Possible first signs and accompanying symptoms of Parkinson’s:

In many patients, the sense of smell deteriorates – often as an early sign of Parkinson’s disease

Sleep disorders that are associated with involuntary and violent movements during dream sleep because dreamed movements are carried out are other possible (early) symptoms (REMS sleep behavior disorder)

Depressive moods can also occur in the early stages of Parkinson’s disease

Diffuse muscle and joint pain, especially in the shoulder and arm area, is common and can be caused by muscle stiffness and limited mobility

The sebum glands on the face often produce excess sebum over the course of the day, leading to what is known as ointment face

Temperature and circulatory regulation, bladder and bowel function and potency can all be disturbed

In some cases, symptoms of dementia appear over time

However, all of the symptoms mentioned can also have other causes. In addition, they do not all have to be present in Parkinson’s disease.

What is an akinetic crisis?

An akinetic crisis can be caused, for example, by infections, medication errors or operations. The patient becomes completely immobile, can no longer speak or swallow. Accompanying symptoms are sweating and a rapid pulse. Such a crisis is dangerous and must be treated in the clinic. Failure to swallow can allow saliva to enter the lungs and cause pneumonia .

How does Parkinson’s disease develop?

In Parkinson’s disease, special nerve cells in the so-called black substance (substantia nigra) in the brain die off in the first place. This leads to a lack of dopamine. Together with other messenger substances, this neurotransmitter is involved in controlling movement. The lack of dopamine upsets the sensitive balance of the messenger substances.

Doctors differentiate between four forms of the disease when symptoms of Parkinson’s are present:

1. Idiopathic Parkinson’s Syndrome (IPS) : Around 80 percent of all Parkinson’s patients suffer from it. The initiating cause is unknown. Genetic influences and environmental influences, such as pesticides, are discussed. When people talk about Parkinson’s disease, they usually mean idiopathic Parkinson’s syndrome.

2. Genetic forms of Parkinson’s syndrome: In very rare cases, Parkinson’s is partly inherited and can appear early in life. There are changes in the genes that lead to a familial form of Parkinson’s disease.

3. Parkinson’s syndromes in the context of other diseases that lead to a loss of nerve cells, for example Lewy body dementia (atypical Parkinson’s syndromes)

4. Symptomatic (secondary) Parkinson’s syndromes : The symptoms arise here from other causes, for example from drugs such as neuroleptics or calcium antagonists, a craniocerebral trauma or poisoning.

How is Parkinson’s diagnosed?

In the early stages of Parkinson’s disease, diagnosis is often difficult. The first indications can be a reduced handwriting, a disturbed sense of smell, strong muscle tension, difficulties with everyday activities such as brushing your teeth, buttoning or working on the computer.

Some patients notice problems walking early on and fall down more easily. Others injure themselves or their bed partner with violent movements during dream sleep.

The doctor makes the diagnosis based on the symptoms of the disease: Parkinson’s disease is indicated if there is a lack of movement and another typical symptom – such as muscle stiffness, tremors or a disorder of the holding and righting reflexes. Symptoms are often unilateral at first.

Imaging procedures such as computed tomography ( CT ) and magnetic resonance imaging ( MRI ) are primarily used to rule out other causes. With positron emission tomography ( PET ), a reduction in the dopamine-releasing cells in the brain can be made indirectly visible.

If the symptoms improve during a therapy attempt with levodopa, this is a strong indication of Parkinson’s disease. Levodopa is a precursor of dopamine, which is converted to dopamine in the brain.

Especially in unclear cases, the diagnosis should be made by a specialist who has a lot of experience with the disease.

How is Parkinson’s disease treated?

Parkinson’s disease is treatable, but not curable. The therapy consists of several components. The most important is the use of medication. In this way, the disease can often be well controlled for years.

However, the effectiveness of certain anti-Parkinson drugs can decrease over time. It is therefore necessary to adjust the medication at certain intervals.

treatment with medication

Levodopa (L-Dopa)

The drug treatment aims to bring the neurotransmitters in the brain back into balance. Levodopa (L-dopa) is a precursor of dopamine and has a positive effect on mobility, against muscle stiffness, but also against tremors. However, after a long period of therapy, unpredictable and not uncontrollable movements (hyperkinesia) and effect fluctuations (on-off phenomena) can occur as side effects.

In order to counteract fluctuating levels of action in advanced stages, there is also the possibility of a dopamine pump, which continuously releases the dopamine messenger substance via a probe into the small intestine or under the skin.

dopamine agonists

A second group of drugs are the dopamine agonists. They increase the effect of the existing dopamine (e.g. pramipexole, lisuride, ropinirole). Newer dopamine agonists ensure a constant level of active ingredient and some only have to be taken once a day (e.g. delayed-release ropinirole, delayed-release pramipexole). Or they release their active ingredient via a patch that has to be changed daily (e.g. rotigotine patches). Side effects of dopamine agonists can occur in the form of daytime tiredness or sleepiness and in the form of compulsive behavior (e.g. compulsive shopping, compulsive gambling).

Other drug groups

In addition, there are other groups of drugs that reduce fluctuations in the effect of dopamine (COMT inhibitors such as entacapone and tolcapone) or slow down its breakdown (MAO-B inhibitors such as selegiline and rasagiline). Anticholinergics (e.g. Biperiden, Bornaprine) can effectively reduce tremors. The NMDA inhibitor amantadine is said to increase dopamine release and improve mobility.

The various groups of active ingredients can also be combined with one another. Drug management is challenging because the symptoms and drug side effects can be very different, as can the response to the drugs.

Surgical interventions on the brain (deep brain stimulation)

In the case of surgical therapy, the doctor and patient must weigh the benefits and risks. The intervention should only be used when the drug therapy is no longer sufficient and the Parkinson’s patient is therefore losing quality of life.

Small electrodes are permanently inserted under general anesthesia at precisely calculated points in the brain. Certain areas of the brain can now be electrically stimulated and thus inhibited. In this way, symptoms can be specifically alleviated. This pacing can be done by a programmed pacemaker or by the patient themselves if needed.

Other therapy components

Good physiotherapeutic care is important in order to maintain mobility for as long as possible.

Speech therapy measures help if the ability to speak and swallow is impaired. You train the muscles in question. Communication via gestures and facial expressions can also be encouraged.

Occupational therapy helps you to be able to cope with everyday life or pursue hobbies independently for as long as possible. If necessary, the use of aids is also trained and the home environment is adapted to the needs of the Parkinson’s patient.

Psychological care: An experienced therapist can support those affected and their relatives in psychologically coping with the illness.

Relaxation exercises can have a positive effect on tremors.

Diet in Parkinson’s disease : There is no specific diet that could affect the course of the disease. It is important that patients consume enough calories and eat a balanced diet.

As the disease progresses, patients and relatives are faced with the question of home care or home care. If you decide to take care of yourself at home, you can take advantage of the financial benefits of the long-term care insurance and turn on a nursing service. You can get help with planning from the doctor treating you, but also from the self-help groups.

There are self-help groups for Parkinson’s patients, but also for relatives of those affected, where you can exchange experiences with the disease, the therapy and the doctors. Self-help groups also inform the public about the disease and thus promote education. They also take care of the special needs of the patients.

Stem Cell Therapy

In Parkinson’s disease, certain nerve cells in the brain die. Researchers around the world are therefore looking for a way to replace these dead brain cells with new, functional cells. One idea is: taking stem cells from the patient’s bone marrow and planting them in patients brain (stem cell injection, stem cell transplantation). According to the theory, the stem cells are supposed to convert into new, functional nerve cells in the brain of the patient or at least to compensate for deficits.