Family members are often the first to notice that something is wrong: the symptoms that appear at the onset of Parkinson’s disease are in many cases silent, inconstant, variable, and do not cause particular concern. What are considered the “early signs” of this neurodegenerative pathology are in fact a combination of several factors: loss of smell, slower reaction times, excessive daytime sleepiness and high hemoglobin levels. When, on the other hand, the disease is in a more advanced stage, even those symptoms that confirm the diagnosis begin to appear: tremors become frequent, motor control tends to be lost and limb stiffness increases, significantly compromising the quality of life of the patient.
The alarm bells
For a diagnosis of the disease as early as possible, with a consequent advance in the start of the treatment of the disorder, it is therefore essential to keep the first indicators of malaise under control.
The occurrence of olfactory deficit, pain in the large joints and variations in the quality of sleep are the first alarm bells that it is important to talk to your trusted specialist: in fact, these are non-motor symptoms that allow you to identify those subjects who present a higher risk of developing the disease about 10 to 12 years earlier. In fact, starting the treatment in the pre-motor phase is an effective strategy to slow down the progression of the disease.
The diagnosis
Other symptoms that are often attributable to Parkinson’s disease are constipation, sexual dysfunction, decreased tone of voice and excessive saliva production. To these is added one of the signals traditionally associated with the disease, namely the difficulty of reasoning, understanding and planning. In most cases, Parkinson’s tends to manifest itself around the age of sixty but there are cases (about 10% of the total) in which the first signs appear already around the age of forty.
Once these revealing factors have been observed and monitored, it is advisable to carry out a specialist visit, during which the patient is listened to and subjected to an initial neurological examination. We then proceed with instrumental examinations, such as nuclear magnetic resonance and brain scintigraphy, which allows us to obtain an estimate of the quantity of dopaminergic nerve endings present.
The way in which the patient responds to the drugs administered is also very indicative: if the person, following an adequate and constant treatment over time, shows signs of improvement, it is very likely that the diagnosis of Parkinson’s is correct. As anticipated, advanced age is one of the risk factors that can be traced back to the development of the disease. Other elements that must be taken into consideration are family history, male gender, head trauma and mood disorders.
The treatment
Unfortunately, today there is no definitive cure for Parkinson’s disease: since it is a degenerative and slowly progressing pathology, those who suffer from it tend, over time, to be increasingly unstable in posture and/or gait. The course of the disease has a negative impact on the lives of patients and their caregivers: to give relief to those who suffer from it, ad hoc measures are therefore implemented to manage the symptoms and treatments are started that see the synergy of various specialists, including neurologists, experienced physiotherapists, speech therapists and nurses. Due to the different combination of symptoms, drug therapy is modified from time to time and is calibrated on the needs of each individual patient. The treatments available help to keep the symptoms under control but are not able to stop the development of the disease: to try to mitigate its impact, studies and research are currently underway aimed at improving therapies, thus improving the quality of life of patients .
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Parkinson’s, treatments and research: the new frontiers
Neurodegenerative pathology that today affects 0.3% of people in the world, involving a total of about one million subjects in Europe and 150 thousand in Italy, Parkinson’s disease is a disease that occurs when dopaminergic neurons alter a protein, alpha-synuclein, which, over time, is deposited in the form of agglomerates causing the degeneration of the cells themselves. From the moment the pathology manifests itself, it is possible to identify three phases. The first, which can last from five to ten years, is characterized by a complex of prodromal symptoms, which include depression, anxiety and alterations in the REM phase. This phase is followed by a period marked by the appearance of motor symptoms, such as stiffness in movement, hunched posture, hand tremors and slowing down when walking. Over time, the situation becomes progressively more serious, as postural instability worsens and cognitive disturbances worsen to such an extent that in some cases we speak of actual dementia.
Drugs
Numerous steps forward have been made in recent years, which have made it possible to improve both the diagnosis and treatment of the disease. Thanks also to the commitment made by bodies and associations, scientific research has achieved significant results, thus improving the quality of life of those suffering from Parkinson’s. To counteract the disease, one of the most effective strategies consists in administering levodopa, a drug that compensates for the lack of dopamine. This substance is effective in the short term, but, in the long run, it can be responsible for further motor symptoms. To reduce these negative effects, therefore, dopamine agonist drugs are taken, in combination or in place. Pharmacological therapy must be combined with an adequate motor rehabilitation program performed with the support of a specialized physiotherapist.
Brain stimulation
In some cases, when the patient suffers from cognitive deficits and psychiatric disorders, deep brain stimulation is performed.
The neurosurgical intervention, carried out after having performed a light sedation, involves the practice of small holes in the skull and the insertion of special electrodes connected to a neurostimulator capable of modulating the activity of the brain circuits involved in Parkinson’s disease.
The balance of cases treated is positive, so much so that in 60-80% of cases the patient’s clinical profile tends to improve.
Stamina cells
Great hopes are also placed in stem cells, i.e. primitive, non-specialised cells with the ability to transform into various other types of cells in the body. In the case of Parkinson’s, in particular, scientists aim to produce cells capable of replacing dopaminergic neurons. According to the latest published studies, investigations in this area have been carried out in the analysis of the disease that affects monkeys: therefore we started from stem cells programmed to create neurons capable of producing dopamine, to be implanted later in the brain.
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Open-air sports, an aid to balance
Exploiting the potential of the territory to promote functional mobility and to improve balance: the project “Sardegna open-air gym: adapted motor interventions in a natural environment in people with Parkinson’s disease” was born with this aim, launched by the Department of Sciences Biomedical Sciences of the University of Sassari.
I study
Patients, of both sexes and diagnosed with Parkinson’s disease, will be involved in the project for a period of one year. During these months they will have the opportunity to carry out various sports activities, such as trekking, surfing, kayaking and sailing, within a natural environment.
The study group is coordinated by Lucia Cugusi, professor of the degree course in Motor Sciences, sports and human well-being of the Sassari university, with the collaboration of other institutes of the same university, the Neurology of the Aou of Sassari, the Asl , the Parkinson associations of Sassari and Alghero and numerous other local partners. The results obtained from the study will be disseminated and specifically published.
This initiative is part of a broader context, which allows us to highlight the benefits of physical exercise in those suffering from the disease. Even dancing seems to have positive effects: according to a study conducted by researchers at the University of Freiburg in Germany, the improvements in stiffness, mobility of hands and fingers and facial expression are notable. Patients took part in the survey together with their relatives, who followed eight months of weekly lessons under the guidance of a professional teacher. Moving to the rhythm of music has done all things well: patients have in fact benefited from improvements both in terms of movement and mentality.
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