What are the 5 stages of Parkinson disease?

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The disease was first described by British physician James Parkinson in 1817 and Dr. Parkinson's disease has been described as "shaking palsy".

What are the 5 stages of Parkinson disease?

What you might be wondering about is Parkinson's disease, which occurs in old age and develops with slowness in movements, tremors in the hands and more rarely in the feet at rest, stiffness in the muscles, and dosing of balance...

What is Parkinsonism?

The word Parkinsonism connotes a condition that is recognized by a set of symptoms that occur due to various causes, rather than a specific disease. The most important of these symptoms are trembling of the limbs, stiffness of the muscles, and slowness of body movements. Other symptoms that can be added to this triad include forward-leaning posture, shuffling walking with small strides, and speaking softly, quickly, and in the same tone. Parkinson's disease has a special place among the various pictures of parkinsonism with its unique symptoms and changes in the brain and will be discussed in detail in the future.

The tremor in Parkinsonism can affect especially the hands and feet, sometimes the lips, tongue, chin, and rarely the trunk. The tremor that occurs when the hand or foot is at rest disappears during a movement. For example, the tremor in the hand disappears during the movement of reaching and holding an object, and it reappears when it comes to rest. The medical term for tremor is "tremor". The feature that occurs at rest helps to distinguish it from various tremors that can be seen in other diseases.

In Parkinsonism, there is rigidity in the muscles that do not change even at rest. When the doctor examining the patient moves the limbs passively, he encounters a constant and unchanging resistance. However, although the affected muscles do not seem to be able to relax, this is stiffness that can be put into the desired shape. This state of stiffness in the muscles is called “rigidity”.The third symptom is slowing of body movements and is called “bradykinesia” (“Brady” means “slow” in Greek, “kinesis” means movement). Hesitation when starting a new movement is a complex phenomenon that is shaped by slowness and rapid fatigue in doing that action. Bradykinesia also includes the inability to perform automatic movements that we unconsciously make, such as blinking eyes, waving arms when walking, descriptive hand or body movements when speaking, or facial expressions. All these movements are slowed down in patients.

Cause of Parkinsonism

Complex symptoms gathered under the name of Parkinsonism are due to the inability of a nucleus of special nerve cells called "substantia nigra" in the brain to function well. It is known that this nucleus, which means "dark matter" in Latin, is deeply dark in color, which can be immediately noticed with the naked eye in autopsy examination. When viewed under a microscope, intense dye (pigment) particles are seen in the nerve cells in this nucleus.

Nerve cells of the substantia nigra make and store a chemical substance called "dopamine". These cells are connected with the nerve cells of a structure called the “corpus striatum” (striated body), which consists of a small gray matter located deep in the brain and adjacent to it. Dopamine produced by the substantia nigra cells is transported to the corpus striatum by nerve fibers and acts as a chemical transmitter between the cells there. If the substantia nigra cells are damaged, they cannot make and store dopamine, and dopamine is depleted in the striatum. When this deficiency is severe, symptoms of parkinsonism begin to appear.

Causes of dopamine deficiency in the brain:

1- Nerve cells of the substantia nigra can be destroyed for various reasons: The most common example of this situation is Parkinson's disease. Other causes include vascular diseases and tumors of the aforementioned part of the brain, the destructive effect of some chemicals, encephalitis (brain tissue inflammation).

2- Some drugs inhibit the natural action of dopamine in the striatum so that dopamine cannot transmit its chemical message and a result appears as if there is a dopamine deficiency. Some drugs (major tranquilizers) used in psychiatric patients, blood pressure-lowering drugs containing reserpine, and many drugs used against vomiting can cause parkinsonism, but this situation improves with the discontinuation of the responsible drug.

3- In cases where the nerve cells in the striatum are damaged as well as the substantia nigra cells, a similarity to the picture occurs in dopamine deficiency. In these diseases, known as "multisystem degenerations", there are neurological symptoms that affect other parts of the brain besides parkinsonism. It is known that a small part of these diseases is inherited.

Without going into further detail, it can be seen that there are many possible causes of parkinsonism, the most common of which is Parkinson's disease.

Early Signs of Parkinson's Disease

Symptoms of Parkinson's disease usually begin very insidiously and slowly, such that patients often cannot tell the exact onset date of the disease. By the time patients become aware of the first symptom, some symptoms of the disease may have started a long time ago. It can be noticed that a patient who presents with a complaint of tremor in one hand does not swing an arm while walking in video films shot 5-6 years ago, or sometimes the forward-leaning posture feature can be noticed in old photographs of the patient. Tremor is often the first symptom in the vast majority of Parkinson's patients, and some patients are brought to the physician when tremors occur, as in the example. Even though some disease symptoms such as these persist for a long time, we witness late referral to the physician due to lack of knowledge about Parkinson's disease.

Key Symptoms of Parkinson's Disease

Tremor

Tremor, which is the most obvious of the three basic symptoms of Parkinson's disease, which is shaped by tremor, muscle stiffness, and lack of movement, is usually the most common reason for the patient to consult a doctor. Tremors occur in approximately 80% of Parkinson's patients. The tremor often occurs in the hand on one side and sometimes in one foot. The tremor may be limited to the tremor of a single finger, and may sometimes affect the tongue, lips, and chin, but does not cause head or voice tremor