Can Parkinson's syndrome be detected early? What are the dangers?

Author: Chen Haibo, chief physician of Beijing Hospital

Reviewer: Hu Wenli, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Parkinson's syndrome has three typical movement symptoms: resting tremor, bradykinesia and muscle rigidity. There may be some prodromal symptoms 10-20 years before the onset of these three symptoms.

Understanding these prodromal symptoms is very helpful for the early detection of Parkinson's syndrome.

1. What are the prodromal symptoms of Parkinson's syndrome?

First, decreased sense of smell. Some patients recalled that they had a poor sense of smell for more than ten years, and then Parkinson's disease developed. Some studies have also found that patients with primary anosmia have no clear cause such as rhinitis or sinusitis, but their sense of smell is poor. After four years of follow-up, it was found that about 1/5 of the patients would show symptoms of Parkinson's disease.

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Second, sleep disorders. Some people sleep a lot during the day and are always sleepy during the day. Some people don't sleep well, often wake up at night, or have difficulty falling asleep, or wake up early. More typically, we call it sleep behavior disorder, which occurs in a specific stage of sleep, which we call rapid eye movement sleep. Nightmares or vivid dreams occur during REM sleep. Patients may talk to each other in their dreams, so some patients may talk incessantly like they are giving a speech. Or have nightmares, swear at each other, or even fight with each other, so they may punch and kick, so they may hurt their spouse, or hit the wall and hurt themselves. They may even fall out of bed and break bones because they hit too hard. This is also a possible early manifestation of Parkinson's disease.

Studies have found that about 50% or even a greater proportion of people with such symptoms will develop Parkinson's disease or Parkinson's plus syndrome in 5-10 years. Of course, it does not mean that if it happens once, you will definitely develop the disease. It must happen frequently, and the chance of getting Parkinson's will be higher.

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Third, constipation. Many patients suffer from long-term constipation 10 or 20 years before the onset of the disease, or have a bad mood, depression, anxiety and other symptoms, which may be some early manifestations of Parkinson's disease.

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Sometimes when the motor symptoms of Parkinson's disease appear in the early stage, the patient himself does not notice it, but the family members notice it. For example, some patients do not swing one arm much when walking. Originally, when walking, both arms swung very naturally and with a large amplitude, but now the family members find that one of his arms does not swing that much, but the other arm swings very well, so the family members often remind him to swing it up quickly. After the reminder, he can swing it up, but after a while, it stops swinging again. The appearance of such symptoms often indicates a manifestation of slow movement.

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Some people may feel limb weakness, which may be due to excessive muscle tension. When muscle tension is high, the muscles compete with themselves, so when they move, they need to exert more force than usual to move, and they will feel as if their limbs are not strong enough. Therefore, some patients think they have hemiplegia or stroke and treat it as cerebrovascular disease.

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Some patients feel that one leg is not so flexible or strong when walking, which may also be an early manifestation of Parkinson's disease. Especially if this weakness does not come suddenly, but gradually, Parkinson's disease should be considered. Because cerebrovascular disease comes suddenly, the symptoms will worsen to the worst within a few days and then gradually ease. If the symptoms come slowly, do not ease in a month, and even have a tendency to worsen, it may be a manifestation of Parkinson's disease.

2. What are the dangers of not treating Parkinson's syndrome in time?

In a broad sense, Parkinson's syndrome includes primary Parkinson's disease, Parkinson's plus syndrome and secondary Parkinson's syndrome.

In the early stages of primary Parkinson's disease, especially if left untreated, motor function declines rapidly, which can quickly affect the quality of life or work ability. This is its greatest harm.

A study found that we used a scoring method called the Unified Parkinson's Disease Rating Scale. In the early stages, the average annual decline in motor function was about 5.1%. In the late stages, the decline was only a few tenths of a percent, which was significantly slower.

Some studies have found that if Parkinson's disease is treated early, the rate of decline will slow down. After one or two years of treatment, the symptoms have not worsened compared to one or two years ago, and remain at the level of two years ago. Therefore, it is emphasized that once Parkinson's disease is diagnosed, it should be treated as soon as possible so that patients can benefit as soon as possible.

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There are very effective treatments for Parkinson's disease now. Although we cannot cure it, we can effectively control the symptoms. However, there is currently no specific treatment for Parkinson's syndrome, especially Parkinson's plus syndrome. However, due to its lesion range, part of which overlaps with the lesion range of Parkinson's disease, has similar manifestations and similar pathogenesis, it is often treated by borrowing the treatment methods of Parkinson's disease.

For secondary Parkinson's syndrome, there is often a very clear cause. For example, some patients with cerebrovascular disease may show slow movements, stiffness, and unsteady walking, just like Parkinson's disease. Brain inflammation, drugs, drug poisoning or genetics can also cause symptoms like Parkinson's disease, which are all secondary. Since there is a clear cause, it is necessary to actively treat the cause during treatment, so as to get a better treatment effect.