Changes in smell: Does Parkinson’s disease start?

Slow movements, as well as tremor and stiffness, are the main symptoms of Parkinson’s disease, which occur in middle age, usually between 60 and 70 years, although there are rare youthful forms of the disease.

Parkinson’s disease may not be as common in the general population (ranging between 0.2-0.4%), but at ages 65 in our country and elsewhere it reaches about 2% of the population. Its symptoms usually evolve slowly, and it may be a period of months or more, until the cause is found.

The above symptoms were pointed out by Professor of Neurology at the School of Medicine at the Aegean Hospital of Leonidas Stefanis, speaking to in.gr, giving the « signal » to a visit to the doctor to investigate a possible disease.

There is now an attempt by our team to study these forms at a forefront even from the forerunner, so that we can understand where, how and when the pathological process of the disease begins

A chuck more slowly

« Slowing in movements, usually starting on one side of the body, is the main symptom that must mobilize interested parties in order to address the doctor, » said Stefanis, saying: « Everything is becoming a chuck more slower.

Repeat movements, such as writing, are more affected, where the letters characteristically become smaller as one writes longer. Automatic movements are also affected, which is why one of the first symptoms may be reduced facial expression or reduced swinging of one hand in walking, with the corresponding foot.

The tremor in one hand is characteristic, usually prevailing in tranquility and leaves with movement, but it is not necessary to exist.

Precursor symptoms

It is important to emphasize that before the above motor symptoms, the so -called « non -motor symptoms » may occur, in particular constipation, depression, a decrease in smell (underlying) and a particular REM sleep disorder, known as the initial RBDs, where the sufferers express their dreamer. The presence of such non -motor symptoms without motor symptoms marks the so -called precursor form of the disease.

It is important when, without clear etiology, there are such symptoms, and in particular either RBD or hypnosis, which have a greater specialty, to become a neurological assessment.

Aegean study

There is also the possibility of our clinic to participate in a systematic study of monitoring of these precursor forms, funded by Michael J. Fox Foundation.

If there is a relative interest, readers can contact e-mail: [email protected]. « 

Exams – indicators

According to Mr. Stefanis, the diagnosis is clinical, and is based on recognition by the historical and clinical examination of the key clinical elements mentioned and the exclusion of other diseases. Ancillary, in cases of clinical doubt, additional imaging tests, such as Dat Scan, may be performed. It is advisable to do a structural imaging, such as a magnetic brain, which is normal in Parkinson’s disease, but in some mimics of the disease it can show pathological findings.

« An important development in recent years is the emergence of new biological indicators, especially those that detect the pathological aggregation of the A-synuclein protein in biological fluids. Recent studies show that such biomarkers are precisely detecting Parkinson’s disease, distinguished by other similar diseases and can detect this pathological process even in the precursor phase of the disease. Such biomarkers are not yet applied to clinical practice, but it seems that this can be done soon if they evolve, simplified and automated further, « Mr Stephanis stressed.

Close to prevention

The professor noted that « to date, we do not know some way to delay or suspend the appearance or the progression of the disease. There is some indications that proper nutrition and healthy life in general, especially the exercise and avoiding living life can help in this area. The point, of course, is to develop through basic and clinical research treatments that will delay or inhibit the onset or progression of the disease. This is the big bet for the future, the development of neuroprotective therapies that could ideally be applied at early stages of the disease, so that it does not fully manifest or develop at a much slower pace. Now, with the emergence of new biomarkers who detect the biological process of the disease many years before it is manifested by motor symptoms, it seems that we are closer to this goal. « 

Heredity

In most cases there is no clear inheritance, although there is a relatively increased genetic predisposition resulting from many genetic factors. In a minority, especially in patients with early age, before 50 years, there is clear heredity, and there the genetic factor is decisive.

Mr. Leonidas Stefanis added that « in our country, there are genetic forms of the disease that are only a few in other populations, and relate to mutations in the A-synuclein gene, mentioned above in the context of biomarkers. These genetic hereditary forms are explored in great depth and have helped us to understand the pathogenic mechanisms of Parkinson’s disease.

There is now an attempt by our team to study these forms at a forest stage even by the forerunner, so that we can understand where, how and when the pathological process of the disease begins, so that one day possible neuroprotective therapies are applied at this stage. « 

Additional care

While the disease in the early stages is fully manageable and sufferers can continue, with proper medication, a normal life, at some point things are difficult, and in many cases the disease leads to another degree of disability and dependence on carers.

As the professor explained, « disability usually comes from the combination of motor and non -motor problems. A very important issue and element of the burden of caregivers is the mental disruption of the patients, who may have delirium or illusions, very often in terms of mental discount. Motor difficulties and especially ups and downs of motor response in medication can be treated to a significant extent by surgical implantation in the deep stroke that reorganizes the affected cerebral circuit, or with the placement of continuous administration.

Successful treatment with such newer methods in appropriate cases can be beneficial in the autonomy and independence of the sufferers. « 

Research on new treatments

Research has been focusing on the development of new treatments in recent years. « Through the genetics – basically – discoveries of recent years, the research of the pathogenesis of the disease has been particularly developed, and through it, and the attempt to find neuroprotective therapies, » Mr. Stefanis stressed, and continued: « If many different approaches are being studied, A-synuclein. Although the first relevant clinical trials did not show a clear positive result, there is hope that different approaches with the same goal may have better luck.

On the other hand, we must also keep in mind that the etiology of the disease is multifaceted, and here comes the concept of pharmacogenesis.

In the future there may be specific causal therapies depending on the genetic and biological background of the disease, which is why it is also important to develop and examine relevant biomarkers who will not only diagnose the disease but also possibly classify it into different biological subtypes. «