The last stage of Parkinson's how long do they live? Parkinson's disease

Many people wonder how long people live with Parkinson's disease and how common is it? Parkinson's disease (PD) is recognized as one of the most common neurological disorders, affecting approximately 1% of people over 60 years of age.

Some estimates place the incidence of PD at 4.5–21 cases per 100,000 population per year, and prevalence estimates range from 18 to 328 cases per 100,000 people, with most studies finding the rate to be variable. The development of the disease in people under 40 years of age is relatively rare. Parkinson's disease is approximately 1.5 times more common in men than in women.

Parkinson's disease is a socially significant problem of modern medicine

Wide variations in estimates of global incidence and prevalence may result from a number of factors, including data collection methods, differences in population structures, patient survival, case detection, and analysis methodology used.

Impact of symptoms and medications on life expectancy of patients with PD

There are 2 main hypotheses for the development of PD: the destruction of pigmented dopaminergic neurons in the substantia nigra and the appearance of Lewy bodies. It is believed that most cases of Parkinson's disease (idiopathic parkinsonism syndrome) are caused by a combination of genetic and environmental factors. However, the environmental cause of PD has not yet been found.

In neurology, there are 3 most important symptoms of Parkinson's disease, which determine the life prognosis for patients - resting tremor, muscle rigidity and bradykinesia. Postural instability is sometimes referred to as the fourth cardinal feature of PD. Postural instability in PD is a late-onset phenomenon, and in fact, significant deterioration in body balance in the first few years suggests that the diagnosis has been misdiagnosed.

If a patient experiences tremor, the clinician will evaluate the medical history and physical examination to differentiate parkinsonian tremor from other types of hyperkinesis. In patients with parkinsonism, a careful medical history should be taken to rule out causes such as drugs, toxins, or trauma. It is also necessary to exclude essential, physiological and dystonic tremor.

Main symptoms of PD

Patients with typical signs of Parkinson's disease do not require laboratory or imaging testing. Patients aged 55 years and older most often have slowly progressive parkinsonism with resting tremor and bradykinesia or muscle rigidity.

Magnetic resonance imaging (MRI) of the brain can be used to rule out cerebrovascular disease (multifocal infarction), spatial lesions, hydrocephalus, and other disorders.

Single-photon emission computed tomography (SPECT) may be used in cases of indeterminate parkinsonism to help differentiate disorders associated with dopaminergic neuron loss from diseases that are not associated with nerve cell degeneration (eg, essential, dystonic or psychogenic tremor, vascular or drug-induced parkinsonism) .

Levodopa in combination with a decarboxylase inhibitor such as carbidopa remains the gold standard for the symptomatic treatment of motor disorders in PD. The drug provides the greatest antiparkinsonian effectiveness with the least side effects in the short term. However, its long-term use is associated with the development of akathisia and dyskinesia, especially in the late stages of Parkinson's disease.

Dopamine receptor agonists (pramipexole and ropinirole) can be used as monotherapy to improve symptoms of early PD or in addition to levodopa in patients who suffer from motor impairment.

Pramipexole can be used as monotherapy or in combination with levodopa

Monoamine oxidase inhibitors (MAOIs), such as selegiline and rasagiline, have moderate therapeutic efficacy. Catechol-o-methyltransferase inhibitors reduce the peripheral metabolism of levodopa, thereby increasing its bioavailability to the brain over a longer period.

Life expectancy and causes of death from PD

How long do people live with Parkinson's disease and how to cope with it? Before the introduction of levodopa, Parkinson's disease caused severe disability or death in 25% of patients within 5 years, 65% within 10 years, and 89% within 15 years. The mortality rate for Parkinson's disease is 3 times higher than that of the general population by age, gender and race.

With the introduction of levodopa, mortality in Parkinson's disease decreased by approximately 50%, and life expectancy increased by 20 years. This is thought to be due to the symptomatic effects of levodopa, as no clear evidence suggests that the dopamine precursor is responsible for the progressive nature of the disease.

The life expectancy of patients with PD has been steadily increasing in recent years.

The American Academy of Neurology notes that the following clinical features can help predict the rate of progression of Parkinson's disease:

• young age and muscle stiffness in early PD can be used to predict the rate of development of akinesis;
• a more rapid development of motor disorders is observed in male patients with concomitant diseases and/or postural instability;
• Early onset of PD, dementia, and decreased sensitivity to dopaminergic therapy may predict earlier nursing home placement and how long the patient will live.

The patient's age plays a key role in the prognosis of Parkinson's disease. Young patients are at greater risk of developing movement disorders (dyskinesia) during levodopa therapy for PD than older patients. If the patient does not respond to levodopa treatment, the prognosis is usually much worse. The chances of dying in the next 10 years, in this case, also increase significantly.

There is growing evidence from research that PD progresses more slowly when treated with dopamine agonists. Similar prerequisites exist for drugs from the group of MAO-B inhibitors. However, until now these assumptions have not been proven in large-scale studies.

In early stage PD, bromocriptine causes significant clinical improvement in patients

The increase in life expectancy in Parkinson's is due to the fact that the drugs significantly eliminate the main complaints of patients with PD.

The positive effect of levodopa on life expectancy appears only in patients with idiopathic parkinsonism syndrome. Atypical parkinsonism, in which patients do not respond sufficiently to levodopa treatment, usually has a significantly worse prognosis.

Patients with PD most often die from complications; upper respiratory tract infections, aspiration pneumonia, dysphagia, severe injuries (acquired as a result of senile insanity), atherosclerosis or thrombosis of the lower extremities. Prolonged physical inactivity (lying down) also shortens the life of patients.

The last phase of PD is not amenable to drug or other therapy. Depending on how many dopaminergic neurons in the substantia nigra are affected will determine the prognosis of patients with late-stage Parkinson's disease.

The old name for this very characteristic disease is “shaking palsy.” This disease received its own name from the English physician James Parkinson, who first drew attention to it by publishing the book “An Essay on Shaking Palsy.”

Parkinson died in 1824, shortly before the discovery of anesthesia. But his ideas and work were in demand in the future. The great French neurologist Jean-Martin Charcot (born a year after Parkinson's death) studied shaking palsy extensively, and named it after his predecessor.

In fairness, it should be noted that the first information about the symptoms of the disease is found in ancient Egyptian papyri, and in Ayurveda, as well as in the texts of the Old Testament.

What is Parkinson's disease, what are its causes, how does it progress and how is it treated? Let's look into these issues.

Parkinson's disease - what is it?

Two completely fair definitions of this disease can be given. The first is morphological, more “scientific”: Parkinson’s disease is a movement disorder of idiopathic etiology (of unknown cause), which is based on changes in dopaminergic neurons of the subcortical structures of the brain, lying in the dense part of the substantia nigra and other nuclei.

If nothing is clear, then a second, clinical definition can be given in simpler language: Parkinson's disease is a disease that is manifested by a triad of symptoms: akinesia (movement disorder), muscle rigidity and tremor.

It is important that Parkinson's disease is a special case of a group of diseases that manifests itself as parkinsonism (akinesia, tremor and rigidity).

The only difference between Parkinson's disease and parkinsonism is that parkinsonism has a known cause, while Parkinson's disease occurs without them and is hereditary. Therefore, when considering the causes of the disease, we will mainly consider secondary parkinsonism.

Causes of Parkinson's disease and hereditary factors

In order for parkinsonism to develop, the neurons that contain melanin must degenerate and therefore darken these structures: the substantia nigra and striatum.

In Parkinson's disease, both right and left structures are affected, and in parkinsonism, unilateral damage is possible. In this case, symptoms occur on the opposite side of the body due to the intersection of nerve pathways. The causes of Parkinson's disease are a number of factors that provoke the development of parkinsonism:

• Encephalitis, especially lethargic and progressive forms;
• Cerebral atherosclerosis, expressed in the elderly. Therefore, certain features of the disease can be found in old people with deep “sclerosis”;
• Tertiary syphilis of the brain, affecting subcortical structures;
• Damage to the midbrain area by a tumor;
• Post-traumatic lesion (formation of a contusion focus in the area of ​​subcortical structures);
• Hemorrhagic or ischemic stroke in the corresponding area. This syndrome is called Benedict's syndrome and is caused by damage to the red nucleus, causing tremors on the opposite side of the body;
• Intoxication with carbon monoxide (carbon monoxide), manganese and its derivatives, organophosphorus compounds.

Young readers don’t know, but people aged 40 will probably remember that their grandmothers in the 70s and 80s of the last century could take such drugs “for blood pressure” as “Raunatin”, “Rauvazan”. They contained rauwolfia alkaloid. With long-term treatment (years) from these drugs, parkinsonism also developed.

As already mentioned, the cause of Parkinson's disease can be hereditary - for blood relatives of the patient, the risk of developing Parkinson's disease increases 10 times compared to ordinary families. In fact, identifying the cause does not affect the treatment of Parkinson’s disease, but we will consider this below.

The incidence of the disease is, on average, one case per 1000 people, but its frequency increases with age.

The clinical picture of this disease consists of several characteristic symptoms and signs of Parkinson's disease: akinesia, rigidity and tremor. In addition, autonomic disorders occur in the form of hypersalivation, facial seborrhea and other symptoms. Let's look at these signs separately.

• Akinesia

The patient's mobility is slowly but steadily decreasing. Facial expressions and all manifestations of expression disappear from his face: anger, joy. It becomes very difficult to start moving. The patient resembles a vulture trying to take off from a flat field after a full dinner. The vulture makes several awkward jumps, and the patient shuffles on tiptoes, and then walks.

Even worse is the end of the movement: he cannot stop suddenly. Additional steps are again required.

Symptoms of Parkinson's disease include propulsion, retropulsion (stepping backwards when pushed in the chest), and lateropulsion (stepping sideways). All movements become complex, slow and incomplete. The patient does not have any unnecessary movements. He does them only when absolutely necessary. Even when walking, the arms do not move, and only the legs take small steps.

The face becomes frozen and mask-like. The eyes “live” on the face and blink very rarely. The patient prefers to communicate with the eyes, for example, by pointing to the desired object. Speech is quiet, monotonous, dysarthria appears due to tongue tremor.

• Rigidity

If you take the arm of a patient who has suffered a stroke, then when you try to bend or straighten it, there will be a distinct resistance at the elbow at the beginning of the movement (the “jackknife” symptom). If you do the same experiment with a patient with shaking paralysis, then a viscous resistance, similar to wax, is clearly observed, despite all requests to relax.

The muscles in Parkinson's disease simply never relax - this leads to some of the characteristic signs of Parkinson's disease. If muscles lend themselves to passive movement, then only in jerks, since their tone changes in steps. This leads to the “cogwheel” symptom, or as neurologists call it, the manifestation of “cogwheel.”

If you lift the head of a lying patient and then suddenly release it, you don’t have to worry about it falling. It will slowly descend, like the second hand on a watch, without any paralysis or muscle weakness.

• Tremor

Most patients have tremor, but some may not have it. This is a low frequency tremor (5-6 movements per second). Its cause is a “game” between opposing muscles - antagonists, which cannot come to a state of rest.

An important feature of Parkinsonism is the disappearance of tremor with conscious movement, for example, when asked to show the tip of the nose. With essential and cerebellar tremor with intention, the trembling will only intensify. Also, tremor is absent during sleep.

The type of movements is also characteristic: it is similar to “rolling a piece of paper”, “bread crumb”, or a movement such as “counting coins”. Tremors are especially pronounced in the hands.

• Autonomic disorders

In parkinsonism, salivation changes. A large amount of sebum is secreted, the face becomes oily, and is often covered with sweat. Seborrheic phenomena appear. Patients experience increased salivation.

As you can see, such a vivid clinical picture allowed Parkinson to specially note this disease at the turn of the 18th-19th centuries and devote an entire monograph to it.

About the stages of Parkinson's disease

Over the years, many classifications of the disease have been proposed. One of the most popular was created by doctors Hen and Yar in the 60s of the last century:

1. At the first stage, the lesion is unilateral;
2. The second stage – bilateral symptoms appear;
3. The third stage is characterized by a developed clinical picture;
4. The fourth stage involves outside help;
5. The fifth stage is profound disability.

The stages of Parkinson's disease can also be classified according to the degree of predominance of symptoms (for example, there is a “non-shaking form” of shaking paralysis, that is, predominantly manifestations of akinetic-rigid syndrome).

When diagnosing this disease, it is necessary to exclude diseases that cause parkinsonism. Thus, progressive supranuclear palsy, strionigral degeneration, Lewy body disease, or Machado-Joseph disease are considered.

Alzheimer's disease and Parkinson's disease do not coexist in the same person. With Alzheimer's, intelligence and memory suffer, and social behavior is disrupted. It is difficult to care for the sick, as they are unkempt and can leave home without finding their way back.

In Parkinson's disease, the patient's untidiness is not due to the fact that he "doesn't care", but because it is difficult for him to move, and he will not leave the house; the intelligence of "Parkinson's" patients does not suffer, despite the fact that it is difficult for them to express their thoughts . Therefore, it is difficult to confuse these diseases.

Therapy for shaking palsy is a lengthy and relatively expensive process. The goal of treatment is to maintain a balance between the dopamine and acetylcholine systems, because in the disease there is inhibition of the first of them. Therefore, it is necessary to either increase dopaminergic activity or reduce cholinergic activity.

The disease has no cure, and the goal of treating Parkinson's disease is to reduce symptoms. The following drugs that increase dopamine are used:

• Levodopa – used for disabling forms, reduces hypokinesis and rigidity;
• Bromocriptine (dopamine agonist);
• Selegiline (“Yumex”) is a dopaminomimetic;
• Amantadine (indirect-acting dopaminomimetic).

Anticholinergics are indicated in the initial stages of Parkinson's disease, for example, to reduce tremor: prophenamine, benzatropine, trihexyphenidine.

Almost all medications for parkinsonism have complex administration regimens that require constant supervision by a specialist and monitoring of side effects, which the drugs have in abundance.

Therefore, combined methods are often used, for example, levodopa in small doses + bromocriptine.

Despite many medications, cyclodol is still used, which relieves tremors. Its side effects are euphoria and hallucinations, as well as psychosis, so it is limited in use, although it is included in the list of vital drugs, primarily due to the low cost of production.

Severe Parkinson's disease may not be stopped by treatment with pills. Surgical methods are used, as well as minimally invasive neurostimulation.

Forecast

Sometimes you can hear the following question: “Parkinson’s disease, last stage - how long do they live?” In this case, the disease is fatal due to intercurrent diseases. Let's explain with an example.

There are diseases, the very course of which leads to death, for example, peritonitis, or hemorrhage in the brain stem. And there are diseases that lead to profound disability, but do not lead to death. With proper care, the patient can live for years, even when switching to tube feeding.

The causes of death are the following conditions:

• Hypostatic pneumonia with the development of acute respiratory and then cardiovascular failure;
• The appearance with the addition of a secondary infection and;
• Habitual constipation, intestinal paresis, autointoxication, vascular collapse.

If the patient is properly cared for, he can live for years, even if he is bedridden. Remember the example of Prime Minister Ariel Sharon, who suffered a severe stroke in 2006 and died without regaining consciousness 8 years later, in January 2014.

He was in a coma for 8 years, and treatment was stopped at the request of his relatives when he turned 86 years old. Therefore, the issue of maintaining the life of a patient with parkinsonism is resolved simply - this is care and support, since the disease does not lead to the immediate death of the patient.

Parkinson's disease, the symptoms and signs of which we have examined, is one of the most striking and memorable in the course of nervous diseases. It leaves a deep impression on students and they remember this disease well. We hope that this article will also leave a mark in your memory, and when you see a patient with signs of shaking palsy, you will be able to determine where the akinesia is, where the rigidity is, and how the tremor is expressed.

This knowledge will not be superfluous - this way you will be able to identify the lesion in your family and friends in time, and begin timely treatment.

Parkinson's disease (shaking palsy) is a progressive chronic disease of unknown origin caused by degenerative damage to the nerve cells of the brain in the basal ganglia region.

The disease is caused by a decrease in the level of the neurotransmitter dopamine.

As a result of the lesion, the conduction of signals from the central nervous system is disrupted, manifested by signs of changes in muscle tone, a decrease in cognitive activity and intelligence. The disease is continuously progressive.

Parkinson's disease and life expectancy are related to a number of different factors - the age and physical condition of the patient, as well as the quality and timeliness of the care provided to him, play a major role.

The symptoms of the disease are quite varied. Characteristic signs are trembling of the body (tremor), especially the arms and legs, inhibition of movements (bradykinesia), gait in short steps, and a “bending posture.” The voice changes and becomes monotonous.

The patient complains of difficulty starting movement, especially taking the first few steps, difficulty ending movement and stopping.

Problems with maintaining balance appear, especially with an unexpected change in body position (postural instability).

Complaints of general stiffness and “numb limbs” appear.

Often, excess saliva accumulates in the mouth, uncontrollable drooling appears, and difficulty swallowing occurs.

During a medical examination, signs of the “cogwheel” syndrome characteristic of this disease are revealed in the affected limbs - their flexion is accompanied by rhythmic twitching. Signs of high muscle tone and resistance to movement (extrapyramidal muscle rigidity) appear.

In this case, close attention is paid to the state of the patient’s nervous system, namely, disturbances in motor activity, the appearance of twitching (hyperkinesis) or immobility (hypokinesia) of muscles, as well as their combinations.

The combination and severity of these signs indicates the presence of the disease.

In the treatment of Parkinson's disease, an integrated approach is used - drug treatment, breathing exercises, and taking folk remedies. We'll look at it in the next article.

Let's look at methods for diagnosing Alzheimer's disease. Instrumental methods and testing.

And in this topic we’ll talk about possible complications of Parkinson’s disease, as well as treatment methods.

Stages of pathology

The most commonly used classification of stages is according to Hoehn and Yahr:

• 0. No disease.
• 1. Symptoms of the disease appear on one of the limbs.
• 1.5. Symptoms are present on one of the limbs and the trunk.
• 2. Symptoms are present on both sides of the body, there is no postural instability.
• 2.5. Symptoms are present on both sides of the body. There is postural instability, but the patient can overcome it.
• 3. Symptoms and postural instability are present bilaterally. The patient can take care of himself.
• 4. Immobility. The patient needs outside help, but can walk independently.
• 5. Chained to one position. Severe disability.

The clinical picture of the disease appears after damage to two-thirds of the neurons in the brain.

Forecast

The disease is classified as chronic, the signs of the disease increase, and the prognosis is conditionally unfavorable. Without drug treatment, the disease passes from the first stage to the fourth after an average of eight years, and after ten years to the fifth. The lack of dopamine is partially compensated by medications, but they do not stop the development of the disease.

Since 2011, the disease has received widespread treatment. When taking the drug Levodopa, the disease enters the fourth stage after fifteen years.

The rate at which symptoms develop is individual in each case. It is noted that with early onset, motor disorders increase more actively, and at the age of seventy years and older, mental disorders are more pronounced.

Life expectancy is shortened. This is not due to the disease itself, but to increasing neurological disorders and the somatic diseases caused by them.

The most common among them are:

• diseases of the respiratory system (asthma, pneumonia);
• cardiovascular diseases (heart attack, stroke);
• kidney and liver damage, gastrointestinal diseases;
• infections of various origins (inflammation of the brain (meningitis));
• physical injuries due to impaired motor activity (postural instability).

It is necessary to avoid being bedridden for as long as possible, because... such a regimen can provoke serious complications of secondary diseases.

Ways to extend life

The ability to move is one of the key ways to prolong life. Assistance should be provided in the patient's movement, at least at home. If possible, it is necessary to find an option for ongoing assistance.

Exercise therapy and sports are extremely useful, mitigating symptoms and maintaining mobility for as long as possible.

It is necessary to regularly take medications that slow down the development of symptoms (muscle rigidity, postural instability, hypokinesia, tremor).

The central drugs that eliminate muscle tone disorders are drugs that increase the level of dopamine in the central nervous system (dopaminergic drugs):

1. Levodopa. To increase the effectiveness of action, it is often used in conjunction with DOPA decarboxylase inhibitors and COMT inhibitors.
2. Dopamine receptor agonists (Ropinirole, Bromocriptine, Cabergoline, etc.).
3. MAO-B inhibitors (Selegiline, Rasagiline, etc.).
4. Dopamine reuptake inhibitors.
5. Central anticholinergic blockers.

In cases of ineffectiveness of conventional means, surgical methods are used.

For unilateral tremor, which is the leading symptom of the disease, surgery is performed on the thalamus (thalamotomy). If symptoms of movement disorders predominate, surgery is performed on the basal ganglia of the brain (pallidotomy).

Surgical treatment methods are relatively safe and lead to an improvement in the patient's condition.

Modern medical devices make it possible to carry out such operations without surgery, using radiation therapy (radiotherapy) methods.

One of the newest minimally invasive treatment methods is neurosurgery for neurostimulation of the brain. To achieve this, a series of measures are carried out to electrically stimulate special parts of the brain, followed by the implantation of a special neurostimulator. The operation gives good results, is easily tolerated and quite safe. Currently, its only disadvantage is its high price.

Life expectancy statistics

Modern therapy slows down the rate of disease progression. Nevertheless, the working capacity of most patients is significantly reduced within ten to fifteen years after the onset of the disease, and they are diagnosed with disability.

Patients at greatest risk are those on constant bed rest. They account for about 24% of deaths.

The second in the group are patients with untreated infectious diseases of the brain.

The mortality rate is about 20%. Cerebrovascular accidents cause death in 4% of cases.

With timely treatment, the life expectancy of people suffering from Parkinson's disease can be up to twenty years or more. Treatment methods for the disease are constantly being improved. Currently, research is being conducted on stem cell treatments and the development of a therapeutic vaccine.

Parkinson's disease is a disease known to mankind since ancient times. In the 19th century, the doctor D. Parkinson described the characteristic symptoms and came to the conclusion that it was shaking paralysis. The disease was named after the scientist - Parkinson's disease. What is this? How does modern medicine see this disease and its treatment methods?

Characteristic

Parkinson's disease is a central nervous system disorder that primarily affects the functioning of the musculoskeletal system. It mainly occurs in old age (after 70-80 years), but there are also cases of the disease developing after 40 years. Statistics show that every 500 people on the planet suffer from this disease.

Many people consider Parkinson's and Alzheimer's diseases to be similar. In both cases, the central nervous system is affected to one degree or another, but the mechanism of development itself is very different. It is characterized by cognitive disorders, and in Parkinson's, the musculoskeletal system is predominantly impaired.

Anatomy of a disease

The central nervous system is responsible for making movements. As soon as a person thinks about what he wants to do, the cerebral cortex already sends a signal to all systems that will be involved in the action. One of the signal receiving parties is the basal ganglia. This is an element of white matter in the form of neural nodes that are involved in complex and complex movements. How accurate, high-quality and fast the action will be depends on the quality of the impulses they transmit.

The process is regulated by the neurotransmitter dopamine. Parkinson's disease affects certain areas as a result of which the conduction of nerve impulses is disrupted. In addition, patients experience a decrease in the level of dopamine, which is responsible for inhibiting constant excitatory signals in the brain. As a result, some of them are transmitted directly to the muscles and stimulate their contraction. What provokes hypertonicity and frequent tremors, explained by constant tension of muscle tissue.

Causes

It has been a long time since a collection of symptoms began to be considered as a separate disease. The mechanism of disorders of the central nervous system in many respects is still presented only theoretically, in particular Parkinson's disease. Scientists know what it is, but what contributes to its formation is unknown. The following factors are believed to influence the development of the disease:

• aging of the body - a natural decrease in the number of nerve cells and dopamine production;
• hereditary factor - the existence of the Parkinson's disease gene has not been scientifically confirmed, but 10% of patients in the family tree have a relative with a similar pathology;
• long-term intoxication (exposure to heavy metals, toxins, pesticides);
• the use of antipsychotics (they reduce the production of dopamine and can provoke illness);
• brain injuries and tumors;
• stress, poor sleep and nutrition, lack of vitamins;
• other diseases.

The causes of Parkinson's disease and treatment are directly dependent on each other. The doctor will proceed from what triggered the development of nerve impulse conduction disorders. High-quality treatment of the root causes will give good results in the general treatment of the disease.

Symptoms

Knowing the first signs of the disease can help in early diagnosis and treatment, which increases the chances of recovery and In the table we consider the main symptoms and the nature of their occurrence:

Clinical picture of Parkinson's disease

	Characteristic
Tremor (shaking)	Occurs in the limbs, lower jaw, eyelids, and head. Manifests itself in the form of uncontrollable trembling, which is explained by excessive contraction of muscle tissue
Rigidity	A decrease in dopamine leads to a lack of inhibition of muscle contractions, which leads to tone. As a result, the muscles become hard and lose elasticity and mobility. Feels like stiffness of movement
Hypokinesia	Disturbances in the structure of the basal ganglia lead to a decrease in motor activity. Actions will be performed slowly and with difficulty
Bradyphrenia	Decreased thought processes, slow and quiet speech. Occurs due to damage to nerve cells and lack of dopamine
Unsteady movements	Destruction of the basal ganglia leads to difficulty maintaining balance, as a result of which gait is disrupted: steps become short and slow
Mental disorders	The development of the disease leads to a decrease in mental abilities, disturbances of consciousness, insomnia, depression, and general weakness

Patients with Parkinson's disease are restricted in their movements. A typical picture of the appearance of such a person: arms are bent at the elbows and pressed to the body, the body is slightly bent, and the weight is shifted forward, the head is slightly elongated. Periodic trembling of the limbs is noticeable, the face is calm and does not express any emotions.

Parkinson's disease and life expectancy

One of the most concerning questions for patients and their relatives is: “How many years can you live after diagnosis of the disease?” The answer of experts is this: “When the disease occurs at an early age, life expectancy is much higher than in old age.” Recent studies indicate an average of 7.4 years. This is the lifespan of the average person diagnosed with Parkinson's disease.

And it would be biased to estimate life expectancy only based on the age of the patient. The rate of progression depends on many factors, which today, fortunately, can be influenced:

• quality of medical care and care;
• Country of Residence;
• timeliness of diagnosis and initiation of therapy.

Research conducted in Britain suggests that for central nervous system lesions occurring around the age of 40 years, the average life expectancy is 39 years. It turns out that, regardless of whether the disease develops or not, a person has every chance of living to a ripe old age. Of course, this is only possible if you maintain a healthy lifestyle and therapeutic treatment aimed at slowing the progression of the disease.

Stages of development

The disease does not appear out of nowhere; it gradually progresses. Each stage is characterized by specific symptoms. Based on the form of Parkinson's disease, the treatment method is determined. There are 6 stages of the disease:

1. Initial (zero) - there are no symptoms, but you can already notice increased absent-mindedness and forgetfulness.
2. The first is a one-sided lesion, the symptoms are weak. At this stage, few people go to the doctor.
3. The second is that the disease affects both limbs, the balance of the body is disturbed, and it is difficult for the patient to maintain balance.
4. Third - it becomes difficult to walk without support, the tremor increases.
5. The fourth is a complete lack of ability to independently carry out movements and walk, but the ability to stand without support is retained. The sick person needs careful care and assistance.
6. Fifth - the person is bedridden, there is a complete loss of control over the musculoskeletal system.

Each stage of disease development requires an individual approach. If initial signs occur, you should immediately consult a doctor. Early therapy will help defeat Parkinson's disease and life expectancy will increase significantly.

Diagnostics

When visiting a doctor at any stage of the disease, a clinical examination is prescribed, which helps determine an accurate diagnosis. The doctor relies on the following algorithm:

• examination and identification of signs confirming the presence of parkinsonism;
• determining the nature of the disease: secondary parkinsonism caused by heart disease and brain damage, or independent;
• confirmation of the diagnosis based on the collected medical history and laboratory and other diagnostic procedures performed.

Most often, modern diagnostics are used: CT, MRI, PET, or an examination of cerebral vessels (REG, EEG) is prescribed.

Characteristic symptoms include signs confirming muscle tone, the long course of the disease and its progression. For example, passive flexion of a joint should be accompanied by relaxation of the nearest muscles, but in the patient, on the contrary, their contraction occurs.

Drug treatments for Parkinson's disease

Making a diagnosis does not always mean immediate treatment. The doctor evaluates all possible risks and complications, the duration of the disease and the speed of its progression. How to treat Parkinson's disease? The therapeutic effect is based on taking medications that are aimed at producing dopamine and blocking elements that destroy it. For these purposes the following means are used:

• containing dopamine, its precursors or agonists (Levodopa, Lisuride, Ropinirole, Bromocriptine);
• blocking enzymes that promote the destruction of dopamine (MAO inhibitors and COMT);
• facilitating the release of neurotransmitter reserves (Bemantan, Amantadine);
• blocking excessive excitation of neurons (Biperiden, Trihexyphenidyl, Procyclidine, Memantadine);
• neuroleptics, antihistamines, as well as antidepressants and muscle relaxants.

In the early stages, opinions on how to treat Parkinson's disease with medications are often highly individual. For example, Levodopa is considered a more serious drug and they prefer to delay its use. Other groups of drugs (agonists and COMT) act more gently and prevent the disease from progressing. It is thanks to such drugs that it becomes possible to delay taking Levodopa.

End-stage treatment

Regardless of the nature of the course of the disease, there comes a point in its development when the disorders become irreversible and significantly increase in number. Long-term use of the drug "Levodopa" (about 5 years or more) leads to the formation of resistance to its effects. There is a need to increase single doses, which entails other problems.

Treatment of the patient comes down to providing quality medical and household care. The dosage of medications taken is adjusted daily depending on the body's response and effectiveness.

Methods of surgical treatment

Surgical intervention is rarely used and only in cases where conservative treatment is powerless. The operation is performed on the brain: thalamus or cortex. Several approaches to such treatment have been developed:

• Electrical stimulation of the motor parts of the brain - electrodes are inserted into the patient’s brain structure and connected to a neurostimulator implanted under the chest. The procedure slows down Parkinson's disease. Reviews about the operation are positive: the general condition improves, the tone and stiffness of movements decrease, the disease progresses more slowly.
• Thalamotomy is a risky method, but sometimes brings good results and restores motor activity of the musculoskeletal system. It involves the destruction of certain structures of the thalamus.
• Dopaminergic tissue transplantation is an experimental approach based on the transplantation of a donor substance. Helps normalize dopamine production and restore motor functions.

Surgery is the last resort for treating Parkinson's disease. The global community of scientists is actively developing and improving existing methods of invasive and conservative effects on the brain.

To maintain the body, you should reconsider your lifestyle and change some habits. The patient must give up harmful addictions, improve his diet, rest more time and not be needlessly nervous. Therapeutic exercise, fresh air and professional massage will also not prevent you from regaining your strength.

It is not forbidden to try traditional treatment for Parkinson's disease, based on the use of medicinal plants. At the same time, do not forget about the need to take medications: natural remedies play a supporting role, but not the main one. Linden, propolis, oats, sage, and St. John's wort are used for treatment. They have an anticonvulsant and muscle relaxant effect.

Parkinson's disease and life expectancy directly depend on the severity of brain damage, the rate of progression, and the current condition of the patient. Early diagnosis and treatment, as a rule, provide up to 20-30 years of life.

“My husband is an officer, a very balanced person. He worked all his life, never complained about anything, I never heard from him about fatigue. But about six years ago he became too quiet, didn’t talk much - he just sat and looked at one point It didn’t even occur to me that he was sick. On the contrary, I scolded him for growing old before his time. Around the same time, a cousin from England came to us - she works in a hospital - and immediately said that Rafik was doing very poorly and needed to be seen tomorrow. and take him to the doctor. That’s how we learned about Parkinson’s disease,” recalls Seda from Yerevan.

What is Parkinson's disease

Parkinson is one of the scariest names you can hear in a neurologist's office. It was worn by an English doctor who, in 1817, described in detail six cases of a mysterious illness. James Parkinson's birthday is April 11, and is chosen as a memorial date by the World Health Organization. Because of the main symptoms, Parkinson called the disease shaking palsy: the patients’ movements slow down, become stiff, muscles become very tense, and arms, legs, chin or the whole body shake uncontrollably. However, in a quarter of cases there is no trembling - the most well-known sign of the disease.

All this resembles ordinary old age. Motor symptoms - collectively called parkinsonism - occur in many healthy older people. But Parkinson's disease doesn't stop there. In the later stages, a person easily loses balance, continually freezes in place while walking, has difficulty speaking, swallowing, sleeping, anxiety, depression and apathy appear, suffers from constipation, blood pressure drops, memory weakens, and in the end dementia often develops. The saddest thing is that it is not yet possible to cure Parkinson's disease.

At the beginning of the 20th century, Russian neurologist Konstantin Tretyakov found out that in Parkinson's disease, cells of the substantia nigra, an area of ​​the brain that is partially responsible for movement, motivation, and learning, die. What causes neuronal death is unknown. Perhaps this is due to malfunctions inside the cells, but it has also been noticed that harmful protein accumulates inside them. Both processes are probably somehow connected, but scientists do not know exactly how.

In 2013, physiologist Susan Greenfield from the University of Oxford presented a new model for the development of neurodegenerative diseases, including Parkinson's and Alzheimer's diseases. Greenfield suggested that when the brain is damaged, for example, from a strong blow, a special substance is released. In young children it causes new cells to grow, but in adults it appears to have the opposite effect, further damaging the cells. This is followed by an even greater release of the substance, and the chain reaction gradually destroys the brain. In a cruel irony, adults fall into infancy because of an enzyme needed by babies.

However, Greenfield’s guess does not explain everything. Parkinson's disease is associated with heredity: a close relative with the same diagnosis or tremor of a different nature is the main risk factor. In second place is constipation: sometimes they are caused by changes in the brain when motor symptoms have not yet appeared. The risk also increases if a person has never smoked, lives outside the city, drinks well water, but has encountered pesticides, and decreases for coffee drinkers, alcoholics and hypertensive patients. What is the secret here is unclear, just as it is unclear why Parkinson’s disease usually begins in old age: if in the fifth decade approximately one in 2,500 people is affected, then in the ninth - already one in 53.

A new lead was provided by fresh work from scientists from Thomas Jefferson University: perhaps Parkinson's disease is associated with the immune system. The researchers took mice with a mutant gene that is often found in patients and injected them with harmless remains of bacteria. Because of this, inflammation began in the animals, which also affected the brain, and there were 3–5 times more immune cells than in ordinary mice. Because of this, processes began in the mutants’ brains that were destructive to the neurons of the substantia nigra. As in Greenfield's model, these processes appear to be cyclical: inflammation in the brain can remain even after the body has dealt with the infection. However, the authors of the study themselves admit that much about this mechanism is still unclear.

What is life like for patients and their loved ones?

In Russia, approximately 210–220 thousand people have Parkinson’s disease. But these data are calculated using indirect indicators, and there is no single register. Anastasia Obukhova, a candidate of medical sciences from the Department of Nervous Diseases at Sechenov University and a specialist in Parkinson's disease, considers these statistics to be underestimated. “Many patients come for the first time already at the advanced stages of the disease. When questioned, it is possible to find out that the signs appeared several years ago. Most of our people have the principle “Until the thunder strikes, a man will not cross himself”: they read on the Internet, ask their neighbors, and They don’t go to the doctor. This is in Moscow, but in small towns and villages they go to the doctor only if they are completely dying,” explains Obukhova.

In addition, getting an appointment is not so easy. To do this, you first need to go to a therapist so that he can refer you to a neurologist. But even then there is no guarantee that the person will be given the correct diagnosis and prescribed the necessary treatment. “A doctor in a clinic cannot understand everything, so he must send the patient to a specialist. And the district parkinsonologists, in my opinion, have been removed. In any case, patients complained about this,” says Obukhova. True, if the patient does get to the right doctor, he will be treated at the world level. That’s why people fly to Russia with Parkinson’s disease even from other countries.

The odyssey through the offices has to be repeated often, because the disease progresses - therapy needs to be adjusted. Treatment is expensive: a month's supply of some drugs costs 3-5 thousand rubles, and in the later stages several drugs are prescribed at once. “In district clinics, medicines are sometimes given free of charge, but only cheap generics. I will not comment on their quality. Sometimes the necessary medicines are not available. Then they are replaced with something else. This makes patients feel bad,” explains Obukhova.

Over time, the pills stop working. “She takes the medicine for half an hour, the rest of the time she screams and makes very loud noises, both day and night. Nothing helps her,” says Lina from Kharkov. Her mother Larisa was diagnosed with Parkinson's disease at the age of 40. 22 years have passed since then. Larisa lives in Lugansk, her husband Alexander constantly looks after her. In the video that Lina showed, her mother, covered in perspiration, convulses and moans that she can’t do this anymore. Lina herself was tired. When asked about hospices, she replies that they are not accepted anywhere.

In Russia, according to Anastasia Obukhova, relatives of patients are forced to either hire a nurse or give up everything and care for the patients themselves. “[But] we have a dance school for patients with Parkinson’s disease, there are special schools where they have meetings, psychotherapy, and swim in the pool. But everything is based on the enthusiasm of the doctors who do this,” says Obukhova.

Ordinary people also need interest: if not in helping others, then in their own health. Several years before motor symptoms, other warning signs appear. Constipation, mood disorders, decreased sense of smell, erectile dysfunction, daytime sleepiness - all this may indicate the initial stage of Parkinson's disease. If any of this bothers you or your loved ones, especially in old age, it is better to see a doctor as soon as possible. Parkinson's disease is incurable, but its progression can be slowed down, and to do this it must first be recognized.

Marat Kuzaev