Parkinson's disease

Parkinson's disease or Parkinson's disease, first described in 1817 by James Parkinson, is characterized by a progressive disorder of movement due to dysfunction of the dopamine secreting neurons in the basal ganglia that control and adjust the transmission of commands coming conscious cerebral cortex to the muscles of the human body. Not only dopaminergic neurons are involved, but other structures that produce serotonin, norepinephrine and acetylcholine are involved in the genesis of the disease. The name "Parkinson" was suggested just to name a disease by the great French neurologist Jean-Martin Charcot, as a tribute to James Parkinson.

Parkinson's disease is idiopathic, ie is a primary disease of obscure cause. There cell death and degeneration of dopamine-producing neurons. It is therefore a degenerative disorder of the central nervous system, usually beginning after age 50. It is one of the most frequent neurological diseases since its prevalence is between 80 and 160 cases per hundred thousand inhabitants, affecting approximately 1% of individuals over 65 years of age.

It is possible that Parkinson's disease is linked to subtle defects in the enzymes involved in the degradation of proteins alfanucleína and / ouparkina (in Parkinsonism genetic defect is in the gene itself or alfanucleína parkin and is most severe). These defects lead to accumulation of these proteins inclusions throughout life (in the form of Lewy bodies visible by microscopic) and translate in the death of neurons that express these proteins (only dopamine) or its dysfunction during aging . Parkinsonism is characterized therefore by the dysfunction or death of dopamine-producing neurons in the central nervous system. The primary site of cellular degeneration in the substantia nigra parkinsonism is present at the base of the midbrain.

Although more common in the elderly, the disease can also appear in young people. A British 23 year old has been diagnosed with Parkinson's and their symptoms began with a small tremor in the hand at 19 years of age.

Psychological Treatment

90% of people with Parkinson's also suffer from another psychiatric disorder at some point. Depending on the case both these disorders may have contributed to the development as being a consequence of the disease or even not having a direct relationship, these three possibilities has scientific basis. But regardless of whether they cause, consequence or coincidental, cognitive disorders, mood disorders and anxiety disorders often cause great losses in the quality of life of patients and their families. The most common disorder was the Blue Devils, identified in 32% of cases, and responsible for serious engine problems, sleep, eating and pain.

Several psychiatric drugs, including the most widely used anti-depressant (fluoxetine) may worsen symptoms of Parkinson underscore the importance of monitoring done by psychologists to improve the quality of life of patients and their caregivers especially. Several major cities have health services aimed at the elderly and include psychological support services to people with Parkinson's and their caregivers as the Parkinson Association Brazil: the ABRAZ: and the Portuguese Association of Patients with Parkinson's.

How antidepressants worsen the patient's functionality is an option transcranial magnetic stimulation (TMS) but it is expensive and difficult to access. A similar option is more affordable and electroconvulsive therapy.

Physiotherapy treatment

The physical therapy works in all stages of Parkinson's, to improve muscle strength, coordination and balance. The patient with Parkinson generally is subject to respiratory infections, which occur more with bedridden patients. In these cases physiotherapy operates in the maintenance of bronchial hygiene, stimulus cough, breathing exercises reexpansivos. In more serious cases, where there is involvement of the respiratory muscles, is indicated treatment with mechanical ventilation equipment and mechanical ventilators, noninvasive, aiming the optimization of ventilation, with consequent improvement in respiratory distress.

Clinical evidence of the effects of exercise or rehabilitation for individuals with PD are usually associated with interventions that are likely to impact on clinical scales - staging Hoehn and Yahr, UPDRS (Unified Parkinson's Disease Rating Scale) - or functional limitations - walking, climbing / down stairs, getting out of bed / chair, fall prevention (CRIZZLE and Newhouse, 2006). The training muscular endurance and balance increased muscle strength, posture and spatial orientation of patients with PD (Hirsch et al., 2003). Training on a treadmill (MIYAI et al, 2002), physiotherapy (NIEWBOER et al., 2001) and adapted sports (KURODA et al., 1992) decreased disease severity by UPDRS. PD patients exercisers had lower mortality rates than sedentary (REUTER et al., 1997).

In several clinical studies was observed slight male predominance, but there are some questions on how to select the patients. In studies that estimated the prevalence and incidence of Parkinson's disease was not demonstrated a significant difference in relation to gender on the risk of contracting the disease. The increase in life expectancy did not change significantly the number of PD patients, the disease prevalence remained fairly stable since the beginning of the century.

Prevention

The idiopathic Parkinson's disease and is still not known what causes specific, so there is no preventive measures in this case. Some studies indicate that the use of antioxidants such as vitamin E and vitamin C help prevent oxidative stress and neuron degeneration. Furthermore, clinical practice shows that the use of selegiline in the onset of disease helps to slow its progression. It is important that physicians be aware of before using any medicine.