Parkinson’s disease “rejuvenated”: more cases under 40 years old

The aging of the world’s population also has a downside. In all civilized countries, there is a sharp increase in neurodegenerative diseases – primarily Alzheimer’s disease and Parkinson’s disease. The pandemic has become an additional risk factor for their development.

Parkinson’s disease begins to develop about 10 to 20 years before the onset of obvious symptoms. This severe pathology has been known to mankind for more than two hundred years, but so far people have not learned how to overcome it. There are no cases of cure for Parkinson’s disease in the world.

How to suspect the beginning of its development? Which doctor should I contact? How to maintain a normal life in different stages of Parkinson’s disease? On World Parkinson’s Day, which is celebrated on April 11, experts told what’s new in its treatment and what patients can hope for in the future.

In 1817, the London physician James Parkinson described the disease in his Essay on Shaking Palsy, based on the observation of six patients with similar symptoms. He noted that the first manifestations of the disease (mild weakness and trembling) are imperceptible, “the disease develops slowly and the patient cannot remember when it began.” But after a few years, a person loses his straight posture, begins to fall out of the blue, it is difficult for him to get up or sit down, he becomes unsure of himself. In addition, memory is disturbed, it becomes difficult to concentrate, hallucinations and disturbing manifestations, insomnia and a decrease in smell appear.

Unfortunately, we do not even know what Dr. Parkinson, who was born on April 11, looked like: history has not preserved a single portrait of him. However, as Sergey Illarioshkin, Deputy Director for Research at the Federal State Budgetary Institution of Science, director of the Brain Institute of the Federal State Budgetary Scientific Institution of Science, Academician of the Russian Academy of Sciences, President of the National Society for the Study of Parkinson’s Disease and Movement Disorders, has gone down in history as a brilliant natural scientist, and 90% of his description disease is still relevant today.

Parkinson’s disease (PD) occurs in 120-150 people per 100 thousand of the population, the main factor in its development is age (at the age of 55-64 it occurs in 1% of the population, and after 75 years – in 3-4%). There are about 6 million such patients in the world; in 20 years their number will at least double. According to the doctor of medical sciences, professor, head of the department of neurology and medical genetics of the Federal State Budgetary Educational Institution of Higher Education, PSMU. ak. E.A. Vagner of the Ministry of Health of the Russian Federation Yulia Karaulova, today doctors and scientists are fighting to increase life expectancy, reaching the planned targets: “But the aging of the population leads to an increase in the incidence of Alzheimer’s and Parkinson’s diseases. Europe, America, Japan are inundated with patients with neurodegenerative pathology – brain damage associated with age. And in the Russian Federation, there is also an increase in such patients.”

There are more than 200 thousand patients in Russia, and every year their number is growing by 20-30 thousand. A shocking new trend is that one in ten falls ill before the age of 50, and one in twenty before the age of 40. “The disease has significantly rejuvenated. Perhaps toxins, ecology, lifestyle play a role, ”continues Illarioshkin.

Of the risk factors for the development of PD, genetic predisposition is now distinguished; exposure to neurotoxins, especially pesticides and herbicides that were used in agriculture before and, finally, the transferred coronavirus infection (today this fact has been scientifically established). In addition, repeated traumatic brain injury can stimulate the development of the disease.

About 35% of cases of the disease are not diagnosed in the first three years. Early diagnosis of PD is difficult: many symptoms are mild, subtle, and nonspecific. “This disease is a motor disease, it is associated with damage to a limited area of ​​\u200b\u200bthe brain in the midbrain, which is called the black place. There are many cells with a dark pigment called neuromelanin and dopamine, which affects motor and some mental functions. But in Parkinson’s disease, the substantia nigra becomes paler because the cells die and disappear. Then other parts of the central nervous system, as well as the peripheral nervous system, are involved in the disease, ”continues Illarioshkin.

Doctors distinguish the latent and prodromal stages of the disease, when there are still no obvious symptoms, and only a very experienced doctor can suspect something is amiss. It all starts with sleep disturbance. Then the patient develops constipation, anxiety, depression, increased daytime sleepiness, muscle pain. “At this stage, the patient goes to different doctors and does not receive help, but an experienced doctor may notice slowness of movement and postural problems. Therefore, a clinical phase develops in which all these symptoms remain, but there are also slowness, stiffness, tremor at rest, apathy, pain, fatigue. The patient is already visible from the first steps: he is “slow”. As one specialist said, such patients could be excellent scouts: not a single emotion will falter on their faces, ”says Sergey Illarioshkin.

Drugs based on the precursor of dopamine, levodopa, have been the gold standard for the treatment of PD for many years. But, alas, the effect of treatment disappears after a few years. “At first, the patient responds very well to the drugs – we call this the ‘honeymoon in treatment’ period of favorable response. It lasts two or three years, but then complications of therapy occur: as soon as the drug wears off, the symptoms reappear. In addition, the patient begins to respond to treatment with hypermotility. And we have to radically change the therapy, ”says the expert.

In some cases, neurosurgical treatment is performed. Today there are methods of interventions without cutting the brain: through focused ultrasound. In addition, the method of deep brain stimulation is used – the introduction of electrodes into the deep parts of the brain. In Russia, this is available in 9 cities, in 11 quota centers. In addition, there are high-tech invasive technologies for the dosed administration of apomorphine preparations through a subcutaneous pump (the pump has not yet been registered in Russia). There is also a technology for administering levodopa in the form of a gel through a pump into the duodenum, where the drug is intensively absorbed. The latter method is available in several regions of the country. One of the first it was introduced in Perm. According to Yulia Karaulova, the Center for Extrapyramidal Disorders has been operating in the Perm Territory since 2013, where patients with neurodegenerative diseases are observed: “We have registered more than 2.3 thousand patients with PD. We keep a register of patients and monitor them. Their life expectancy is growing on the background of therapy, but the number of patients with advanced stages is also growing, and such patients become dependent on relatives: they cannot stand up on their own, walk, sometimes they cannot stop, they fall … Unfortunately, despite the medicines, the disease progresses, and there is a phenomenon of wear and tear of drug-responsive neurons. We were able to introduce high-tech methods of treatment: out of 127 patients with severe stages, more than 50 underwent deep brain stimulation – as a result, their condition improved, symptoms decreased, and activity increased. And two of our patients receive medicinal levodopa gel through a stoma in the intestine – as a result, the drug is not destroyed by enzymes in the stomach, but is completely absorbed. These patients have significant relief. I hope these methods will appear in other regions. In Kazan, 15 patients receive such treatment.”

According to Elena Khvostikova, director of the Patient Care Center, today modern treatment for such patients gives a second chance and returns them not only to normal life, but sometimes to work: “In St. Petersburg, patients have received such treatment since 2013 as part of a clinical study for 8 years, and today the regional authorities pay for it. But for many regions of the country, this is still a dream. I hope this situation will change in the near future.”

“We cannot stop the disease, but we can control the patient for a long time and provide him with many years of a decent life,” says Academician Illarioshkin.

As for the prospects, today in the world more than 100 molecules are being studied in terms of their influence on the course of Parkinson’s disease, and 20 of them have already entered the clinical research stage. “We are closely following these works. Of greatest interest are drugs with a neuroprogressive effect that could stop the process. But this is still in the realm of fantasy, although there are attempts, ”says Sergey Illarioshkin. By the way, drugs are also being developed that try to act on nicotinic receptors – there has long been evidence that smoking can be an anti-risk factor in relation to PD. “Maybe it’s the intoxication of certain neurotoxins, but smoking increases the risk of cardiovascular disease, cancer, and the risks associated with it far outweigh the benefits,” warns Illarioshkin.

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Parkinson’s disease (PD) is a continuously progressive neurodegenerative disease that is accompanied by the development of motor and cognitive disorders. Today, Parkinson’s disease is the second most common neurodegenerative disease after Alzheimer’s disease. Worldwide, rates of disability and death from Parkinson’s disease are rising faster than from other neurological disorders. Salvador Dali, Pope John Paul II, Jorge Luis Borges, Arkady Raikin, Yan Arlazorov were ill with PD.