Parkinson's disease (PD) is a neurodegenerative disease affecting about one percent of individuals above the age of sixty-five years (Rizek, Kumar and Jog, 2016) . The disease is associated with marked debilitation and function loss, especially at advanced stages. An in-depth understanding of its manifestations, prognosis, and pathophysiology is thus critical as it would result in the improved care of affected individuals.
Parkinson’s disease is typified by three key manifestations including bradykinesia, rest tremors, and rigidity (Caggiu et al., 2019) . However, with time, postural instability ensues. Patients may also present festinating gait, dysphagia, flexed posture, dysarthria, hypomimia, and autonomic dysfunctions. Accordingly, they may have urinary incontinence, constipation, sialorrhea, and diaphoresis. Patients may also be apathetic and markedly anxious. Sleep disturbances, depression, dementia, and bradyphrenia may also manifest. Symptoms are typically debilitating and people with PD commonly depend on the assistance of caregivers.
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Prognosis
PD itself is fatal and the average life expectancy of affected persons is almost similar to that of their unaffected counterparts. However, years after diagnosis, Brugger et al. (2015) report that the symptoms of the patient may become significantly worse especially secondary to a systemic infection. In serious cases, akinetic crisis may develop. Comorbid infections in patients with PD may result in cognitive deterioration and psychosis which may affect patient’s adherence to medication. Secondary complications like choking, falls and related injuries, and pneumonia could, however, lead to death.
Pathophysiology
There two forms of PD – primary and secondary Parkinsonism. Though idiopathic, it is hypothesized that primary PD stems from a complex interaction between age, genetics, and environmental factors. Pathological findings in PD are typically point to the degeneration of dopaminergic neurons in the nigrostriatal pathway. Another hallmark feature in primary PD is the presence of Lewy bodies in the neurons that survive depigmentation. The extent of dopaminergic neuron loss in the nigrostriatal pathway reportedly corresponds with the severity of PD manifestations. Secondary PD, on the other hand, occurs following exposure to drugs, infections, and other factors.
References
Brugger, F., Erro, R., Balint, B., Kägi, G., Barone, P., & Bhatia, K. P. (2015). Why is there motor deterioration in Parkinson’s disease during systemic infections-a hypothetical view. Npj Parkinson’s Disease , 1 (1). https://doi.org/10.1038/npjparkd.2015.14
Caggiu, E., Arru, G., Hosseini, S., Niegowska, M., Sechi, G., Zarbo, I. R., & Sechi, L. A. (2019). Inflammation, Infectious Triggers, and Parkinson’s Disease. Frontiers in Neurology , 10 . https://doi.org/10.3389/fneur.2019.00122
Rizek, P., Kumar, N., & Jog, M. S. (2016). An update on the diagnosis and treatment of Parkinson disease. Canadian Medical Association Journal , 188 (16), 1157–1165. https://doi.org/10.1503/cmaj.151179
