Parkinson's disease - causes, signs and symptoms, treatment of Parkinson's disease

Stages of Parkinson's disease according to Hoehn-Yahr

There are several classifications of the stages of Parkinson's disease, but the Hoehn-Yahr rating scale is considered the simplest and most convenient. It was developed by English doctors Margaret Hen and Melvin Yahr in 1967. The Hoehn-Yahr system is an international criterion that allows one to determine the intensity of disease progression and evaluate the effectiveness of treatment.

As with most diseases of old age, only earlier identification of signs in the initial stages and individually selected treatment for Parkinson’s disease will significantly slow down the progression of pathological processes. But, unfortunately, it is impossible to completely defeat this disease in old age.

Stage zero: structural changes

The ominous disease does not reveal itself in any way; there are no symptoms at all. And structural changes are already taking place in the brain. They are not always noticeable during a diagnostic examination. Many people are concerned about the health of their elderly relatives and want to know how to recognize Parkinson's disease at an early stage. As usual in such cases, it is necessary to carefully monitor the behavior of the relative and, if even the slightest deviation from the norm is detected, consult a doctor.

First stage: unilateral lesion

The first stage manifests itself when a person is agitated in any way. When the patient is worried, the fingers on one hand begin to tremble a little, which he usually does not pay much attention to. Over time, the shaking gets worse. Then it begins to become a permanent sign of the disease and is observed even during the rest period.

If an elderly person once slept well at night, now his sleep is disturbed. With any, even minor physical activity, severe fatigue quickly occurs, and there is often a depressed mood. A small percentage of older people have a distorted sense of smell. And subtle changes in facial expressions and gait appear. But they are almost invisible to outsiders and only very close people who know their dear pensioner well will be able to see them. At the same time, working capacity and normal lifestyle are still in the same volumes.

Intermediate or transitional stage

The disease then progresses and enters an intermediate stage. If you do nothing, an unpleasant tremor covers the entire arm; the shaking stops only during sleep. Handwriting changes and fine motor skills deteriorate. The patient feels stiffness in the neck and upper back. Hands stop moving when walking.

Second stage: bilateral lesions with preservation of balance

If treatment has not yet begun, the disease enters the second stage, in which the disease affects both sides of the body. Possible tremor of the tongue and lower jaw. Increased salivation is observed. Sweating is impaired, the skin becomes too dry or excessively oily. The facial expressions of your loved one are getting worse and worse, speech slows down, and the timbre of the voice changes.

Now the patient can only move slowly. The joints become less mobile, the person begins to fall due to disorders of the vestibular system. The patient often loses his balance, which can lead to severe fractures, after which he may become bedridden. At the second stage of the disease, a person is still able to perform usual actions, but they take much longer than before.

Stage three: bilateral lesions of moderate severity

The risk of falling and breaking bones due to clumsiness and loss of balance increases many times over. The muscles become inflexible, movements are constrained, and the joints work like a gear mechanism. The elderly begin to have problems with self-care; the patient has difficulty performing daily hygiene, nutrition and other activities. He can still take care of himself, but it all takes twice as long. A person needs help to fasten buttons, tie shoelaces, and get into sleeves. The progression of the disease is stronger and faster, characteristic symptoms appear:

• “doll gait” - steps become small, mincing, feet are parallel, shuffling movements;
• “supplicant pose” - the body leans forward, the head is tilted, the back is hunched, the legs are bent, the elbows are pressed to the body;
• “mask effect” due to limited facial expressions and slow blinking;
• nodding tremor of the head, reminiscent of gestures of agreement and denial;
• monotony and muffled speech, unambiguous answers, repetition of the same words.

Stage 4: Severe immobility with loss of balance

The fourth stage is already indicated by endless continuous tremor of the limbs and head. It is already becoming so pronounced that no one can confuse this disease with anything else. It very rarely stops. The patient's speech becomes unintelligible and nasal, and his voice becomes quiet. Now the patient cannot perform physical work at all, is unable to care for himself, cannot get out of bed and roll over on his own. He often falls, which often leads to serious injuries and fractures (as a rule, these fractures never heal). Therefore, in order to move, a person needs supporting devices - walkers, crutches, and a cane. Depression appears, thoughts of suicide arise, and dementia may develop.

Fifth stage: loss of ability to move

A person with Parkinson's disease rapidly loses weight, his body becomes increasingly depleted, and his already depressing depression and dementia worsen. The fifth stage ends the classification, with motor function completely impaired. The person becomes completely helpless and completely dependent on others. The development of the last stage is indicated by symptoms:

• inability to stand up, walk, or sit down independently (they use a wheelchair for movement or the patient constantly remains in bed);
• inability to eat due to tremor, limited movement and impaired swallowing function (the patient is fed using a special spoon or tube);
• difficulty controlling the process of urination and bowel movements;
• unintelligibility of speech.

Classification of parkinsonism

There is no perfect classification of parkinsonism. There are many gradations and scales that make it possible to fairly accurately determine the stage of parkinsonism, the level of activity, and the patient’s adaptive capabilities. In our article we will focus on some of the most popular classifications of Parkinson's disease (parkinsonism).

Classification of Parkinson's disease (parkinsonism) by severity (Hoehn-Yahr scale - Hoehn, Yahr, 1967)

• Stage 0.0 - motor manifestations and signs of parkinsonism are absent;
• Stage 1.0 - clinical manifestations are only unilateral;
• stage 2.0 - bilateral symptoms without postural reflexes, balance is not impaired;
• stage 3.0 - clinical manifestations are moderate, but bilateral, postural instability is slight, the patient does not need outside assistance;
• stage 4.0 - motor activity is significantly lost, but the patient is able to stand and move without support;
• Stage 5.0 - if there is no help from a third party, the patient will be confined to a chair or bed.

Classification of Parkinson's disease (parkinsonism) by secondary nature

1. Primary idiopathic parkinsonism - appears as an independent disease in the form of Parkinson's disease or juvenile parkinsonism.
2. Secondary symptomatic parkinsonism - with lesions of various origins (infectious, vascular, traumatic, toxic, drug-related), with a brain tumor, hydrocephalus, etc.
3. Parkinsonism syndrome - as a symptom of other diseases of the nervous system of a degenerative nature (strio-nigral degeneration, olivopontocerebellar degeneration, progressive supranuclear palsy, juvenile form of Huntington's chorea).

Classification of Parkinson's disease (parkinsonism) according to clinical form

• Trembling.

This form is characterized by almost constant trembling of the head, lower jaw, and limbs. The tremor is either medium or large amplitude. Muscle tone is preserved or slightly increased.

• Trembling - rigid.

It is characterized by tremor most often of the distal extremities. As the disease progresses, voluntary movements become stiff.

• Akinetic - rigid form - the most unfavorable.

Active movements are so slow that immobility may occur. Increased muscle tone. High risk of developing muscle contractures.

• Mixed.

One form passes into another.

Classification of Parkinson's disease (parkinsonism) according to the degree of manifestation:

• Stage 1 – slight increase in tone, trembling of fingers, bradykinesia is slightly expressed;
• Stage 2 – tremor of the fingers and hand (foot), rigidity and bradykinesia are manifested moderately;;
• Stage 3 – large-amplitude trembling of the fingers, the entire foot and/or hand, lower leg and/or forearm appears, the phenomena of bradykinesia and rigidity are sharply expressed;
• Stage 4 – the condition is severe, muscle tone is altered, symptoms of a “gear wheel”, “sticky ductility” is observed, flexion of the feet occurs, trembling of the head, limbs, tongue, and lower jaw.

Classification of Parkinson's disease (parkinsonism) according to social and everyday adaptation

• Stage 1 – early.

The clinic is minimal, does not interfere with a person’s daily activities, everyday activity is complete. The patient lives a full life.

• Stage 2 – expanded.

Daily activities are disrupted. Additional stimulation of dopamine receptors is necessary.

• Stage 3 – late.

Symptoms and syndromes are resistant to medications. Dementia develops, the patient loses balance, and is prone to falls and freezing.

Classification of Parkinson's disease (parkinsonism) by rate of progression

• Rapid rate of progression - the stages of the disease change within 2 years.
• Moderate rate of progression - the stages of the disease change over 2 to 5 years.
• Slow rate of progression - the stages of the disease change and the disease progresses over more than 5 years.

All these classifications of Parkinson's disease (parkinsonism) help prescribe adequate therapy and predict the risk of complications and the level of everyday and social activity of the patient.

Causes of Parkinson's disease

Among the causes of Parkinson's disease:

• Genetic predisposition (the disease is inherited).
• Natural aging (every year the body produces fewer and fewer neurons, which negatively affects the functioning of the nervous system).
• Environmental factors (toxins, herbicides, pesticides). It has been proven that people living near industrial zones get sick more often.
• Injuries (especially to the brain) affecting the state of the nervous system.
• Chronic cerebrovascular accidents.
• Brain tumors.
• Viral infections (can provoke the development of postencephalitic parkinsonism).
• Atherosclerosis of cerebral vessels (causes the death of nerve cells in the brain).

Hereditary predisposition and environmental factors play a dominant role in the development of Parkinson's disease. Their synthesis triggers the process of degeneration in pigment-containing and other neurons of the brain stem.

This reaction is irreversible and gradually spreads throughout the brain. Among all the protein substances of the nervous system, alpha-synuclein is subject to the greatest destruction.

If we study the pathological process of the development of Parkinson's disease at the cellular level, it will look like a failure of the respiratory functions of mitochondria and oxidative stress (leading to neuronal apoptosis).

Diet for Parkinson's disease

If you have Parkinson's disease, you need to eat in small portions 5-6 times a day. The bulk of hearty meals should be consumed before lunch. It is advisable to leave easily digestible food for the evening.

If you suffer from constant bouts of nausea, it is recommended to eat very slowly. Drink only half an hour after finishing the meal.

It is important that the diet for Parkinson's disease is well balanced. If you have no appetite, you should still eat.

To avoid constipation, you need to enrich your diet with fiber, grains and dairy products.

Determination of disability according to the degree of Parkinson's development

There is an opinion that all people diagnosed with Parkinson's are officially recognized as disabled. In reality, the situation is somewhat different. In the first stages, the disease does not have a serious impact on a person’s normal life and does not interfere with his ability to work, so doctors do not consider him incompetent. As the disease progresses, the situation worsens, but even then the degree of disability is determined in accordance with the rules.

Disability in the first degree of Parkinson's

Stage 1 Parkinson's disease does not reduce a person's motor activity, although the symptoms already affect one limb. At this stage, trembling may be invisible not only to the people around the patient, but also to himself. In this case, work activity is practically not affected. Excessive fatigue and some discomfort in the muscles are certainly present in daily life, but the person remains able to fulfill his usual obligations.

Only activities related to personal life and hobbies decrease, since in his free time the patient prefers to relax in silence, mistaking the existing signs of impairment for physical weakness characteristic of his age. Parkinson's degree 1 persists on average for up to 3 years, after which deterioration occurs and motor capabilities sharply decrease.

Disability in Parkinson's disease 2 degrees

The answer to the question at what degree of Parkinson’s disability is given can be unequivocal - the medical and social commission makes a positive decision starting from the second stage of the disease, although not always. At this stage, the disorder already affects both the left and right sides of the body. The patient still maintains her balance well, but rigidity and bradykinesia become more pronounced, so it becomes more difficult to carry out work activities.

If the symptoms of the disease manifest themselves so sharply that the patient cannot spend as much time at work as before without reducing the quality of the result, doctors may decide to assign him a 3rd disability group. This does not necessarily happen immediately after the disease affects the other side of the body. Stage 2 Parkinson's disease can last up to 7-10 years and a decrease in work activity occurs at different times.

Disability and Parkinson's disease 3 degrees

Parkinson's degree 2 practically does not change the patient's quality of life, which cannot be said about the next stage of the disease. The third stage of the disease is primarily characterized by postural instability. The ability to maintain normal balance is lost with any attempt to change body position. In addition to this, tremors of all extremities intensify, significantly reducing physical capabilities.

Parkinson's degree 3 still allows the patient to care for himself independently, therefore, during a medical and social commission, a decision is made to assign a second or third disability group. The duration of this stage of the disease with normal treatment can be up to 15 years, although only a few achieve this result, mainly those who became victims of the disorder at a fairly young age.

Disability with Parkinson's 4 degrees

Parkinson's stage 4 means that a person gradually becomes immobile. Even turning over while lying in bed is becoming more and more difficult for him every day; he cannot get out of it on his own. We are not talking about active work at this stage. The patient’s well-being deteriorates sharply, and the quality of life decreases. He can still walk or stand on his own, but only if there is a person nearby who can help him up and support him.

At this stage, the commission decides to assign a second or even first disability group, depending on many factors. The patient remains in this condition for a relatively short time - a maximum of 5 years. after this there is a transition to the last stage of the disease.

Disability in Parkinson's 5th degree

The last stage of the disease leads to severe disability and the patient is guaranteed to receive group 1 disability. The patient cannot take care of himself or move around. At best, he ends up confined to a wheelchair, at worst, to a bed. Even eating without assistance becomes impossible.

It is very difficult to judge life expectancy in such conditions. The fact is that ultimately it is not Parkinson itself that kills patients, but the accompanying problems. Thus, at the fifth stage of the disease, due to problems with swallowing and chewing, pneumonia or other similar diseases become a common cause of death.

Depending on what degree of Parkinson’s is detected in the patient and how competent the treatment is prescribed to him, the conditions in which he should live are determined. The first and second stages make it possible not to change your usual way of life, at least in relation to most things. In the third and fourth cases, it is better for the patient to move to relatives who will provide assistance in self-care.

Stage five Parkinson's is often called terminal. Nothing can help the patient in her treatment, but you can try to ensure at least some comfortable stay. Often at this stage of the development of the disease it is recommended to seek help from professional nurses or a boarding house. Providing comfort for the patient on your own is too labor-intensive.