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Monday 22 July 2019

Parkinson's Disease

                            Parkinson's Disease 

      Parkinson's Disease is a progressive nervous system disorder that affective movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement. 

      In the early stages of Parkinson's disease, your face may show little or no expression. Your arms may not swing when you walk. your speech may become soft or slurred, medications might significantly improve your symptoms, occasionally your doctor may suggest surgery to regular certain regions of your brain and improve your symptoms.

  Parkinson's disease signs and symptoms can be different for everyone. Early signs may be mild and go unnoticed. Symptoms often begin on one side of your body and usually remain worse on that side, even after symptoms begin to affect both sides. 
Signs and symptoms:
 Tremor:
  
   A tremor, or shaking, usually begins in a limb, often your hand or fingers. You may a rub your thumb and forefinger back- and - forth, known as a pill-rolling tremor. 
 . Your hand may tremor when it's at rest.
 Slowed movement (bradykinesia):

   Over time, Parkinson's disease may slow your movement, making simple tasks difficult and time- consuming. Your steps may become shorter when you walk. It may be difficult to get out of a chair. You may drag your feet as you try to walk. 

 Rigid muscles

   Muscle stiffness may occur in any part of your body. The stiff muscles can be painful and limit your range of motion. 

Tremor:

 A tremor, or shaking, usually in a limb, often your hand or fingers. You may a rub your thumb and forefinger back and forth, known as a pill-rolling tremor. Your hand may tremor when it's at rest. 

Impaired posture and balance:

 Your posture may become stooped, or you may have balance problems as a result of Parkinson's disease. 

 Loss of automatic movements:

  You may have a decreased ability to perform unconscious movements, including blinking, smiling or swinging your arms when you walk. 

Speech changes

 you may speak softly, quickly, slur or hesitate before talking. Your speech may be more of a monotone rather than with the usual inflections. 

Writing changes:

 It may become hard to write, and your writing may appear small. 

Causes:

 In Parkinson's disease, certain nerve cells in the brain gradually break down or die. Many of the symptoms are due to a loss of neurons that produce a chemical messenger in your brain called dopamine. When dopamine levels decrease, it causes abnormal brain activity, leading to symptoms of Parkinson's disease. 

The cause of Parkinson's disease is unknown, but several factors appear to play a role, including:

Your Genes:

  Researchers have identified specific genetic mutations that can cause Parkinson's disease. But there are uncommon except in rare cases with many family members affected by Parkinson's disease. However, certain variations appear to increases the risk of Parkinson's disease but with a relatively small risk of Parkinson's for each of these genetic markers. 

Environmental triggers:
  
  Exposure to certain toxins or environmental factors may increase the risk of later Parkinson's disease, but the risk is relatively small. 

  Clumps of specific substances within the brain of people with Parkinson's disease. although it's not clear why these changes occur.

 These changes include

The presence of Lewy bodies:

 Clumps of specific substances within brain cells are microscopic markers of Parkinson's disease. These are called Lewy bodies, and researchers believe these Lewy bodies hold an important clue to the cause of Parkinson's disease. 

Alpha-synuclein is found within Lewy bodies

    Although many substances are found within Lewy bodies, scientists believe an important one is a natural and widespread protein called alpha-synuclein (a-synuclein). Its' found in all Lewy bodies in a clumped form that cells can't break down. This is currently an important focus on Parkinson's disease researchers.  

Risk Factors

 Risk factors for Parkinson's disease include:

 Age: Young adults rarely experience Parkinson's disease. It Ordinarily begins in middle or late life, and the risk increases with age. People usually develop the disease around age 60 or older. 

Heredity: Having a close relative with Parkinson's disease increases the chances that you will develop the disease. However, your risks are still small you many relatives in your family with Parkinson's disease. 

Sex: Men are more likely to develop Parkinson's disease than are women. 

Exposure to toxins: Ongoing exposure to herbicides and pesticides may slightly increase your risk of Parkinson's disease. 

Pathophysiology:

 The main pathological characteristics of PD are cell death in the brain's ganglia and the presence of Lewy bodies in many of the remaining neurons. This loss of neurons is accompanied by the death of astrocytes and a significant increase in the number of microglia in the substantia nigra. 

 There are five major pathways in the brain connecting other brain areas with the basal ganglia. These are known as the motor, oculomotor, associative, limbic and orbitofrontal circuits, with names indicating the main projection area of each circuit. All of them are affected in PD, and their disruption many of the symptoms of the disease, since this circuit has been examined the most intensively. 

Complications

Parkinson's disease is often accompanied by these additional problems, which may be treatable:

Thinking difficulties

 You may experience cognitive problems and thinking difficulties. These usually occur in the later stages of Parkinson's disease. Such cognitive problems aren't very responsive to medications. 

Depression and emotional changes:

 You may experience depression, sometimes in the very early stages. Receiving treatment for depression can make it easier to handle the other challenges of Parkinson's disease. 
You may also experience other emotional changes, such as fear, anxiety or loss of motivation. Doctors may give you medications to treat these symptoms. 

Swallowing problems:

  You may develop difficulties with swallowing as your condition progresses. Saliva may accumulate in your mouth due to slowed swallowing, leading to drooling. 

Chewing and eating problems. Late-stage Parkinson's disease affects the muscles in your mouth, making chewing difficult. This can lead to choking and poor nutrition. 

Sleep problems and sleep disorders

 People with Parkinson's disease often have sleep problems, including waking up frequently throughout the night, waking up early or falling asleep during the day. People may also experience rapid eye movement sleep behavior disorder, which involves acting out your dreams. 

Bladder problems. Parkinson's disease may cause bladder problems, including being unable to control urine or having difficulty urinating. 

Constipation. Many people with Parkinson's disease develop constipation, mainly due to a slower digestive tract. 

Also experience:

 Blood pressure changes: You may feel dizzy or lightheaded when you stand due to a sudden drop in blood pressure.

Smell dysfunction: You may experience problems with your smell. You may have difficulty identifying certain odors or the difference between odors. 

Sexual dysfunction: Some people with Parkinson's disease notice a decrease in sexual desire or performance. 

Fatigue: Many people with Parkinson's disease lose energy and experience fatigue, especially later in the day. The cause isn't always known. 

Pain: Some people with Parkinson's disease experience pain, either in specific areas of their bodies or throughout their bodies. 

Differential Diagnosis:

 . Arthritis
 . Corticobasal syndrome
 . Dementia with Lewy bodies
 . Depression
 . Drug-induced Parkinson's 
 . Huntingtons disease 
 . Idiopathic basal ganglia calcification
 . Fragile X-associated tremor 
 . Multiple system atrophy 
 . Normal-pressure hydrocephalus
 . Obseesional slowness 
 . Toxins
 . Wilson's disease

Prevention :

 Exercise in middle age may reduce the risk of Parkinson's disease later in life. Caffeine also appears protective with a greater decrease in risk occurring with a larger intake of caffeinated beverages such as coffee. People who smoke cigarettes or use smokeless tobacco are less likely than non- smokers to develop PD, and the more they have used tobacco, the less likely they are to develop PD. It is not known to underlie this effect. Tobacco use may actually protect against PD, or it may be that an unknown factor both increases the risk of PD and causes an aversion to tobacco or makes it easier to quit using tobacco. 

 People who smoke cigarettes or use smokeless tobacco are less likely than non-smokers to develop PD, and the more they have used tobacco, the less likely they are to develop PD. It is not known what underlies this effect. Tobacco use may actually protect against PD, or it may be that an unknown factor both increases the risk of PD and causes an aversion to tobacco or makes it easier to quit using tobacco.[82]



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