Understand Parkinson's disease, know "Parkinson" and don't be afraid

Author: Liu Na, deputy chief physician, Peking University Third Hospital

Reviewer: Sun Aping, deputy chief physician, Peking University Third Hospital

Zhao Haiyan, deputy chief physician, Peking University Third Hospital

Parkinson's disease is a common neurodegenerative disease, which is known for its symptoms such as resting tremor, slow movements, and muscle stiffness, which brings many inconveniences to patients' lives. With the advent of an aging society, the number of Parkinson's disease patients has increased year by year, and the number of Parkinson's disease patients has also tended to be younger. However, Parkinson's disease has an insidious onset, and the initial symptoms are often atypical and easily overlooked. Let us get to know it and understand it together, and we will not be afraid of it if we know it.

1. Slow movements and dull expression—Do I have Parkinson’s disease?

If one of the upper limbs shakes involuntarily and rhythmically, which is obvious when still and relieved after movement; the limbs are stiff; the movements are slower than before, and the feet drag on the ground when walking; the expression decreases, or even falls inexplicably, accompanied by dry stools, decreased sense of smell, shouting and punching and kicking during sleep, you need to be alert to Parkinson's disease. So, do you know what clinical manifestations of Parkinson's disease are? It mainly includes two major symptoms: motor symptoms and non-motor symptoms. Let's focus on motor symptoms below.

(1) Resting tremor is often the first symptom of Parkinson's disease, usually starting from the distal end of one upper limb, with rhythmic movement of the fingers to the palm.

Movements, such as "pill-rolling" movements, occur when the patient is quiet, decrease or stop during voluntary movements, increase during tension, and disappear after falling asleep.

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(2) Myotonia usually starts from one side of the limb, and manifests as "lead pipe-like" or "gear-like" myotonia. In the early stage of increased tension, the patient will feel that the affected limb is inflexible, stiff or tense, and the feeling gradually worsens, leading to difficulty in movement.

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(3) Bradykinesia and less activity of facial muscles, manifested as binocular gaze, reduced blinking, and mask-like appearance; throat involvement, manifested as

Symptoms include drooling, hesitation in speaking, low voice and dysarthria; difficulty with fine finger movements (such as buttoning, lacing shoes, etc.), finger stiffness, micrographia; slowness in getting up, turning over, walking and changing direction.

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(4) Abnormal posture/gait: flexed posture, difficulty starting, small steps when walking, loss of upper limb swing, and dragging of lower limbs

The person may drag his feet, walk faster and faster in a panic gait, or suddenly freeze in the middle of walking, as if frozen on the ground; the trunk is stiff, balance is difficult, and the person uses small continuous steps to slowly turn the trunk and head together.

2. Why do you have difficulty in defecation and decreased sense of smell?

In addition to the familiar resting tremor, muscle rigidity, bradykinesia and abnormal posture/gait, the clinical manifestations of Parkinson's disease also include many non-motor symptoms, such as hyposmia, constipation and sleep disorders. Some non-motor symptoms appear several years or even decades before the motor symptoms of Parkinson's disease appear, and they run through the entire course of Parkinson's disease, seriously affecting the patient's quality of life. Non-motor symptoms specifically include the following aspects.

(1) Sensory impairment Sensory impairment includes olfactory impairment and pain. 80% to 90% of Parkinson's disease patients have olfactory impairment, which manifests as decreased or lost sense of smell. Olfactory impairment may occur before motor symptoms appear, which has early diagnostic value. Pain is often located in the neck, waist, lower limbs and joints, and is easily misdiagnosed as an orthopedic disease.

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(2) Sleep disorders Sleep disorders include difficulty falling asleep, difficulty maintaining sleep (sleep fragmentation), excessive daytime sleepiness,

Restless legs syndrome (RLS) and rapid eye movement sleep behavior disorder (punching, kicking, etc. during sleep).

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(3) Neuropsychiatric disorders Neuropsychiatric disorders include depression, anxiety and apathy, memory loss, dementia, visual hallucinations of non-horror images such as people and animals, and mental symptoms such as suspicion of spouse infidelity and relatives stealing one's property.

(4) Autonomic dysfunction Autonomic dysfunction includes constipation, frequent urination, urgency, urinary retention, orthostatic hypotension, abnormal sweating, and sexual dysfunction.

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3. Is Parkinson’s disease hereditary?

Many patients who are diagnosed with Parkinson's disease worry that the disease will be passed on to the next generation. So, is Parkinson's disease really hereditary?

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It is undeniable that some Parkinson's patients do have a family clustering phenomenon, and this ratio is usually around 1/10, which is relatively low. If there is a Parkinson's patient among your immediate family members, then the risk of Parkinson's disease will be higher than that of normal people, but it is still at a low level, so there is no need to worry too much. The characteristics of Parkinson's patients with a family history are somewhat different from those of general Parkinson's patients. For example, the age of onset is earlier, and they may develop the disease in their twenties or thirties; and some drugs are not effective enough.

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Of course, the causes of Parkinson's disease are very complex. In addition to genetic factors, unhealthy lifestyles and exposure to toxic and harmful substances can increase the risk of Parkinson's disease. Non-genetic factors can be changed, thereby reducing the risk of Parkinson's disease.

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For individuals with hereditary Parkinson's disease, in addition to genetic testing, it is even more important to avoid Parkinson's risk factors.

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