Parkinson Disease and parkinsonian syndrome are caused by alteration of the functions of two basal ganglion regions – nigral substance and striatum body – given that they contain practically the total human encephalon dopamine, (being this the chemical substance in charge of the electric message transportation). When dopamine concentration suffers a reduction synapses decreases, decreasing thus the neuronal influence of the nigral substance to the pallid balloon through the track uniting them, then producing the Parkinsonism signs and symptoms.
The cause of degeneration of the nigral substance and striatum body is unknown, what we do know is that it is a gradual process and its duration between onset and death is from 10 to 15 years.
Certain toxic or infectious agents can also cause this affliction. It usually occurs in patients between 40 and 70 years old, with no preference for any gender, race or weather.
Parkinson and Parkinson Syndrome
Parkinson disease and parkinsonian syndrome comprise a range of typical disorders due to the tremor and alteration of voluntary movement, posture and balance.
The parkinsonian syndrome is a group of alterations in which signs and symptoms characteristic of Parkinsonism are developed, but in a secondary basis to other neurological illness (such as lethargic encephalitis, Alzheimer’s disease, due to prolonged consumption of certain medicines, etc.). Thus while Parkinson disease is primary degenerative disorder which appears in the second half of people’s lifespan, following a progressive course; parkinsonian syndrome has a natural history which is cause dependent. The term Parkinsonism is used to describe the signs and symptoms regardless the cause of the pathological status.
Clinical Features
A patient with Parkinsonism can appear with characteristic tremor. Diagnosis is then easily established, though it is important no to label as “parkinsonism” other types of tremor.
Common symptoms at presentation are slowness in walking and balance alteration with occasional falls or difficulty in performing fine-finger movements such as those used while dressing or shaving. Pain is a usual complaint at presentation.
The passage from different decubitus to a sitting position or from the latter to bipedestation is made with much difficulty given that the patient moves in blocks, not with the natural segmented sequence. As regards intellect, it is unaffected as well as its sensibility.
Early symptoms of the disease can include specific movement difficulty such as those made while writing, turning in bed or rising from a low chair; excessive skin fatness or unusual tendency to constipation, and incapacity to raise the voice or cough efficiently. All the symptoms tend to worsen disproportionately when the patient is under pressure, so they tend to avoid social engagements and to reduce the amount of work they do.
Signs
Posture: Usually the patient shows some alteration. When standing there is a slight flexion in all joints causing the “apelike posture” with knees and hips mildly flexed, rounded shoulders and head forward with arms curved through the body. When sitting, the patient often slides to the sides.
Abnormal posture may be corrected voluntarily, though only temporarily and with considerate effort and concentration.
Balance:
When standing, they usually have the characteristic tendency to fall forward.
They are not able to perform compensatory rapid movements to regain balance and are easily knocked down.
When walking they have difficulties in deriving their gravity centre from one foot to the other, so that their steps become short and slow.
They also have specific difficulties to turn or initiate walking movements (bradycinesia).
ILearned and Voluntary Movements
Magnitude and speed of movements is reduced (acinesia).
As mentioned above walking pace is slower, with shorter steps. Speech becomes slower and softer. Handwriting tends to shrink (micrography) and become untidy. Food cutting, buttoning or tying of laces can become impossible, as well as those activities involving repetitive movements such as whipping or brushing.
However, movements complexly coordinated, such as driving, cooking, house cleaning or machine writing may be relatively unaffected particularly when they are being carried out.
Parkinson disease and parkinsonian syndrome comprise a range of typical disorders due to the tremor and alteration of voluntary movement, posture and balance.
