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Parkinson's disease (also called Parkinson's disease or shaking palsy) is a disease of the brain . It occurs mainly in older age. Restricts the ability to move. Its causes are not fully understood until today.

There is no cure for the disease, but there are effective therapies that can relieve symptoms. Primarily treated with medication. Normally, Parkinson's progresses slowly. After diagnosis, many people continue to lead a largely independent life for a long time.

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Parkinson's disease can manifest itself in very different ways. The typical symptoms are:

Lack of movement (akinesia): Only slow movements are possible. For example, gait becomes very hesitant, with short, smaller steps. It is difficult to initiate movements – for example, when walking, the first step in particular is often unsuccessful. Once in motion, it also becomes more difficult to stop the movement, for example, to stop on command. The resonance of the arms when walking disappears as the disease progresses. Hand movements and activities that require some skill, such as tying shoes, also become more difficult. Because the mobility of the facial muscles decreases, the face appears mask-like over time. Speech becomes quiet and monotonous, even swallowing becomes difficult. Muscle stiffness (rigor)The arms, legs and neck in particular can be permanently stiff and tense. Arms and legs can usually only be moved against resistance or not at all, even with the help of a second person, and stiffen even more during such attempts. The excessive tension often leads to muscle pain. Tremor at rest (rest tremor)This tremor occurs in most people with Parkinson's disease. It decreases with movement. The hands tremble particularly frequently. Writing becomes smaller and less clear.

Symptoms are often more noticeable on one side of the body. Other possible consequences of the disease include bladder and digestive disorders, circulatory problems, increased sebum production in the skin, concentration problems and depression .

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Depending on the cause, different forms of the disease are distinguished. The most common is the so-called idiopathic Parkinson's syndrome. "Idiopathic" means that no cause can be found. In Parkinson's disease, nerve cells in the brain that produce the neurotransmitter dopamine are damaged. Among other things, dopamine ensures that electrical impulses are transmitted from the brain to the muscles via the nerves. This is how movements are controlled, for example. Destruction of cells impairs ability to initiate or coordinate movements. Problems with balance may occur, increasing the risk of falls and fractures.

Parkinson's disease can also be the result of other nervous system disorders, such as dementia. Inflammations, tumors or medications such as psychotropic drugs can also cause such complaints.

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On average, about 1 to 2 out of every 1000 people have Parkinson's disease. It usually occurs after the age of 50. year of life. The condition is much more common in old age: from the age of 70, about 20 out of every 1000 people are affected. Men are affected slightly more often than women.

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Long before Parkinson's disease is diagnosed, the first signs may appear. They often go unnoticed or are seen as a normal sign of aging. Typically, for example, fine motor skills deteriorate and handwriting changes. Sometimes the sense of rhythm fades, or the arms no longer swing when walking. In many people, the facial expression becomes more rigid. There is often constipation, sleep problems, or mood swings. Many experience that their sense of smell decreases or disappears completely.

It is not uncommon for several years to pass between the first signs of Parkinson's disease and a diagnosis. How the disease progresses varies widely.

The symptoms usually increase gradually. Over time, lack of movement, muscle stiffness, and tremors worsen. In the early stages, medication can usually significantly improve the symptoms or even make them disappear.

After about five to ten years, the symptoms often intensify again. This is because the brain cells are further damaged by the progression of the disease. The effect of the medication is then no longer sufficient and fluctuates strongly. The symptoms alternate between extreme lack of movement and normal movement. This is called the "off" or "on" phase. Involuntary movements may also occur, such as flailing of the arms, smacking or jerky movements. Additional complaints such as speech disorders, memory problems, bladder disorders, hallucinations or depression may follow. Some sufferers develop dementia.

In the late stages, people with Parkinson's need assistance with many daily activities, such as eating and drinking, getting up and walking around, dressing and personal hygiene. Movements become increasingly difficult for them, some speak very softly or have swallowing difficulties.

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The doctor usually makes the diagnosis after physical examinations and a detailed discussion of the symptoms and previous medical history. It can be helpful if relatives take part in the interview, as they sometimes notice complaints or limitations that you do not notice yourself. In addition to a general physical examination, the doctor will test reflexes, sensitivity (to pain or prere, for example) and mobility – for example, whether the joints can move normally or the muscles offer resistance.

To confirm the diagnosis, the so-called L-dopa test is sometimes performed. For this purpose, the drug L-dopa (levodopa) is taken and it is observed whether the symptoms decrease. If there is a rapid improvement, this indicates Parkinson's disease .

Particularly in the early stages, Parkinson's disease is not always easy to distinguish from other diseases. It is then useful to observe the course of the symptoms for a while. A computerized tomography ( CT ) or magnetic resonance imaging ( MRI ) is sometimes performed, especially to rule out other illnesses.

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At the beginning of the disease – when the symptoms are not burdensome – treatment may not yet be necessary. If symptoms increase, drugs that replace the missing dopamine can help. This often alleviates the symptoms. However, since the drugs cannot stop the progression of the disease, their effect is no longer sufficient over time. Therefore, the type and dosage of the agents must be adjusted repeatedly. A medication pump can be used to ensure that they work evenly. She delivers the active ingredient either under the skin or directly into the small intestine.

Everyday movements and activities are practiced as part of an accompanying occupational therapy program. Limited mobility leads to a decrease in muscle strength. Exercises and sports should help to compensate for this and improve mobility and coordination. If the voice becomes quieter and speech more slurred, speech therapy (logopedic therapy ) may also be considered.

Some people whose symptoms do not improve sufficiently with medication are offered deep brain stimulation. This requires an operation in which electrodes are inserted into certain areas of the brain. These continuously emit electrical stimuli that affect muscle activity.

More knowledge

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Parkinson's disease affects many areas of life – whether at work, in partnerships and families, or in leisure activities. Even if the everyday life changes little in the early stages of the disease: Many affected people are afraid of becoming dependent and in need of care over time. However, it is possible to lead a life that is not too much affected by the disease for a long time to come.

Nevertheless, it makes sense to be prepared for the time when support becomes increasingly necessary. It is very important to have good medical support. Most people also succeed better in dealing with their disease if they do not withdraw, but exchange information with others right from the start. It is also important to involve relatives, friends and acquaintances when help is needed in everyday life.

Many people with Parkinson's disease report that it is good for them to remain active as much as possible. It is crucial to recognize one's own limitations and to continually adapt physical activity, everyday activities, and occupational activities to one's own capabilities.

For people with Parkinson's disease, there are numerous offers of support in Germany. This includes support groups. Counseling centers. However, many of these facilities are organized differently locally. A list of contact points helps to find and use suitable offers.

Clarke CE. Parkinson's disease . BMJ 2007; 335(7617): 441-445.

German Society of Neurology (DGN). Idiopathic Parkinson's disease (S3 guideline). AWMF Registry No.: 030-010. 01.2016. (Guidelines for diagnostics. therapy in neurology). 2016. (Diagnostic Guidelines. Therapy in Neurology). (Guidelines for diagnosis and therapy in neurology).

Lees AJ, Hardy J, Revesz T. Parkinson's disease . Lancet 2009; 373(9680): 2055-2066.

Updated on 19. June 2019 Next planned update: 2022

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