Parkinson's: Symptoms beyond tremor

Just as we associate clouds with rain, there are symptoms that immediately remind us of certain diseases. A clear example is the relationship between tremor and Parkinson's. Parkinson's is the most common neurodegenerative disease after Alzheimer's. Yaroslau Compta, a neurologist at the Hospital Clínic Barcelona , ​​establishes a simple distinction between the two: "If Alzheimer's primarily affects cognitive functions, Parkinson's affects movements." However, although tremor is the symptom most associated with this condition, its manifestations and consequences go much further.

The disease develops gradually and evolves progressively, with an incidence that increases with age: between 1% and 4% of the population between 70 and 85 years of age suffer from it. Its main signs are motor: slowness in repetitive and automatic movements, loss of manual dexterity, muscle stiffness with pain, gait disturbances, lack of facial expression and reduction in the size of handwriting. Tremor, although characteristic, is not always present: 40% of people who experience Parkinson's never develop it, which underlines the importance of paying attention to other symptoms for an accurate diagnosis.

No two Parkinson's cases are the same: some are quite benign and take many years to develop complications. Dr. Francesc Valldeoriol Head of the Parkinson's and Movement Disorders Unit at the Hospital Clínic

In recent decades, it has been discovered that motor symptoms can be preceded by prodromal symptoms, such as loss of olfactory acuity, constipation, sleep disorders, apathy or pain beyond muscle stiffness. In fact, these non-motor symptoms can become as serious and disabling as the motor symptoms throughout the course of the disease. However, as Dr. Francesc Valldeoriola, head of the Parkinson's and Movement Disorders Unit at Hospital Clínic, points out, "no two Parkinson's cases are the same: some are frankly benign and take many years to develop complications."

In general, when Parkinson's disease progresses favourably and without complications, it does not reduce life expectancy. However, factors such as severe dysphagia, dementia or falls with fractures can worsen the short-term prognosis. Among the most frequent acute complications are hyperpyrexia syndrome – triggered by the reduction of medication doses –, acute cessation of movement, episodes of involuntary movements and withdrawal syndrome associated with certain drugs.

Cognitive impairment may also occur, although, as Dr. Almudena Sánchez, a neurologist at the Hospital Clínic Barcelona, ​​points out, “it usually occurs in much more advanced stages of the disease.” Cognitive impairment is the main symptom of Alzheimer's, but, as Dr. Valldeoriola points out, “the cognitive disorder associated with Parkinson's is generally not similar to that of Alzheimer's.”

The causes of the disease remain unknown. According to Dr. Yaroslau, “there may be a combination of genetic factors and, most likely, environmental factors.” Since the late 1990s, genetic mutations linked to clinical symptoms similar to classic Parkinson's have been identified, although they only explain 2% of sporadic cases and 7% of familial cases.

Among the best-documented environmental risk factors are pesticides. Living in rural environments, exposure to heavy metals, and head trauma have also been suggested as contributing factors to the development of the disease. Due to the complexity of Parkinson's and its symptoms, diagnosis remains clinical, i.e. based on an interview with the patient and a physical examination. However, there are additional tests that can help rule out other causes or diseases, such as blood and other biological fluid tests, structural neuroimaging, or functional neuroimaging.

There may be a combination of genetic factors and, certainly, environmental factors. Doctor Yaroslau Compta Neurologist at Hospital Clínic Barcelona

Unfortunately, Parkinson's is a chronic disease. As Dr. Sánchez points out, "currently available treatment is not curative," but rather focuses on alleviating symptoms. As for non-pharmacological treatment, maintaining good lifestyle habits is essential. Speech therapy, cognitive stimulation, physical activity and, in the case of deficiency, vitamin supplements can also be of great help. In the initial stages, when the disease has little functional impact, it is recommended not to start pharmacological treatment for the symptoms.

If necessary, it is usually started at low doses and gradually adjusted to ensure tolerance. In addition, it is personalized according to the needs of each patient. There are also treatments for non-motor symptoms, such as constipation, depression, apathy or cognitive impairment. As a last resort, surgery may be used, although this option is limited to patients under 70 years of age or without active cognitive or psychiatric disorders.

It is clear, then, that Parkinson's is a complex disease that varies greatly from patient to patient. However, thanks to the treatments available, symptoms can be significantly alleviated.