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Parkinson's disease

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Parkinson's disease

Parkinson's disease (PD), or simply Parkinson's, is a neurodegenerative disease primarily of the central nervous system, affecting both motor and non-motor systems. The motor symptoms, collectively called parkinsonism, include tremors, slowness in initiating movement (bradykinesia), rigidity, and difficulty maintaining balance (postural instability). Non-motor symptoms such as autonomic nervous system failures (dysautonomia), sleep abnormalities, decreased ability to smell (anosmia), and behavioral changes or neuropsychiatric problems, such as cognitive impairment, psychosis, and anxiety, may appear at any stage of the disease. Symptoms typically develop gradually and non-motor issues become more prevalent as the disease progresses. Most Parkinson's disease cases are idiopathic, though contributing factors have been identified. Pathophysiology involves progressive degeneration of nerve cells in the substantia nigra, a midbrain region that provides dopamine to the basal ganglia, a system involved in voluntary motor control. The cause of this cell death is poorly understood, but involves the aggregation of alpha-synuclein into Lewy bodies within neurons. Other potential factors involve genetic and environmental influences, medications, lifestyle, and prior health conditions. Diagnosis is primarily based on signs and symptoms, typically motor-related, identified through neurological examination. Medical imaging techniques such as positron emission tomography can support the diagnosis. PD typically manifests in individuals over 60, with about one percent affected. In those younger than 50, it is termed "early-onset PD". No cure for PD is known, and treatment focuses on alleviating symptoms. Initial treatment typically includes levodopa, MAO-B inhibitors, or dopamine agonists. As the disease progresses, these medications become less effective and may cause involuntary muscle movements. Diet and rehabilitation therapies can help improve symptoms. Deep brain stimulation is used to manage severe motor symptoms when drugs are ineffective. Little evidence exists for treatments addressing non-motor symptoms, such as sleep disturbances and mood instability. Life expectancy for those with PD is near-normal, but is decreased for early-onset.

Infobox

Other names
mw- .inline, .inline dl, .inline ol, .inline ul, dl dl, dl ol, dl ul, ol dl, ol ol dd dd dd , dd dt , dd li , dt dd , dt dt , dt li , li dd dd dd , dd dt , dd li , dt dd , dt dt , dt li , li dd dd ol li Idiopathic or primary parkinsonismhypokinetic rigid syndromeparalysis agitansshaking palsy
Specialty
Neurology
Symptoms
Tremorbradykinesiarigiditypostural instabilitydysautonomiadepressionanxietysleep abnormalities
Complications
Fallsdementiaaspiration pneumonia
Usual onset
Age over 60
Duration
Long-term
Risk factors
Family historydyspepsiageneral anesthesiapesticide exposurehead injuries
Diagnostic method
History and neurologic examinationmedical imagingdopamine levels in urine
Differential diagnosis
Dementia with Lewy bodiesprogressive supranuclear palsyessential tremorantipsychotic use fragile X-associated tremor/ataxia syndromeHuntington's diseasedopamine-responsive dystoniaWilson's disease
Treatment
Supportive measures and control of symptoms, physical therapy, deep brain stimulation, medication
Medication
Levodopa, COMT inhibitors, AAAD inhibitors, dopamine agonists, MAO-B inhibitors
Prognosis
No known cure; 5–10 year life expectancy after diagnosis
Frequency
0.2% (Canada)
Named after
James Parkinson

Tables

mw- Table featuring the prevalence of neuropsychiatric symptoms in PD · Signs and symptoms › Neuropsychiatric and cognitive
Prevalence (%)
Prevalence (%)
Symptom
Prevalence (%)
Anxiety
Anxiety
Symptom
Anxiety
Col 2
40–50
Apathy
Apathy
Symptom
Apathy
Col 2
40
Depression
Depression
Symptom
Depression
Col 2
20–40
Impulse control disorders
Impulse control disorders
Symptom
Impulse control disorders
Col 2
36–60
Psychosis
Psychosis
Symptom
Psychosis
Symptom
Prevalence (%)
Anxiety
40–50
Apathy
40
Depression
20–40
Impulse control disorders
36–60
Psychosis
· Diagnosis › Differential diagnosis
Corticobasal syndrome
Corticobasal syndrome
Disorder
Corticobasal syndrome
Distinguishing symptoms and features
Levodopa resistance, myoclonus, dystonia, corticosensory loss, alien limb phenomenon, apraxia, and non-fluent aphasia
Dementia with Lewy bodies
Dementia with Lewy bodies
Disorder
Dementia with Lewy bodies
Distinguishing symptoms and features
Levodopa resistance, cognitive predominance before motor symptoms, and fluctuating cognitive symptoms
Essential tremor
Essential tremor
Disorder
Essential tremor
Distinguishing symptoms and features
Tremor that worsens with action, normal SPECT scan
Multiple system atrophy
Multiple system atrophy
Disorder
Multiple system atrophy
Distinguishing symptoms and features
Levodopa resistance, rapidly progressive, autonomic failure, stridor, present Babinski sign, cerebellar ataxia, and specific MRI findings like the "Hot Cross Bun"
Progressive supranuclear palsy
Progressive supranuclear palsy
Disorder
Progressive supranuclear palsy
Distinguishing symptoms and features
Levodopa resistance, restrictive vertical gaze, pseudobulbar crying, eyelid twitching, specific MRI findings, and early and different postural difficulties
Disorder
Distinguishing symptoms and features
Corticobasal syndrome
Levodopa resistance, myoclonus, dystonia, corticosensory loss, alien limb phenomenon, apraxia, and non-fluent aphasia
Dementia with Lewy bodies
Levodopa resistance, cognitive predominance before motor symptoms, and fluctuating cognitive symptoms
Essential tremor
Tremor that worsens with action, normal SPECT scan
Multiple system atrophy
Levodopa resistance, rapidly progressive, autonomic failure, stridor, present Babinski sign, cerebellar ataxia, and specific MRI findings like the "Hot Cross Bun"
Progressive supranuclear palsy
Levodopa resistance, restrictive vertical gaze, pseudobulbar crying, eyelid twitching, specific MRI findings, and early and different postural difficulties
Prognosis of PD subtypes[202][203] · Prognosis
Severe cognitive or movement abnormalities
Severe cognitive or movement abnormalities
Parkinson's subtype
Severe cognitive or movement abnormalities
Mean years post-diagnosis until:
Death
Mild-motor predominant
Mild-motor predominant
Parkinson's subtype
Mild-motor predominant
Mean years post-diagnosis until:
14.3
Mean years post-diagnosis until:
20.2
Intermediate
Intermediate
Parkinson's subtype
Intermediate
Mean years post-diagnosis until:
8.2
Mean years post-diagnosis until:
13.1
Diffuse malignant
Diffuse malignant
Parkinson's subtype
Diffuse malignant
Mean years post-diagnosis until:
3.5
Mean years post-diagnosis until:
8.1
Parkinson's subtype
Mean years post-diagnosis until:
Severe cognitive or movement abnormalities
Death
Mild-motor predominant
14.3
20.2
Intermediate
8.2
13.1
Diffuse malignant
3.5
8.1

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