"First Part - other Symptoms of Parkinson's Disease
- Gait disorders and alteration of postural reflexes : it is certainly evident that in an individual with Parkinson's disease there is some difficulty in starting the movement.
- Pain : it is one of the symptoms of the onset of the disease and often appears one or more years before other symptoms.
- Speech disorders : it is shown that the individual with Parkinson's speaks in a rather monotonous manner. This is due to a loss of pitch and modulation of the voice; moreover there is a tendency to accelerate the emission of sounds, eating the words. This leads to a kind of stuttering, which however can be cured through appropriate language rehabilitation exercises.
- Among the Parkinson's patients, an important note also belongs to the so-called psychic symptoms that can occur. Among the most common symptoms, depression occurs in 25-40% of Parkinson's disease cases. Generally, depression precedes motor symptoms or occurs within a year of disease onset. The extent of this form of depression is mild to medium and only in rare cases there are suicidal episodes. Two theories have been hypothesized to attempt to explain why depression appears in patients with Parkinson's disease. In the first theory, depression is considered as "reactive", due to progressive functional disability, while in the second theory depression is considered as an integral part of the pathology, understood as a primary alteration of the amines present in the brain. In recent years, in the field of pharmacological research, attempts have been made to identify new drugs with characteristics such as to modulate the neurotransmitter systems in order to cover a control function, such as the serotonergic system. In fact, selective serotonin reuptake inhibitors (SSRIs) are known to have been particularly useful, so much so that they can be associated with antiparkinson therapy.
Alongside depression, another symptom affecting Parkinson's disease is dementia, which affects 8-10% of patients. It is not yet known, however, whether this type of dementia, which is classified as primary degenerative dementia, is an integral part of the pathology. For example, some investigations have shown that individuals suffering from Parkinson's disease have coexistent Alzheimer's disease, since plaques with signs of neurofibrillary degeneration and atrophy of neurons and cortical neurons have been recognized in the brains of these individuals.
Finally, another psychic symptom that accompanies the Parkinson's patient may be bradyphrenia, that is: slowness in thought processing, inattention and poor concentration. Because of its characteristics, this symptom hardly differs from dementia, even if memory and cognitive abilities remain unaltered, unlike what happens, instead, to individuals suffering from dementia. Some studies have hypothesized that at the base of bradyphrenia could be the degeneration of the locus coeruleus, given that the cerulosa-cortical pathways are involved in maintaining attention and vigilance.
- In addition to the psychic symptoms described above, Parkinson's disease, being a chronic and progressive disease, therefore susceptible to wide variability, can also be characterized by symptoms in the gastro-intestinal, cardiovascular and genitourinary system, which in the together they are grouped under the term autonomic dysfunction . If systemic symptoms occur, they do not have the same characteristics in all subjects and above all do not necessarily induce disability in the individual, especially if the individual is well cared for and controlled.
Speaking of the gastro-intestinal system, in the more advanced phases of Parkinson's disease, due to a dysfunction of the control of the muscles of the tongue, pharynx and esophagus, the act of swallowing may be compromised . Swallowing is a complex automatic movement, where the muscles of the mouth and tongue must move in a coordinated manner between themselves to push food from the oral buccal cavity to the esophagus. If this mechanism is altered, the individual has difficulty swallowing solid foods, but also drugs in tablets, as a result gastroesophageal reflux appears as a disorder. For this reason, liquid formulations of levodopa have been studied, which prove to be useful even in the case of slowing down of motility or gastric emptying (which would cause delayed or even zero absorption at the duodenal level of the drug itself). A disorder related to the reduction of the act of swallowing is also sialorrhea, an excessive accumulation of saliva in the oral cavity due to the fact that the subject suffering from Parkinson's disease cannot swallow it.
Another highly debilitating disorder, which often occurs in individuals with Parkinson's disease, is constipation, caused by decreased intestinal motility, but also by the fact that there is difficulty in coordinating the complex motor act of defecation, which comes from from the synergistic action between the pelvic and abdominal diaphragmatic muscles.
For this reason the individual will suffer from an expulsive problem linked to the lack of coordination of these muscles and to the absence of relaxation of the pelvic muscles. The problem can be alleviated through proper nutrition standards, preferable to the use of laxatives. The gastrointestinal symptoms described, together with an excessive movement caused by dyskinesias, can lead to a weight reduction, sometimes even significant.
- Furthermore, an individual suffering from Parkinson's disease also has a more compromised genitourinary system ; the symptoms of this alteration manifest themselves urgently with urination, caused by the difficulty in coordinating the relaxation of the perineal plane and the contraction of the bladder muscles. As a result, the frequency of urination increases because the bladder never empties completely or because the urge to urinate is felt even when the bladder is not yet full. Another symptom that manifests itself, however rarely, is urinary retention, which occurs when the perineal plane is loosened.
- When Parkinson's disease is at an overt stage, individuals with the disease can develop - at the cardiovascular system level, particularly in the post-prandial period - orthostatic hypotension (which consists of a marked reduction in arterial pressure during changes of position ). This symptom is particularly unpleasant both for the affected individual and for the relatives, who see the patient suddenly collapse unconscious on the ground. A remedy for this symptom of parkinson's disease may be to consume small but frequent meals, drink coffee and take a short break after lunch. Instead, alcohol intake should be avoided.
