April 11 is World Parkinson's Day, in honor of all those who experience Parkinson's disease as well as of James Parkinson, the English physician who first identified the disease in the 18th century.
Parkinson's disease is a degenerative disease characterized by neurological dysfunction and is caused by reduced production of cells that produce dopamine (a chemical that controls muscle activity at the brain level). Its prevalence increases with age, being rare before the age of 50, and is more common in males than females.
It is estimated that about 20 thousand Portuguese have this disease. With the increase in longevity of the population, it is expected that this disease will affect around 30 thousand people in the next 20 years.
The motor symptoms of the disease are the best known, the most prevalent being tremor when muscles are at rest, increased muscle tone (rigidity), slowness in voluntary movements and difficulty in maintaining balance (postural instability). In many people, cognitive function is compromised, and dementia may develop.
In addition, this disease presents a set of non-motor symptoms - physical, cognitive, and psychological - that contribute to the consequent disability of this disease, and to the negative impact of this condition on the quality of life of patients. Recent scientific literature (e.g., Montanaro, et al., 2022; Laux et al., 2022) shows that patients may experience visual difficulties, difficulties in chewing and swallowing, urinary incontinence, cramps, fatigue, or constipation. In addition, they tend to experience sleep disturbances, memory loss, and high levels of depressive and anxiety symptoms.
For symptoms to manifest, 70 to 80 percent of brain cells must die, it is not yet known what causes cell death and why some people develop this disease and others do not. Some factors that may be at its origin are related to family history, exposure to pesticides or industrial toxins, and aging itself.
The diagnosis of the disease is made based on the patient's clinical history and neurological evaluation, and there is no laboratory test that allows a definitive diagnosis. With a picture suggesting the disease, a trial of treatment with levodopa is usually followed to confirm the diagnosis. If the symptoms improve during this trial, the probability of Parkinson's disease is very high.
Although there is no cure for Parkinson's disease, symptoms can be controlled by pharmacologic therapy, with levodopa (an antiparkinson's drug that is very effective in reducing motor symptoms in the early stages of the disease) being the most commonly used drug. Pharmacological therapy may also be characterized by the use of other drugs, alone or in combination with levodopa, such as dopamine agonists and other drugs that slow the degradation of dopamine in the human body. There are also some studies that indicate a growing interest in the use of some antioxidants and vitamin E and C supplements.
It should be emphasized that the choice of treatment should always be made by a physician with the scientific and technical knowledge to do so.
A balanced diet, regular physical exercise and physiotherapy have been shown to be effective in improving the mobility and flexibility of patients, as well as their overall quality of life. Cognitive stimulation is also used to stimulate and maintain cognitive abilities for as long as possible. This type of intervention also focuses on identifying, understanding, and alleviating depressive and anxious symptomatology experienced by patients, as well as helping the family cope with behavioral changes (e.g., compulsivity and apathy). Recently, the practice of self-compassion has been shown to be associated with lower levels of psychological distress (i.e., depressive and anxious symptomatology and stress) in Parkinson's disease patients, necessitating the development and evaluation of compassion-focused interventions tailored to this condition (Eccles et al., 2023).
Parkinson's disease requires a multidisciplinary approach, in which psychological counseling plays a key role.
The diagnosis of Parkinson's disease is a demanding and emotionally challenging time, in which doubts and concerns about symptoms, treatment, and disease progression arise for both the patient and his or her caregivers. Psychological support aims to help patients and caregivers express and regulate their emotions, seeking to facilitate the process of adaptation to the disease at the individual, family, and social levels. In addition, it aims to help decrease the depressive and anxious symptomatology potentially present, and to decrease pain. In addition, the psychologist is intended to facilitate the patient's adherence to treatment, help him or her adjust expectations and personal goals. It is important to promote assertive communication between the patient and his or her caregivers. Finally, a specially trained psychologist may also use cognitive stimulation exercises (e.g. for attention and memory).
If you have been diagnosed with Parkinson's disease, and you feel that you need help in dealing with the challenges of this disease, seek expert help and take care of yourself.
References
Bucur, M., & Papagno, C. (2022). Deep Brain Stimulation in Parkinson Disease: A Meta-analysis of the Long-term Neuropsychological Outcomes. Neuropsychology Review. https://doi.org/10.1007/s11065-022-09540-9
Eccles, F, Sowter, N., Spokes, T., Zarotti, N. & Simpson, J. (2023). Stigma, self-compassion, and psychological distress among people with Parkinson’s. Disability and Rehabilitation, 45(3), 425-433, https://doi.org/10.1080/09638288.2022.2037743
Laux, G. (2022). Parkinson and depression: Review and outlook. Journal of Neural Transmission, 129, 601–608. https://doi.org/10.1007/s00702-021-02456-3
Montanaro, E., Artusi, C.A., Rosano, C. et al. (2022). Anxiety, depression, and worries in advanced Parkinson disease during COVID-19 pandemic. Neurological Sciences 43, 341–348. https://doi.org/10.1007/s10072-021-05286-z