosed by the patient itself in its initial stage
and if it went unnoticed then the period of overall treatment goes on long as it directly reaches to
an irrecoverable state.
Computed Tomography scans usually appears to be normal in case of Parkinson’s
disease. MRI, in such cases is able to make rather more accurate diagnosis of the disease
overtime (Odekerken and et.al., 2013). Hence, in such cases of doubt, MRI and CT scan both are
generally performed by the health care professional on Parkinson’s disease. It can be stated that
it is important to rule out the disease in specific duration so that treatment for the same can be
started at initial phase only.
Treatment
Parkinson’s disease cannot be treated or cured, yet certain medications can be given to
the patient that can help in controlling symptoms of the disease. In later stages of Parkinson’s
disease, health care professionals generally advice for surgery. Doctors also recommend lifestyle
3

change where aerobic exercise is generally advised. In extreme cases, physical therapy which
focus upon balance and stretching also becomes important for the patient. It can also be asked to
hire a speech-language pathologist that can help in improving speech issues of the patient as well
(Postuma and et.al., 2015).
Medication can help the patient with walking, tremors and movement issues. It increases
the substitute of dopamine which is a specific signalling chemical of neurotransmitter in the
brain. Since, people with Parkinson’s disease tend to face issues due to low dopamine
concentration in the body. A significant improvement can be felt in the symptoms after taking
treatment fort Parkinson’s disease. However, benefits of the drugs tend to decrease and become
less consistent. Certain medications that are generally prescribed to the Parkinson’s disease
patients are: Carbidopa -levodopa: Levodopa is considered to be the most effective drug for Parkinson’s
patients. It is a natural chemical that can be passed into the patient’s brain and the same is
converted into dopamine. Some side effects of this medicine include, light headedness or
nausea. Dopamine agonists: This medication does not convert into dopamine for the brain. Rather it
mimics its effects in the patient’s brain. The impact of this drug generally lasts for longer
duration. However, its side effects generally quite similar to that of Carbidopa -levodopa
(Kordower and et.al., 2013). Amantadine: Doctors generally prescribe this medicine in the early stage of Parkinson’s so
as to provide short term relief from the symptoms to patient. It is also given at the last stage
of Parkinson’s with the aim to control involuntary movements. Common side effects of this
medication are, ankle swelling, hallucinations or purple mottling of skin.
There are certain surgical procedures as well which are advised to the patients at the last
stage of Parkinson’s and there is no other option as the body become resistant to medications at
this stage. One kind of surgery is Deep Brain Stimulation, in which surgeons tend to implant
electrodes into specific parts of the brain whose generator is implanted in chest of the patient
near collarbone which is responsible for sending electric pulses to the brain and can help in
reducing the symptoms of Parkinson’s disease. This procedure is generally offered to the people
who have been facing advanced level Parkinson’s disease. It helps in reducing halt or
involuntary movement, tremors and rigidity.
4

Certain lifestyle changes are also initiated by the doctors, such as increase in intake of
food with high fibre content, drinking adequate fluids. Moreover, a balanced diet with Omega 3
fatty acids can be quite helpful for the patients with Parkinson’s disease.
CONCLUSION
From the above report, it can be concluded that Parkinson’s disease is incurable, yet
appropriate medications and surgery can help in reducing the impact of its symptoms in daily life
style. Further, the common symptoms that are related to it are tremors, involuntary movements,
etc. At the later stage of Parkinson’s, caregiver is required to be present with the patient so as to
avoid any kind of fall and to help in day to day activities. The report outlines that, Parkinson’s
generally occurs due to combination of both environmental and genetic factors that further
reduce the presence of dopamine in mid brain which creates these types of changes in a patient’s
body. Hence, it can be stated that certain medicines and surgical procedures can help in
controlling the symptoms of this disease.
5

REFERENCES
Books and Journals
Allen, N. E., Schwarzel, A. K. and Canning, C. G., 2013. Recurrent falls in Parkinson’s disease:
a systematic review. Parkinson’s disease, 2013.
Bonnet, A. M. and et.al., 2012. Nonmotor symptoms in Parkinson’s disease in 2012: relevant
clinical aspects. Parkinson’s disease, 2012.
Kelly, V. E., Eusterbrock, A. J. and Shumway-Cook, A., 2012. A review of dual-task walking
deficits in people with Parkinson's disease: motor and cognitive contributions,
mechanisms, and clinical implications. Parkinson’s Disease, 2012.
King, L. A. and et.al., 2012. Comparing the Mini-BESTest with the Berg Balance Scale to
evaluate balance disorders in Parkinson's disease. Parkinson’s Disease, 2012.
Kordower, J. H. and et.al., 2013. Disease duration and the integrity of the nigrostriatal system in
Parkinson’s disease. Brain. 136(8). pp.2419-2431.
Litvan, I. and et.al., 2012. Diagnostic criteria for mild cognitive impairment in Parkinson's
disease: Movement Disorder Society Task Force guidelines. Movement disorders. 27(3).
pp.349-356.
Odekerken, V. J. and et.al., 2013. Subthalamic nucleus versus globus pallidus bilateral deep
brain stimulation for advanced Parkinson's disease (NSTAPS study): a randomised
controlled trial. The Lancet Neurology. 12(1). pp.37-44.
Plotnik, M., Giladi, N. and Hausdorff, J. M., 2012. Is freezing of gait in Parkinson's disease a
result of multiple gait impairments? Implications for treatment. Parkinson’s
disease, 2012.
Postuma, R. B. and et.al., 2015. MDS clinical diagnostic criteria for Parkinson's
disease. Movement Disorders. 30(12). pp.1591-1601.
Pringsheim, T. and et.al., 2014. The prevalence of Parkinson's disease: A systematic review and
meta‐analysis. Movement disorders. 29(13). pp.1583-1590.
Online
Diagnosis. 2015. [Online]. Available through: <https://www.mayoclinic.org/diseases-
conditions/parkinsons-disease/diagnosis-treatment/drc-20376062>.
6