Parkinson's ABCs

-Yajika Dagar, Amity International School Saket, New Delhi, India

The leading cause of disability in the world is now neurological disorders. And among all,
the fastest-growing is Parkinson’s disease. Characterised by degeneration of the
dopamine, and laminated inclusions called Lewy bodies in neurons, it is associated with
depletion of the neurotransmitter dopamine, which does not readily cross the blood-brain
barrier and the major motor and sensory functions are hence affected (NEJM 1993).
Though for most of human history, Parkinson was a rare disorder, however recent
decades have witnessed a growing number of patients globally.

From 1990, in just 25 years, the number of people with Parkinson disease (PD) doubled to
over 6 million. Individuals over age 50 with PD in the world’s 10 most populous countries
will double to 9.3 million by 2030, as compared to 4.6 million in 2005 (DOI 2006).

By 2040, the global burden of Parkinson disease would be on a projected 17.5 million peo-
ple, accounting for changes in longevity, smoking rates and industrialisation (Journal of
Parkinson’s disease 2018).
Source- J Parkinsons Dis. 2018; 8(Suppl 1): S3–S8.
A prevalence of literature regarding depression in Parkinson's disease has helped under-
stand the behavioural manifestations of the same. A history of depression enables a
greater risk of PD. At the early stages of the disease, female genders and more left-brain
involvement are also potential risk factors. Approximately half of the depressed patients
with Parkinson's disease meet the criteria for major depressive episodes(MDE). The his-
tory of depression may trigger the same in stages of Parkinson diagnosis. Although it can
vary from 2.7% to more than 90%, depressive disorders indeed prove to be fatal for the
mental health of individuals and their families, and surrounding people as well (PsycINFO
Database Record 2016).

The causes of Parkinson's disease still are largely unknown. Most researchers speculate
that the causes can be twofold- genetic and non-genetic. Non-genetic factors like head
trauma, high-calorie intake tend to interact with susceptibility genes. While genetic factors
like major gene mutations cause only a small proportion of cases.

An extensive debate on the neurological consequences of COVID-19 and its impact on pa-
tients with PD has witnessed effects on observatory clinical cases. A study of 10 clinical
cases was conducted at King's College Hospital in London, UK. The group consisted of 6
men and 2 women, all older than 60 years of age with severe motor dysfunction and most
requiring additional levodopa dosing following infection (Wiley Public Health Emergency
Collection 2020). Anxiety, fatigue, cognitive impairment worsened during the infection. Fa-
tigue was a dominant symptom in all cases of advanced therapies and three patients died
from COVID‐19 pneumonia. The findings suggested that PD patients with longer disease
duration are more susceptible to a high mortality rate. This study depicts how, in recent
years, Parkinson’s disease has been full of hidden sorrows yet emerging research oppor-
tunities. It allows us to test which factors protect patients from the deleterious conse-
quences of this crisis, hopefully bringing long-term positive outcomes for people world-
wide.

The discovery of levodopa revolutionised the treatment of PD, but after several years of
treatment, most patients develop involuntary movements, termed dyskinesias. These are
difficult to control and significantly impair the quality of life. The current research is directed
toward the prevention of dopaminergic neuron degeneration, as neurons that have
stopped functioning cannot be regenerated. Despite advances toward this goal, all current
treatments are symptomatic; none halt or retard dopaminergic neuron degeneration (Neu-
ron issue 6, 2006).

When we talk about the treatment of PD globally, we see the prevalence of surgical ap-
proaches too- (a) Ablative surgery, (b) brain stimulation (DBS) of the thalamus and sub-
thalamic nucleus and (c) grafting fetal mesencephalic cells into the striatum. DBS is pre-
ferred to ablative procedures by many experts owing to its reversibility, programmability,
and the ability to be safely performed bilaterally (Neurotherapeutics 2014). The device and
electrodes painlessly stimulate the brain in a way that helps stop many of the movement-
related symptoms of Parkinson's, such as tremors. Despite recent growth in DBS knowl-
edge, there is currently no consensus on the ideal surgical technique and the most appro-
priate surgical target. Although a great deal of work remains to be done, advances in surgi-
cal therapies for the treatment of Parkinson's disease are moving forward at an unprece-
dented pace (The Lancet Neurology Volume 3). Undeniably, diagnosis of a long-term ill-
ness like PD does not just affect the individual but also the family unit, a lifeworld-led ap-
proach to healthcare would re-humanize services provided. This would help the patients
with PD and their families to work through the challenge of living with PD and offer them a
smoother way along the illness journey.
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References-
1) E. Ray Dorsey, Bastiaan R. Bloem- The Parkinson Pandemic
2) E. R. Dorsey, R. Constantinescu, J. P. Thompson, K. M. Biglan, R. G. Holloway, K.
Kieburtz, F. J. Marshall, B. M. Ravina, G. Schifitto, A. Siderowf, C. M. Tanner, Novem-
ber 2, 2006, Projected number of people with Parkinson disease in the most populous
nations, 2005 through 2030- Neurology
3) Lonneke ML de Lau, Prof Monique, June 2006, Epidemiology of Parkinson's disease -
The Lancet Neurology
4) Donald B. Calne, September 30, 1993, Treatment of Parkinson's Disease - The New
England Journal of Medicine
5) Aparna Wagle Shukla, Michael Scott Okun, 2014, Surgical Treatment of Parkinson’s
Disease: Patients, Targets, Devices, and Approaches - Neurotherapeutics
6) Benjamin L Waltera, Dr Jerrold L Viteka, 2004, Surgical treatment for Parkinson's dis-
ease - The Lancet Neurology
7) Laura J. Smith, Rachel L. Shaw, 2017, Learning to live with Parkinson’s disease in the
family unit: an interpretative phenomenological analysis of well-being- Med Health
Care Philos.