Parkinson's Disease: Impact, Treatment, and Social Challenges - Family Medicine

Dr. Liu Jinyong reply Family Medicine

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Parkinson's disease is a common neurodegenerative disorder that typically occurs in middle-aged and older adults, with the average onset age being between 50 and 79 years.
The main clinical symptoms of this disease include bradykinesia, tremors in the hands, feet, or other parts of the body, and loss of flexibility.
Patients often report feelings of stiffness and heaviness in their limbs, as well as pain and weakness, particularly in the lower limbs, leading to mobility issues and an unsteady gait.
The earliest systematic description of this disease was made by British physician James Parkinson, who initially referred to it as "shaking palsy" in 1817.
He defined the condition as "involuntary tremors accompanied by muscle weakness, typically occurring at rest or even when the body is supported; a tendency to lean forward while walking, transitioning from walking to running; with no impairment of sensation or intellect."
Subsequent observations revealed that, in addition to tremors, patients often exhibit a mask-like facial expression, reduced blinking, and overall slowed movements, with prolonged times for activities such as bathing and eating.
Walking speed is often slow, with the body frequently leaning forward, sometimes resulting in shuffling steps and a tendency to rush forward.
Arm swing during walking is reduced, and patients commonly report unsteadiness and a propensity to fall.
Tremors primarily affect the hands and feet and are generally more pronounced at rest, although some individuals may experience intensified tremors during specific activities, such as drinking or using chopsticks.
Other symptoms may include muscle rigidity, micrographia (small handwriting), oily skin, and autonomic dysfunction, but limb muscle strength remains intact.
Therefore, the term "shaking palsy" is considered inappropriate, and the condition is now referred to as "Parkinson's disease."
Parkinson's disease results from degeneration of a group of neurons in a part of the brain called the substantia nigra, which produce a neurotransmitter known as dopamine.
These neurons project to other areas of the brain, such as the striatum, to regulate motor functions.
When more than 80% of these dopaminergic neurons degenerate and die, dopamine levels in the brain decrease to a point where normal regulatory functions of the nervous system cannot be maintained, leading to the symptoms of Parkinson's disease.
The exact cause of this disease remains unclear.
Current research suggests that it may be related to a combination of factors, including aging, genetic susceptibility, and exposure to environmental toxins, with no single factor fully explaining the etiology of Parkinson's disease.
Most researchers believe that the disease results from the interplay of these factors, particularly in individuals who are susceptible to environmental influences after middle age, which may damage brain neurons and impair detoxification functions.
As age increases, the progressive death and degeneration of dopaminergic neurons worsen, ultimately leading to the clinical symptoms of Parkinson's disease.
Epidemiological studies indicate that approximately 1% of the elderly population under 55 years of age is affected by this disease, with incidence rates in developed Western countries being similar to those in Taiwan.
Due to improvements in public health and an aging population, the number of individuals with Parkinson's disease is gradually increasing.
Most cases are sporadic, with only a few being familial.
Currently, there is no treatment that can halt or reverse the neurodegeneration believed to underlie this disease, but existing therapies can significantly alleviate symptoms for many patients.
The key to any treatment approach is to maintain appropriate health status and neuromuscular coordination through planned exercise, activity, and rest; specialized physical therapy can be very beneficial in achieving these goals.
Additionally, patients often require emotional support to cope with the stress of the disease and to understand its nature.
Pharmacological treatment should be tailored to the patient's needs, which may vary depending on the stage of the disease and the primary symptoms.
The decision to use medication and the choice of drugs are influenced by the disease stage.
The commonly used classification system in clinical practice is the Hoehn and Yahr scale, published in 1967 by Margaret Hoehn and Melvin Yahr, which distinguishes the severity of the disease.
The Hoehn and Yahr scale consists of five stages, defined as follows: Stage 1: Unilateral involvement with minimal or no functional impairment.
Stage 2: Bilateral or midline involvement without balance impairment; patients can live independently.
Stage 3: The first symptom is postural instability, with significant unsteadiness when turning or when pushed while standing with feet together; patients are slightly affected in their activities but can live independently.
Stage 4: Severe disability but patients can still walk and stand unassisted.
Stage 5: Patients are bedridden or in a wheelchair unless assisted.
Although there is currently no cure for Parkinson's disease, appropriate pharmacological treatment can control the condition, and life expectancy is not significantly reduced.
From a neuroanatomical perspective, the primary pathway of dopaminergic deficiency in Parkinson's disease includes connections from the substantia nigra to the striatum, through the globus pallidus to the thalamus and cortical layers, involving pathways related to cognitive function.
Parkinson's disease is the third most common neurological disorder in the elderly.
Nuclear medicine studies have shown that a reduction in striatal dopamine levels leads to tremor symptoms, with the gradual decrease of dopamine content in brain neurons until a deficiency of over 20% triggers Parkinson's disease.
Early detection of the disease can lead to earlier pharmacological intervention, which may help prevent disease progression.
Parkinson's disease is characterized by insufficient production of dopamine, a neurotransmitter in the brain, and treatment focuses on addressing this underlying cause through the administration of dopaminergic agents, dopamine agonists, and anticholinergics.
In daily life, attention should be paid to home arrangements and safety measures to prevent serious injuries from falls.
Shoes should be easy to wear, avoiding those with laces, and using an electric razor is advisable for shaving.
Warm baths and massages can provide slight relief for muscle stiffness.
Surgical treatments, such as deep brain stimulation, can be effective for tremors, while tissue transplantation involves legal issues and its efficacy is not universally accepted.
The presence of Parkinson's disease in family members or friends can significantly impact individuals, families, and society.
Patients must confront physiological changes, altered appearance, functional decline, the long-term burden of treatment, and complex psychological challenges such as feelings of inferiority, sadness, frustration, and anger.
Additionally, this condition can lead to reduced social interactions, a shrinking social circle, and occupational limitations.

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Reply Date: 2002/05/01