Early signs that are usually missed
By the time tremor appears, a significant portion of dopamine neurons have already died. But the body gives signals much earlier, and these signs are rarely associated with neurology.
- Decreased or loss of sense of smell is one of the earliest symptoms
- Persistent constipation not explained by diet
- Behavioral disorder in the REM sleep phase: a person screams, waves his arms, “acts out” dreams
- Changes in handwriting - letters become smaller towards the end of the line
- Quiet, monotonous speech, which is complained about by loved ones, not the person himself
- Reduced arm span when walking on one side, “frozen” facial expression
- Depression and fatigue for no apparent reason
Basic motor symptoms
The classic triad develops gradually and almost always begins asymmetrically - on one side of the body.
- Гипокинезия — замедленность и обеднение движений: труднее застегнуть пуговицы, шаги становятся мелкими, шаркающими.
- Ригидность — повышенная скованность мышц, ощущение «зажатости», боль в плече, которую нередко лечат как остеохондроз.
- Тремор покоя — дрожание руки в состоянии покоя, часто по типу «счёта монет»; уменьшается при движении и усиливается при волнении.
- Постуральная неустойчивость — нарушение равновесия, появляется на более поздних стадиях и повышает риск падений.
Non-motor manifestations
The disease is not limited to movement, and it is the non-motor symptoms that often have the greatest impact on quality of life. It is important to discuss them with your doctor - they can be corrected.
- Depression, anxiety, apathy
- Sleep disturbances, daytime sleepiness
- Decreased blood pressure when standing up, dizziness
- Constipation, drooling, swallowing problems
- Frequent urination, especially at night
- Decreased memory and attention in later stages
How is the diagnosis made?
There is no specific test or image that confirms Parkinson's disease. The diagnosis is clinical: the doctor assesses the presence of hypokinesia in combination with resting tremor or rigidity, asymmetry of onset and response to therapy.
MRI of the brain is prescribed not to confirm the diagnosis, but to exclude other causes: vascular parkinsonism, hydrocephalus, tumor. Some medications can give a similar picture, so the doctor must clarify what the patient is taking.
- Vascular parkinsonism - after strokes, symptoms are more often in the legs
- Drug-induced parkinsonism - against the background of a number of antipsychotics and antiemetics
- Essential tremor - shaking when moving, often familial, relieved by alcohol
- Multiple system atrophy and progressive supranuclear palsy - rapid progression, early falls
- Normal pressure hydrocephalus - gait disturbance, urinary incontinence, memory loss
Treatment
Treatment is aimed at replenishing dopamine deficiency and controlling symptoms. Levodopa remains the main and most effective drug; Along with it, dopamine receptor agonists and drugs that slow down the breakdown of dopamine are used. The regimen is selected individually, taking into account age and severity of symptoms, and is regularly adjusted.
- Taking medications strictly according to the clock - the effect depends on the stability of the blood level
- Protein foods may impair the absorption of levodopa, so your diet should be discussed with your doctor.
- Over time, an “on-off” phenomenon may appear - this is a reason to adjust the regimen, and not a sign of ineffective treatment
- For severe fluctuations in effect, deep brain stimulation is considered
- Physical therapy, walking, balance exercises have been proven to slow down the deterioration of movements
- Classes with a speech therapist for speech and swallowing disorders