pathology: parkinson’s disease

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Parkinson’s disease

Definition

Predominantly hereditary condition, but most Parkinson’s is acquired. Occurs 40-60 years of age, men more frequently. There is a defect in the substantia nigra (the neurons there contain a lot of melatonin). These neurons use dopamine as a transmitter; if they become defective, there is a lack of dopamine, which results in all symptoms (or the imbalance between dopamine and acetylcholine)

ICD G20, G21

Cause

  1. Toxic effects of psychotropic drugs
  2. Trauma and vascular damage are also suspected, e.g. diabetes mellitus (causes angiopathies)
  3. Arteriosclerosis

Symptoms

  1. Parkinson’s triad: rigor, tremor, akinesia:
  2. Tremor: continuous tremor, trembling when fingers are bent Pill-popping or money-counting phenomenon
  3. Rigor: increase in muscle tone, cogwheel phenomenon: the patient can only lift the arm (elbow fixed on the table) against resistance in stages, not in a gliding motion
  4. Akinesia or hypokinesia: lack of voluntary movements
  5. Often rigid, stooped posture,
  6. small-stepping, tapping gait.

Complications

  1. Impoverishment of gestures and facial expressions.
  2. vegetative disorders: Hypersalivation, ointment face (increased sebum production leads to oily, shiny skin), smooth muscle spasms affecting the urinary tract, i.e. constipation with urinary retention;
  3. Vascular regulation disorders,
  4. depressive moods
  5. All of this happens in clear consciousness, so there is no dementia. In the final stage, those affected lie on their back in an embryonic position and even if the pillow is pulled away, the head remains in a bent position

Therapy

  1. L-dopa, a precursor of dopamine which, unlike dopamine, can cross the blood-brain barrier and is assembled into dopamine in the brain; however, this leads to anxiety and stress symptoms in the rest of the body due to its similar effect to adrenaline; many people develop resistance to L-dopa after many years, in which case no further therapeutic intervention is currently possible. There are attempts to transplant NNR tissue (USA) or embryonic material (Sweden) into the brain.