Parkinson's: the symptoms of a disease with 50% of patients still undiagnosed

It affects more than 7 million people worldwide. And in Spain, according to data from the Spanish Society of Neurology (SEN), about 150.000 people suffer from this disease.

Age is the main risk factor for suffering from the disease. In fact, its incidence and prevalence increase exponentially from the sixth decade of life. So much so that while the percentage of people over 65 years of age affected is 2%, that figure rises to 4% among those over 80. 

For this reason it is a more common disease in countries with longer life expectancy.

It will triple in the next 30 years

Furthermore, it is one of the neurological disorders that has had the greatest growth in the world, also due to the diagnostic and therapeutic advances that this disease has experienced. 

Taking these conditions into account, neurology specialists estimate that, in Spain, the number of people affected will triple in the next 30 years. 

As explained by the doctor Diego Santos, Coordinator of Movement Disorders Study Group from the Spanish Society of Neurology:

"Although the majority of cases occur after the sixth decade of life, it is not an exclusive disease of older people. Approximately 15% of the cases currently diagnosed in our country correspond to people under 50 years of age. This is what which is called young-onset Parkinson's.

Other risk factors for Parkinson's

In addition to aging, various investigations have determined the existence of other factors associated with an increased likelihood of suffering from Parkinson's.

Specifically hypertension or type 2 diabetes.

However, its cause remains unknown and is considered to be the result of a combination of environmental factors in genetically predisposed individuals, except in hereditary forms. 

More than 20 mutations associated with Parkinson's Disease have been described that can explain up to 30% of the familial forms, especially in those who debut with the disease under the age of 45. 

However, 90% of cases are apparently sporadic and there is no family relationship.

That is why it is considered a multifactorial disease, in which various factors such as neuroinflammation, oxidative stress, certain infections and genes are involved.

Symptoms of the disease

According to the incidence of this disease, each year about 10.000 Spaniards begin to develop the symptoms of this disease. However, the fact that in Spain there is a delay of between 1 and 3 years in diagnosis, the SEN estimates that more than 50% of the new cases that have debuted in the last year are still undiagnosed.

 "Despite the advances that have been made in this field, the diagnosis of Parkinson's disease is fundamentally clinical," comments Dr. Diego Santos. 

The specialist lists the main motor alterations that warn of the onset of Parkinson's: 

• Presence of tremor at rest.
• Muscle stiffness.
• postural instability.
• Bradykinesia, which is motor slowness and inability to perform delicate movements. 

As the neurologist explains, when these symptoms appear "there are usually no significant delays in diagnosis. However, today we know that five, or even ten years before these motor symptoms, patients may present non-motor alterations related to the disease."

first symptoms

Among these first signs of Parkinson's, Dr. Santos highlights:

• cognitive degeneration
• Depression
• Sleep disturbances
• loss of smell
• Gastrointestinal disorders… 

And a recent study published in "JAMA Neurology" has just pointed to two new non-motor symptoms:

• hearing loss
• Epilepsy.

Not all patients start with tremors

"Taking into account that 30-40% of patients with Parkinson's do not present tremor, and that in 40% of cases the first manifestation of Parkinson's is depression, it can be difficult to identify it early."

"And it is also difficult to differentiate from other parkinsonian syndromes in the early stages of the disease," explains the expert. 

The SEN estimates that up to 24% of cases recently diagnosed as Parkinson's disease actually have another parkinsonian syndrome other than tremors. 

"Therefore, it is necessary to focus on the development of a greater number of consultations specialized in movement disorders, in all hospital centers, to improve these figures," he concludes.

 In any case, since Parkinson's disease is a progressive degenerative disorder, regardless of what the first symptoms are, the motor symptoms end up becoming visible in almost all patients.

Thus, motor fluctuations appear in up to 80% of patients before 5 years from the onset of symptoms, and abnormal and involuntary movements before 7 years.

Treatments to control motor symptoms

There is a great variability of resources available for the treatment of motor symptoms of Parkinson's Disease, both pharmacological and non-pharmacological. 

However, there is still no cure for this disease.

And current pharmacological therapies, although they are capable of improving symptoms in the initial phases, with clear benefits in autonomy for the development of activities of daily living and quality of life in the vast majority of patients, are not as effective in controlling the progression of the disease.

On the contrary, the therapeutic approach to the non-motor symptoms of this disease is more complicated. 

Insomnia, depression, apathy, hallucinations, confusion, pain or impulse control disorder are other non-motor symptoms of this disease, which have very negative consequences both on the quality of life of patients and in caregivers.

"Parkinson's disease requires a multidisciplinary treatment that is as individualized as possible. Because it must be adapted according to the degree of disability, the age of the patient and the complications and symptoms that arise throughout the evolution of the pathology. In In this sense, consultations and units specialized in movement disorders also play a crucial role," concludes Diego Santos.

Source: El Periódico de Aragón