What happens to cognitive changes in patients with Parkinson's?

Since ancient times, the existence of patients with tremor and gait difficulties has been known; however, this disorder was not known as Parkinson's disease (PD) at the time. The term was considered until the description made at the beginning of the 19th century by the British doctor who bears his name: James Parkinson.

Early studies of PD were directed at the movement disorder per se, without taking behavioral and cognitive changes into account. as a symptom of the condition.

• Related article: "Neuropsychology: what is it and what is its object of study?"

Delving into Parkinson's disease

Motor-type symptoms characterize this disease, although in recent years more and more attention has been paid to non-motor disorders, especially those cognitive and emotional symptoms that sometimes become more disabling than the motor component, it is highly probable that in 25 to 30% of cases they develop a dementia. That is why Jean-Martin Charcot and Edme Felix Alfred describe in their work Of shaking paralysis

their observations of the cognitive alterations of PD. Charcot in one of his works reviewed the subject of the PE and specified in some related concepts with memory capacities, stating that "at a given moment the mind becomes cloudy and memory becomes misses".

PD is considered the second most frequent neurodegenerative disease after Alzheimer's. 1% of the population over 60 years of age will present Parkinson's and 3% between 75 and 84 years of age, with the average age of onset around than 55 and it is more common in men (55%); however, 40% of diagnosed patients start symptoms before the age of 40 years. c. Saens Zea (2013).

The causes are unknown, although there is a small percentage of around 5% of cases in which the cause is genetics, there are also environmental factors such as the consumption of pollutants, neurotoxic metals (mercury, aluminum, arsenic).

• You may be interested in: "Neurodegenerative diseases: types, symptoms and treatments"

What causes movement disorder?

This condition derives from a death of the dopamine-producing neurons of the substantia nigra, the substantia nigra is located in the midbrain bilaterally, the depigmentation of the substantia nigra at the anatomopathological level implies a progressive neuronal loss.

The black substance is part of basal ganglia, which control movements through connections with the motor cortex. In addition, it helps to adjust movements, including fine movements that, when affected, will give rise to tremors, especially in the hands like the tremor of counting coins and tremor at rest, with time the rigidity and instability will appear postural. The diagnosis in PD is mainly clinical, the most relevant symptoms being: tremor (rest) bradykinesia (kinesia) muscle rigidity, postural instability.

• Related article: "Basal ganglia: anatomy and functions"

How does Parkinson's disease affect cognition?

A reduction of dopamine at the level of the prefrontal cortex could result in behavioral alterations, neuroaffective and cognitive alterations.

There are studies that relate mild alterations in PD with an increase in dementia and cognitive alterations. The most commonly observed neuropsychological symptoms in PD are:

• Difficulties in visuospatial ability
• Mild difficulties in memory
• Reduced verbal fluency
• Difficulties in initiation
• Changes in processing speed

It is worth noting that within the cognitive changes they can be found isolated or multiple, both in the cases that start with the condition, as well as those who have already developed it. Cognitive performance in each patient will depend on several factors such as: the lifestyle that has been led, the educational level, the age of onset of PD, if there are associated psychiatric comorbidities, Adjacent medical comorbidities such as vulnerability to developing dementia, family medical history, and whether the patient has generated cognitive reserve etc This will determine cognitive pictures from normal to advanced degrees of neurocognitive impairment.

Among the isolated cognitive deficits we can find patients with deficits in executive functioning or in combination with other disorders such as serious memory or attention difficulties selective. There are various studies that show a percentage of between 30-40% of patients with PD will suffer from clinically defined dementia.

In the same way within neuroaffective conditions some studies report that 30-40% of patients with PD have depression. Delgadillo et al. (2013)

1. attention disturbances

This ability is found in PD patients without dementia. Tests to measure attention include the Neuropsychological Battery Neuropsi, cancellation tasks, inhibition tasks, mazes among others.

2. Executive functioning disorders

This is usually one of the earliest and most characteristic symptoms of PD. The tests that help to have a better cognitive vision of the condition are BANFE, Wisconsin Card Sorting Test, the Trail-Making Test, the Stroop test, the complex figure of King, the Tower of London, the Tower of Hanoi.

3. Visuospatial disorders

This deficit is frequently found in patients with PD, since there are difficulties in observing the relative position of the stimuli presented in space and to integrate them as a whole in a manner consistent. The copy of the Rey figure and the Corsi cube tasks will help determine the severity of impairment of these cognitive functions and networks.

4. Language alterations

Since most patients with PD suffer from hypokinetic dysarthria, it is common for verbal fluency to be affected as there is a slowdown in the process of speech. generation of language and in many patients problems related to writing also appear, resulting in hypokinetic writing, with the presence of micrography. To evaluate if there are alterations in language and in what intensity can be assessed with the Boston naming tests, and the FAS test for phonological and semantic verbal fluency speed.

5. Apraxias

In a study of patients with PD, more than 60% in the apraxia test evaluations obtained worse results than control subjects, several of the authors attribute this to alterations frontal. Motor apraxias are the most common in this condition, especially visuo-constructive apraxias.

• You may be interested in: "Apraxia: causes, symptoms and treatment"

How does it affect affectivity?

All these alterations both motor and non-motor have an impact on the psychological and emotional life of the patient. Social stigma affects significantly and this causes the patient to choose to isolate themselves and stop socializing, they may begin to present depressive and anxious symptoms.

In most cases, in order to protect their loved one, relatives limit their activities both inside and outside the house. This makes the patient begin to progressively lose functionality, feeling unproductive, and sometimes even useless.

10 warning signs

These are the main signs to look out for.

1. Shaking

Tremors or muscle contractions are among the symptoms that appear first in PD. On some occasions they start in a finger of the hand that becomes progressive until lateralizing towards the other side of the body.

2. handwriting alterations

Changes in writing could begin to be noticed, such as making the letter significantly smaller than usual, the weak and descending stroke.

3. Gait difficulties or “freezing” effect

They are transient episodes of the motor disorder in which the person may experience an inability to generate movement that lasts for a few seconds.

4. low voice (hypophony)

It is characterized by a decrease in the volume of the voice when speaking that is due to a lack of coordination of the speech muscles.

5. Lack of facial expression (hypominia)

It consists of a reduction in the ability to convey emotions with facial gestures.

6. Muscular stiffness

This stiffness can be present in any part of the body, limit the range of movement and cause pain.

7. Impaired posture or balance

Also called the “pizza” effect, the body may adopt a hunched posture and to one side.

Risk factor's

Some of the risk factors are:

• Age: it usually begins in the second age of life, although there are cases of early onset (45) that is also called atypical Parkinson's.
• Heredity: having a family member with PD increases the chance of having the disorder
• Sex: various studies have shown that men are more likely to have PD than women.
• Exposure to toxins: continuous exposure to herbicides, pesticides, can increase the risk of suffering from PD.

How to prevent PE?

Although it is a condition that is being widely studied today, the causes of the disease are still unknown. Some research has shown that getting regular aerobic exercise (swimming, bicycling, dancing) may reduce the risk of getting the disease; there is also research that has shown that people who consume caffeine (coffee or tea, green tea or cola drinks) present PD less frequently than those who do not consume them. However, there is no conclusive evidence that caffeine protects against disease.

We are our reality, if our reality is that we have a poor quality of life due to bad habits food, not giving priority to health, practicing a sedentary lifestyle, not giving importance to health emotional; in the end we will be the result of all these bad practices. The definition of insanity “expect different results doing the same thing” (Einstein) if you want to go down the risk of suffering from PD or any other medical condition, it is time to evaluate your habits and improve them.