World Brain Day 2020 0n July 21st in Trichy
World Brain Day 2020 : Moves to End Parkinson’s Disease
HIDDEN SORROWS IN PARKINSON DISEASE
PROF DR.M.A.ALEEM M.D., D.M.,(NEURO)
EMERITUS PROFESSOR OF NEUROLOGY
THE TAMILNUDU DR.M.G.R. MEDICAL UNIVERSITY
PAST PRESIDENT TAMILNADU PONDICHERY ASSOCIATION OF NEUROLOGISTS
FORMER OF VICE PRINCIPAL HOD& PROFESSOR OF NEUROLOGY KAPV GOVERNMENT MEDICAL COLLEGE& MGM GOVERNMENT HOSPITAL
CONSULTANT NEUROLOGIST AND EPILEPTOLOGIST (TRAINED AT INSTITUTION OF NEUROLOGY QUEEN`S SQUARE . LONDON.UK.) ABC HOSPITAL, ANNAMALAI NAGAR , TRICHY -620018
SECRETARY NEUROLOGIST ASSOCIATION TIRUCHIRAPPALLI
DIRECTOR ABC HOSPITAL TRICHY
drmaaleem@hotmail.com
World Brain Day was launched in 2014. Since then, the World Federation of Neurology (WFN), chooses a topic with a view to drive home the importance of brain health and promote better neurological care globally on 22 july every year.
The 7th World Brain Day 2020 is a joint collaboration between the World Federation of Neurology and the International Parkinson and Movement Disorders Society (IPMDS) and the theme is “Move Together to End Parkinson’s Disease” campaign throughout the year.
Move Together to End Parkinson’s Disease
Based on this background, the WFN chose the topic of Parkinson’s disease jointly with the International Parkinson and Movement Disorders Society (IPMDS) as the topic for World Brain Day 2020. As in preceding World Brain Day events, the aim of World Brain Day 2020 is to alert the public on critical neurological issues.
Facts of Parkinson's Disease
Prevalence: Parkinson’s disease is a chronic neurodegenerative brain disease that affects more than 7 million people of all ages worldwide, and its prevalence continues to increase.
Disability: Parkinson’s disease is a whole-body disease that affects the mind, movement, and almost all aspects of brain function, with symptoms worsening over time.
Standard of Care: Access to quality neurological care, life-changing treatments, and essential medication is unavailable in many parts of the world for Parkinson's disease
Research: Additional resources are needed to help unlock the cause, onset, progression, and treatment of this disease across all ages.
Advocacy: It’s important to work together to diagnose earlier, treat more effectively, and improve the lives of those living with Parkinson’s disease and their caregivers.
Risk Factors for Parkinson's Disease
People do not know exactly what causes Parkinson’s disease, but there is evidence that certain factors may make it more likely to occur.
Read on to find out more about genetic factors and environmental exposures that might make Parkinson’s disease (PD) more likely to appear in some people.
Some of these are unavoidable, but for others, early lifestyle choices and caution may help reduce the risk.
Age and sex
Older age and being male increase the risk of PD.
Two unavoidable factors that affect the risk of having PD are increasing age and whether a person is male or female.
Age: In most people who have PD, symptoms become noticeable at the age of 60 years or over.
However, in 5–10 percent of cases they appear earlier. When PD develops before the age of 50 years, this is called “early onset” PD.
Sex: Men appear to have a 50-percent higher chance of developing PD than women.
However, at least one study has found that, as women get older, their chance of developing it increases.
Researchers have suggested that this could be due to a variety of factors, including:
lifestyle exposures
Read on to find out more about genetic factors and environmental exposures that might make Parkinson’s disease (PD) more likely to appear in some people.
Some of these are unavoidable, but for others, early lifestyle choices and caution may help reduce the risk.
Age and sex
Older age and being male increase the risk of PD.
Two unavoidable factors that affect the risk of having PD are increasing age and whether a person is male or female.
Age: In most people who have PD, symptoms become noticeable at the age of 60 years or over.
However, in 5–10 percent of cases they appear earlier. When PD develops before the age of 50 years, this is called “early onset” PD.
Sex: Men appear to have a 50-percent higher chance of developing PD than women.
However, at least one study has found that, as women get older, their chance of developing it increases.
Researchers have suggested that this could be due to a variety of factors, including:
lifestyle exposures
genetic features
hormonal and reproductive factors
differences in the brain structures that relate to the production of dopamine.
Genetic factors and family history
A person who has a close relative — such as a sibling or parent — with PD has a slightly higher risk of developing it, compared with others.
Around 10 to 15 percent of cases of Parkinson's disease are probably due to hereditary genetic factors.
The others are “sporadic.” There is currently no way to predict that they will occur.
Autosomal dominant: In 1 to 2 percent of people with PD, the condition results from a change in just one copy of a specific gene. Genes that it can affect include Alpha-synuclein (SNCA) and leucine-rich repeat kinase 2 (LRRK2).
Men of North-African Arab origin have a higher chance of having this trait.
Autosomal recessive: If changes occur in two copies of a certain gene, PD can occur. These changes may involve the genes known as PARK7, PINK1, and PRKN.
Risk-factor modifier genes: These genes affect the risk of developing PD, but they do not cause symptoms. The gene known as GBA is one of these. This gene makes the enzyme glucocerebrosidase.
Not everyone with a gene mutation will develop PD. Some people with a family history of PD choose to undergo genetic testing to have some idea of how likely they are to have this problem.
This can be useful to know, but it is not always a good idea. Some people have a genetic factor but never develop PD. This can lead to unnecessary anxiety.
Head trauma
Footballers must wear helmets for protection against a head injury. Traumatic brain injury (TBI) appears to be a risk factor for PD.
People who receive a blow to the head on at least one occasion may have a higher chance of developing PD.
A study published in 2018 found that, among military veterans, even a mild traumatic brain injury (TBI) can increase the risk of PD by 56 percent, even after taking psychological and other factors into consideration.
This link has raised concerns among sporting associations, as concussion is a common injury in football and many other activities.
To prevent this, people who participate in sports where a head injury is likely should wear protective headgear and seek medical help if they do experience a blow to the head.
Everyone should use a safety belt or helmet or other age-appropriate restraint when traveling in a motor vehicle.
Exposure to chemicals
People who work in certain professions may have a higher chance of developing PD because of exposure to certain chemicals.
Toxins
There is some evidence that exposure to certain toxins can increase the chance of developing PD.
Herbicides and pesticides
These may include:
some herbicides, such as paraquat
fungicides, such as maneb
insecticides, such as the colorless, odorless rotenone
pesticides
Chemicals that were present in the defoliant Agent Orange, used in the Vietnam War, have been linked to PD.
Studies have suggested that there is a higher rate of PD among people who work as farmers, those who are exposed to well water, and those who live in the countryside.
Although more studies are necessary to confirm any precise links, researchers believe that exposure to toxins, such as pesticides, increases the risk.
Metals
Researchers have noted a probable link between long-term exposure to certain metals and a higher risk of PD.
Exposure to chemicals, including solvents and metals, may increase the risk.
The metals that might do this are:
mercury
lead
manganese
copper
iron
aluminum
bismuth
thallium
zinc
People who work in an environment where exposure is common may have a higher risk of PD.
However, the risk is difficult to measure, and there is no evidence to confirm an exact that any of these metals specifically pose this type of hazard.
Solvents
Trichloroethylene (TCE) is a solvent that many industries use.
It is also commonly present in groundwater. People who experience long-term exposure to TCE may be more likely to develop PD later in life.
However, several studies, including a large cohort study in the United States, have not confirmed a link between PD and solvent exposure.
Polychlorinated biphenyls (PCBs)
Some scientists have found that people with PD have higher levels of PCBs in their bodies than those without the disease. This suggests that PCB exposure may increase the risk.
However, other studies have not found a link.
Medications and other drugs
Some medications — such as antipsychotics for treating severe paranoia and schizophrenia — can also cause Parkinsonism, or Parkinson-like symptoms.
Synthetic heroin
There is evidence that the use of a synthetic heroin product, MPTP, can lead to Parkinson-like symptoms.
In April 2018, scientists published notes on case studies of seven young adults who had used the drug. The individuals showed symptoms of Parkinsonism after short-term use of the drug.
The researchers do not conclude that the people developed PD, but the symptoms suggest that they have undergone similar processes.
Impact of smoking
Interestingly, people who smoke cigarettes appear to have a smaller chance of developing PD than those who do not.
This does not mean that people should smoke in order to stave off PD, because smoking is responsible for a host of unwanted health problems.
However, researchers are interested in the role nicotine could play in a future treatment for the disease.
Prevention
People who do the following may have a lower risk of PD:
drinking coffee or tea that contain caffeine
using statins to reduce cholesterol levels
having a higher level of vitamin D
Exercise
One point that may be worth noting, however, is that people who participate in physical activity early in life appear to have a lower risk of developing PD in their later years.
A review published in 2018 concluded that exercise can play a preventive role and it can help to treat symptoms and slow the progression of PD, especially in the early stages.
Takeaway
As with many conditions that can have both genetic and environmental causes, it may be neither one nor the other that produces symptoms.
In most cases, a person probably has a genetic tendency, or predisposition, to develop particular PD, but it takes an environmental trigger to cause it.
However, exactly which triggers activate the disease remain unclear.
The 2016 Global Burden of Disease of Parkinson’s disease studied its global burden between 1996 and 2016 to identify trends and to enable necessary public health, scientific, and medical responses in 2018. Over the past generation, the global burden of Parkinson’s disease has more than doubled with potential longer disease duration and environmental factors. We can expect that the trend will continue in the next few decades with the possibility of 12 million patients with Parkinson’s disease worldwide by about 2050.
Hidden Sorrows
The comorbid diagnosis itself has not emerged as a specific risk factor for poor outcomes of COVID-19. The hidden sorrows (potential medication supply issues, disruption to research, and clinical trials), and emerging opportunities (telemedicine, how the pandemic influences the course of Parkinson’s disease, and taking advantages of technology, such as wearable technology) have been visible during the COVID-19 pandemic.
Parkinson’s disease is a complex disease process of the human brain that results in a broad spectrum of clinical features encompassing all aspects of human function. These primarily motor dysfunctions as well as non-motor symptoms can significantly limit the patient’s ability to take part in typical day-to-day activities with poor quality of life
It is indeed essential to understand the caregiving aspects and burden in Parkinson’s disease. Findings from a published meta-analysis indicate that motor symptoms and dependence in activities of daily living have a moderate relationship with caregiver distress. Non-motor symptoms such as impaired cognitive function, including hallucinations, confusion, and affective disorders such as depression and anxiety, have a significant effect on caregiver strain. It is the hours spent on caregiving activities and sleepless nights that are strongly associated with caregiver burden.
The comorbid diagnosis itself has not emerged as a specific risk factor for poor outcomes of COVID-19. The hidden sorrows (potential medication supply issues, disruption to research, and clinical trials), and emerging opportunities (telemedicine, how the pandemic influences the course of Parkinson’s disease, and taking advantages of technology, such as wearable technology) have been visible during the COVID-19 pandemic.
Parkinson’s disease is a complex disease process of the human brain that results in a broad spectrum of clinical features encompassing all aspects of human function. These primarily motor dysfunctions as well as non-motor symptoms can significantly limit the patient’s ability to take part in typical day-to-day activities with poor quality of life
It is indeed essential to understand the caregiving aspects and burden in Parkinson’s disease. Findings from a published meta-analysis indicate that motor symptoms and dependence in activities of daily living have a moderate relationship with caregiver distress. Non-motor symptoms such as impaired cognitive function, including hallucinations, confusion, and affective disorders such as depression and anxiety, have a significant effect on caregiver strain. It is the hours spent on caregiving activities and sleepless nights that are strongly associated with caregiver burden.
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