Parkinson’s disease is usually associated with tremors, slowness of movements, stiffness… but non-motor symptoms are crucial in the evolution and progression of the pathology and also in its onset. In fact, coinciding with World Parkinson’s Day, experts from Sant Pau point out that they can precede motor signs by 10 to 15 years and that they mainly include olfactory loss, REM sleep behavior disorder and mood disorders , such as depression or anxiety. The most serious affects the patient’s cognitive ability.
“It is increasingly important to recognize the presence of non-motor signs”, says Dr. Jaume Kulisevsky, director of the Parkinson’s and Movement Disorders Unit of the Neurology Service at Sant Pau Hospital and the Parkinson’s and Movement Disorders Research Group at IIB Sant Pau. “We know that the disease does not start when the motor symptoms appear, but before. And non-motor symptoms can be as disabling as or more than motor impairments. Of all of them, the most serious is the one that affects cognition, not as in Alzheimer’s disease, but in the form of a loss of mental speed, of the ability to concentrate, that the patient cannot get out the word he is thinking. .. this is very characteristic in these cases”, he explains.
Sant Pau focuses an important part of its care and research activity on the cognitive impairment of Parkinson’s patients, where it has great expertise. In assistance, it carries out cognitive stimulation through the Clinical School of Neuropsychology and Language Pathology and, among other initiatives, it has a choir of patients made up of more than 30 people. In addition, it is a center of reference in deep brain stimulation for Parkinson’s disease, a technique that has been applied for 25 years and where it was a pioneer.
In research, he carries out different research projects: IIB Sant Pau was a pioneer in describing and designing specific tools to assess cognitive impairment in Parkinson’s, such as the Parkinson’s Disease Cognitive Rating Scale (PD-CRS) used by all studies focused on this area; and promotes studies either independently or in collaboration with the pharmaceutical industry. In this sense, it plans to start an independent research project at the end of 2023 with the Instituto Carlos III in Madrid and coordinating 21 centers throughout Spain.
It is estimated that 1 in 100,000 people over the age of 60 will develop Parkinson’s disease. It is a chronic, progressive and multisystemic pathology. The symptoms worsen over time – although the evolution is very variable between patients – and in the late stages complications can appear such as motor and non-motor fluctuations, dyskinesias (disorders of voluntary movements and appearance of abnormal involuntary movements) , cognitive and behavioral disorders.
There are several causes involved in the onset of Parkinson’s disease. Mainly, the degeneration of so-called dopaminergic neurons, which produce abnormal patterns of nerve activation in the brain and cause movement impairment. But there are also others – known and still unknown. For example, “between 10% and 15% of the causes are genetic – dominant and recessive – and these cases usually affect very young people, around the age of 40 and even younger. We are used to it being a disease of the elderly, from the age of 60, but there are also young people who suffer from it”, explains Dr. Kukisevsky.
Today there is still no cure for Parkinson’s, but it is a disease that can be treated and today we have different therapies that are very much appreciated and that significantly improve the quality of life of patients. The main drug in Parkinson’s is levodopa, which is transformed into dopamine and which very clearly improves the symptoms, especially the motor ones, and the patients’ quality of life. And we also have treatments for non-motor symptoms.
Although initially there is a very good response to the medication, after years complications can appear: related to the progression of the disease and in the form of symptoms that no longer respond to the medication, or related to the treatment, which are motor fluctuations and response to medication is very good but short-lived.
According to Dr. Kulisevsky, “in the last 25 years, new advanced treatments have been introduced to relieve fluctuations and dyskinesias: from the administration of medication continuously through the intestine, that is, by opening a hole; until giving it continuously with an infusion pump through the skin; or Parkinson’s surgery, which in many cases is the most effective and is the second major milestone in the treatment of the disease after levodopa therapy”.
The surgery of Parkinson, which is carried out in very selected patients, with motor complications that do not respond to medication, consists of the implantation of electrodes in the brain – specifically in the subthalamic nucleus – to control the involuntary muscle activity that causes the pathology . All this with a multidisciplinary approach and with new imaging techniques that allow to be very precise in the placement and control of the electrodes.
