Parkinson’s disease signs and its management

Qn: “How can one limit the effects of Parkinson’s disease? My grandfather has just been diagnosed with the condition.”

In 1817, an English physician by the name James Parkinson wrote an essay on the “Shaking Palsy”. The disease we now call by his name is characterised by tremor, rigidity and stiffness. This is due to the damage of nerves in the brain in a part known by the rather fancy name, substantia nigra or black bodies. When cells in this part of the body begin to malfunction, or die, (a process known as neurodegenaration) then the disease that is said to have afflicted your grandfather is said to have set in.

There is no known cure for this disease but a number of relatively inexpensive treatments are available to control some of the more debilitating symptoms. In 1997, a rather invasive treatment was approved for the treatment of the condition and it goes by the name, Deep Brain Stimulation.

This treatment involves the insertion of probes into the substance of the brain and although fairly effective in severe cases, it has its complications and is not available in Kenya yet.

The relationship between stress and Parkinson’s disease remains controversial, though some experts believe that it exists. That stress makes Parkinson’s disease worse is less controversial.

Just in case you are wondering what to expect could happen to your grandfather, the condition itself does not lead to death, though in its advanced stage, the problems to the swallowing mechanisms can lead to complications that can be fatal. But it runs a chronic course with increasing challenges characterised by the tremour and rigidity.

As you might have realised already, the disease leads to significant difficulties in gait, in which the patient has the appearance of a person walking with head leaning forward. Many also lose the usual swing of arms as they walk. Other conditions include gradual loss of memory, poor concentration and emotional changes. Facial expression is often blank in a most characteristic way. In the later stages, dementia could set in.

Now that you know something about the disease and what might happen to your grandfather, we will now turn to address the concerns of others who might have questions that could arise from the answer we have given you. Let me explain.

For many years, mental disorders were classified into two broad categories. The first were those for which a cause was known (organic) and those for which a cause could not be established using the technology available at the time (functional).

For the second group, the idea was that they wer ”Psychological” in origin and therefore no physical or biological explanation could be found for the illness. It now turns out that this was merely a function of the limitation of technology at the time. Recent Magnetic Resonance Imaging studies have shown clear evidence of anatomical changes in the brains of people diagnosed with depression as well as those with schizophrenia.

The old theories must now be replaced as our understanding of the brain and how it functions (and malfunctions) increases. Cutting edge radiological studies are now able to locate “hot areas” of the brain as one is involved in some mental tasks such as calculations! Though still far from a full understanding of how the brain works, much progress has been made in the last ten years.

Of equal significance is the recent finding that depression is now associated with inflammatory process, meaning that in future, depression could turn out to be an inflammatory disease much like arthritis! These new findings are turning old theories on the causation of mental disorders on their head.

The idea that depression could be due to a process that is in any way similar to cytokine storm (made popular by Covid-19) seems far-fetched today but that seems to be the direction science is taking us.

Of equal significance is the link between heart disease and depression. Heart attacks for example are more common in people who are depressed. Put differently, depression makes it more likely that one could get a heart attack. The converse is also true. If you have a heart attack and are also depressed, the chances of making a full recovery are affected. The relationship between diabetes and depression is also well recognised. Many studies on the link between the two conditions are ongoing and there is now no doubt that the two are linked in some ways in many patients. So the doctor treating you for diabetes has to be aware of the increased risk of depression making treatment more difficult.

The lesson for today shows the field of mental health is changing rapidly and seems to be moving in the direction of mental disorders having causes that we might find in the course of time, much as we now know what causes Parkinson’s disease.