The disease is surprisingly heterogeneous regarding age of onset, clinical presentation, response to treatment and progression
I have been suffering from Parkinson’s disease for several years. I would like to know if there are criteria to predict what type of evolution the pathology will have and how rapid the worsening of the symptoms may be. Are there any exams or tests I could take to find out?
He replies Daniela Calandrella, neurologist, Graubünden Foundation for Parkinson’s disease; Parkinson and Parkinsonism Center, ASST Gaetano Pini – CTO, Milan (GO TO THE FORUM)
There Parkinson’s disease mainly a movement disorder characterized by motor symptoms, i.e slowness (bradykinesia), tremor at rest and rigidityin addition to changes in posture and gait, but also associated with a variety of non-motor symptoms in many patients, including decreased sense of smell (hyposmia), constipation, urinary dysfunction, orthostatic hypotension, memory difficulties, mood swings, pain and sleep disturbances. However, the disease is surprisingly heterogeneous with regard to age of onset, clinical presentation, response to treatment and progression. For example, the so-called predominantly tremor-causing disease has been associated with slower progression, while the more prominent form postural instability and walking difficulties seems to have a more rapid progression.
Learn about genetic mutations
It has been observed that patients presenting at onset some specific symptoms (mild cognitive impairment, REM sleep behavior disorder, orthostatic hypotension) worsen more rapidly. Furthermore genetic informationobtained through a simple blood sample, are improving our understanding of the disease and in some cases provide prognostic information: for example patients carrying mutations of the GBA1 gene they often have peculiar clinical characteristics, such as an earlier onset and a slightly more rapid evolution of symptoms, both motor and non-motor. Anyway the absence of progression excludes the diagnosis of Parkinson’swhile a very rapid progression, with the appearance for example of falls and dementia, indicates an alternative diagnosis.
Parkinson’s is not a single entity
These observations suggest that Parkinson’s disease may not exist as a single entity and that progression varies considerably from one patient to another. The evolution of Parkinson’s disease, i.e. the prognosis, has profound implications for patients and their families and, despite important advances in research, it remains a challenge, even if most patients live with Parkinson’s for a long time and with excellent compensationthanks to pharmacological and surgical therapies.
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November 28, 2023 (modified November 28, 2023 | 07:14)
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