From the Guidelines
Parkinson's disease is a chronic, progressive neurodegenerative disorder resulting from dopamine depletion in the brain, characterized by symptoms such as tremor, muscular rigidity, bradykinesia, and postural instability. The disease typically begins with mild symptoms that worsen over time, and while there is no cure, medications like levodopa, dopamine agonists, and MAO-B inhibitors can significantly improve symptoms 1.
Key Characteristics of Parkinson's Disease
- The main symptoms include tremor, muscular rigidity, bradykinesia, and postural instability
- As the disease progresses, other symptoms emerge, such as dysphagia, dysarthria, impaired gastrointestinal motility, fatigue, depression, and cognitive impairment
- Patients with Parkinson's disease are at increased risk of malnutrition and weight loss, and nutritional status should be monitored routinely throughout the natural history of the disease 1
Management and Treatment
- Drug therapy is essential to control symptoms and maintain mobility in Parkinson's disease, and acts by replacing or mimicking dopamine in the brain 1
- Treatment is usually started when symptoms begin to interfere with daily activities, with levodopa often being the most effective medication
- Physical therapy, regular exercise, and a healthy diet are also important parts of managing the condition
- Regular monitoring of body weight and nutritional assessment are recommended, as malnutrition has been associated with disease severity and weight loss can involve fat mass with substantial sparing of skeletal muscle mass 1
Nutritional Considerations
- Parkinson's disease patients should undergo active monitoring of vitamin status, particularly vitamin D, as low levels have been associated with the risk of developing Parkinson's disease and serum levels are lower in Parkinson's disease patients than healthy controls 1
- Supplementation with vitamin D should be considered, as it may slow disease progression, at least in patients with high-risk genotype of the vitamin D receptor 1
- Administration of folate and vitamin B12 is effective in reducing homocysteine levels and should be considered to prevent neuropathy and other complications associated with hyper-homocysteinemia 1
From the Research
Definition and Overview of Parkinson's Disease
- Parkinson's disease (PD) is a complex neurologic disorder that involves motor and nonmotor brain functions 2.
- It is the second most common neurodegenerative disease after Alzheimer's disease, affecting approximately 1.5 to 2.0% of the elderly population over 60 years and 4% for those over 80 years of age 3.
- PD is caused by the necrosis of dopaminergic neurons in the substantia nigra, resulting in a decrease in dopamine in the synaptic cleft 3.
Motor and Nonmotor Symptoms
- Motor symptoms include resting tremor, cogwheel rigidity, extreme slowness of movement, shuffling gait, and impaired balance 2.
- Nonmotor symptoms include depression, hallucinations, and sleep disturbances that seriously affect quality of life 2.
- Other symptoms may include swallowing and speaking difficulties, dementia, urinary incontinence, and orthostatic hypotension 4.
Diagnosis and Treatment
- There are no laboratory tests, biomarkers, or imaging studies to confirm the disease, and diagnosis is made by analyzing motor features 3.
- Treatment consists of a dopaminergic supplement with levodopa, COMT inhibitors, anticholinergics agents, dopaminergic agonists, and inhibitors of MAO-B, which aims to control symptoms and improve functional mobility 3.
- A multidisciplinary approach to optimizing care can include physical and occupational therapy, speech therapy, and psychological therapy 2.
- Surgical management, such as deep brain stimulation, is indicated in chronic cases 5.