Parkinson’s: Eye For Non-Visible Symptoms

Facts And Parkinson disease with tremor and the elderly, however, there is a high percentage of patients who do not present this symptom and a not inconsiderable number of people under 50 who suffer from this pathology.

Facts And Parkinson Eye For Non-Visible Symptoms
Facts And Parkinson Eye For Non-Visible Symptoms

In fact, according to data from the Spanish Neurology Society (SEN), approximately 30-40% of patients do not have tremor. On the contrary, in 40% of cases, the first manifestation of this pathology is depression, although the disease can also manifest itself in cognitive, gastrointestinal, autonomic, sensory or sleep disorders. In addition, up to 15% of cases the disease begins before the age of 45.

One of the most relevant changes that Parkinson’s has undergone in recent years “is the knowledge that the pathological changes characteristic of pathology begin in the brain many years before the appearance of the first typical motor symptoms of the disease,” he explains. a CuídatePlus, Gurutz Linazasoro, neurologist and director of the Parkinson’s and Alzheimer’s Advanced Therapies Program at Quirón Salud-Guipúzcoa Polyclinic.

This premotor phase, details the neurologist, is characterized by a series of symptoms, among which are “decreased smell, conduct disorder in REM phase (development of violent behaviors during deep sleep), constipation or depression” .

They are what are called invisible symptoms of the disease and that “it is very important to detect and treat them because they are the ones that most alter the quality of life of patients,” as Leopoldo Cabrera, president of the Spanish Parkinson’s Federation, mentions. “These symptoms such as decreased tone of voice, sleep disorders or altered writing are invisible signs that should be known”, also, for the early detection of the disease.

This fact, according to Linazasoro, “opens a window of opportunity for a diagnosis and very early therapeutic action.” And it is that, although it is estimated that 2% of those over 60 suffer from Parkinson’s disease, that is, around 160,000 people affected in Spain, the reality is that this percentage would be much higher, since still today there are many patients who are undiagnosed. According to SEN data, Parkinson’s patients take an average of 1 to 3 years to obtain a correct diagnosis. So the SEN estimates that more than 50% of the new cases that occur each year – around 10,000 new cases – are currently undiagnosed.

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For this to be a reality, the concept of “Parkinson’s disease” must be clarified and “biomarkers of total or very high predictive capacity must be identified because the symptoms of the premotor phase do not appear in all cases of the disease, nor in all the people who present those symptoms end up developing Parkinson’s disease in the future ”. Furthermore, “these biomarkers do not yet exist, although it is a priority line of research.”

In other words, “telling a person who has lost their sense of smell that they will end up suffering from Parkinson‘s is reckless, since the risk of error is very high,” warns the expert, and the question of when they are going to start motor symptoms “since it is not the same to start with 65 years as with 86 years. For this reason, today, it is only possible to diagnose a person with Parkinson’s disease when they have different combinations of tremor, rigidity, slow movement and postural instability.

Like other neurodegenerative diseases, the incidence of Parkinson’s increases with age, but age is not the cause of its appearance. In fact, as mentioned before, “up to 15% of cases start before the age of 45”, as Linazasoro recalls. It is, therefore, a pathology with many subtypes, therefore, today, it is not possible to establish a specific patient profile, with the same and determined characteristics.

Thus, he describes, “while in some cases tremor dominates, in others, slowness or instability with falls stand out.” While in some cases “the disease begins at an early age, less than 30, in other patients it appears when they are elderly.” In addition, “a percentage will develop non-motor symptoms, another, cognitive deterioration and others will maintain a splendid memory throughout the process.”

But this is not the only characteristic of the disease, but there are also differences in terms of treatment and its progression. As the expert explains, “although most patients respond very well to medications, there is a percentage of them who develop problems early.” Furthermore, “in some cases the situation is reasonably good after 20 years of evolution and, in others, the progression is rapid”.

All these subtypes and situations show that there is no type patient profile, nor are the causes for which the disease develops, although genetics are known to play an important role in many of the cases. Thus, for example, “In 15% of cases there is a family history and around twenty genes related to family forms of the disease have been identified,” in addition, “many genetically based cases tend to appear at younger ages (between 25 and 45 years). and mutations are known that increase the risk of suffering it at later ages ”.

However, there are also other factors that can influence, such as “the environment, the environment, exposure to pesticides, or even the profession,” he explains, which is that, “it tends to appear more frequently in white-collar professionals, that is, , in those who carry out administrative tasks in an office ”.

Given this diversity of patients, causes and progression of the disease, what options for pharmacological treatments are there? As Linazasoro recalls, “60 years after its introduction on the market, levodopa continues to be the most powerful and effective antiparkinson drug”, although it is not the only option, since, as the expert points out, “this medicine can be complement with other drugs that have emerged in recent years, such as rasagiline, opicapone or dopaminergic agonists.With these drugs it is not possible to cure the disease, but it does “make it possible for people with Parkinson’s to live many years with a very acceptable quality of life.”

But just as important as pharmacological treatments are the other therapies that must be applied to these patients (physiotherapy, speech therapy or psychotherapy). These treatments, “misnamed complementary, are essential for the comprehensive approach to the disease,” stresses the expert. Do patients respond equally? As each affected person presents certain symptoms and a specific progression, the response to the medication is also variable, as well as the day to day of the patients.

According to Cabrera, “the daily life of people with Parkinson’s is very irregular and depends a lot on the level of development or the years they have been living with the disease.” Broadly speaking, “it is characterized by on-off periods, that is, the times when we are active and with fewer symptoms due to the effect of the medication and the times when the effects decrease and the symptoms reappear” .

This means that “there are times of the day when we find it really difficult to carry out some routine tasks, such as brushing our teeth, cooking or dressing.” These off moments “also affect all areas of our lives, since they create obstacles in communication with our environment.” Hence the importance of taking the medication daily and of personalizing the doses and guidelines in each patient.

And it is along this line that progress is being made. As the neurologist explains, “Another great conceptual change that has occurred in recent years is that thanks to advances in omic technologies, we live in the era of 5P medicine: Predictive, Preventive, Personalized, Accurate, and Participatory.”

For this reason, the main current therapeutic objectives in Parkinson’s disease are “to identify the preclinical phase with a high degree of certainty to propose therapies directed at the biology of the degenerative process (neuroprotection) and to personalize pharmacological therapies and to be precise in surgical ones. (functional and regenerative) to gain efficacy and safety ”.

In a few years, the expert confides, “a genomic analysis will be carried out that will guide the choice of the most convenient drug for each affected person.” Meanwhile, “we will continue to elaborate the therapeutic plan based on other parameters, such as the age of onset, the quality and intensity of the symptoms and the effect on the quality of life.”

Other tips to improve the quality of life of these patients would be to “take care of the brain while maintaining physical, intellectual and social activity, follow a Mediterranean diet, avoid toxic habits, sleep a regular number of hours and control blood pressure, diabetes and cholesterol ”, he concludes.

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