Parkinson Disease

Abstract

Parkinson disease is a neurodegenerative condition characterised by the motor features of rest tremor, bradykinesia, and rigidity. The neuropathological process of Parkinson disease consists in the progressive loss of dopaminergic neurons at the level of the basal ganglia (substantia nigra). Over the last few years, the focus of clinical research has shifted from the motor symptoms to the non-motor features of Parkinson disease, especially changes in mental state and behaviour. Behavioural symptoms are common and have been shown to affect patients’ health-related quality of life to a greater extent than motor disability. The intrinsic neuropsychiatric manifestations are mainly related to hypodopaminergic states and encompass depression, anxiety, and apathy. The iatrogenic neuropsychiatric manifestations are mainly related to hyperdopaminergic states and include psychosis, dopamine dysregulation syndrome, and impulse control disorders. Impulse control disorders can occur in about 30% of patients with Parkinson disease treated with dopamine replacement therapy, particularly dopamine receptor agonists. Modulation of dopamine replacement therapy is the first-line treatment approach for iatrogenic behavioural problems, followed by targeted psychotherapy and, where appropriate, pharmacotherapy with atypical antipsychotics.

How nerves sometimes operate by themselves without any command from other functioning parts or the soul. This is clearly apparent for you will see paralytics and those who are shivering and benumbed by cold, move their trembling parts, such as their heads or hands without the permission of their soul; which soul with all its forces cannot prevent these parts from trembling

Leonardo da Vinci (1452–1519)