A Holistic Approach to Parkinson's Disease: Integrating Advances in Pathophysiology, Diagnosis, and Therapy
Abstract
Background: Parkinson's disease (PD) is a prevalent neurodegenerative disorder affecting millions worldwide, with an increasing burden projected in the coming years. It involves complex neurological decline primarily affecting the Substantia nigra and Locus coeruleus, leading to motor and non-motor symptoms.
Objective: This study aims to provide a comprehensive overview of Parkinson's disease, including its epidemiology, pathophysiology, diagnosis, and available therapies, encompassing both traditional pharmaceutical treatments and emerging technological advancements.
Methods: A thorough review of literature was conducted, synthesizing information from various studies and clinical trials to elucidate the current understanding of Parkinson's disease and its management strategies.
Results: Parkinson's disease is characterized by the gradual loss of dopamine-producing cells and the presence of Lewy bodies in the brain. Diagnosis relies on clinical evaluation, and treatment typically involves pharmaceutical interventions such as levodopa, COMT inhibitors, dopamine agonists, and deep brain stimulation. Additionally, advancements in technology offer promising avenues for objective symptom assessment and personalized treatment approaches.
Conclusion: The management of Parkinson's disease requires a multidisciplinary approach, integrating traditional pharmacological treatments with emerging technologies and complementary therapies like dance therapy, tai chi, and speech therapy. By combining these diverse modalities, healthcare professionals can provide more effective and personalized care, ultimately enhancing the quality of life for individuals living with Parkinson's disease.
Keywords: Parkinson's disease, medical therapy, device-aided therapy, alternative interventions, personalized treatment, neurodegenerative disorder
Keywords:
Parkinson's disease, medical therapy, device-aided therapy, alternative interventions, personalized treatment, neurodegenerative disorderDOI
https://doi.org/10.22270/jddt.v14i5.6558References
Dorsey ER, Constantinescu R, Thompson JP et al. Projected number of people with Parkinson disease in the most populous nations, 2005 through 2030. Neurology. 2007;68:384-6. https://doi.org/10.1212/01.wnl.0000247740.47667.03 PMid:17082464
J. P. An essay on the shaking palsy. London: sherwood, Neely and Jones; 1817; republished as Parkinson J. An essay on the shaking palsy. J Neuropsychiatry Clin Neurosci. 2002;14(2):223-236. https://doi.org/10.1176/appi.neuropsych.14.2.223
Galvan A WT. Pathophysiology of Parkinsonism. Clin Neurophysiol. 2018;119(7):1459-1474. https://doi.org/10.1016/j.clinph.2008.03.017 PMid:18467168 PMCid:PMC2467461
Poewe W MP. The clinical progression of Parkinson's dis ease. Park Relat Disord. 2009;15:S24-S27. https://doi.org/10.1016/S1353-8020(09)70831-4 PMid:20123553
Chaudhuri KR, Healy DG SA. Non-motor symptoms of Parkinson's disease: diagnosis and management. Lancet. 2006;5 (3):235-245. https://doi.org/10.1016/S1474-4422(06)70373-8 PMid:16488379
Comi C, Magistrelli L, Oggioni GD et al. Peripheral nervous system involvement in Parkinson's disease: evidence and controversies. Park Relat Disord. 2014;20(12):1329-1334. https://doi.org/10.1016/j.parkreldis.2014.10.010 PMid:25457816
Amplitud De Movimiento L, Equilibrio E, Flexibilidad La Movilidad Funcional En Personas Con Parkinson LY, Ensayo Controlado Aleatorio Ane Luyze Izidoro Walkowski U, Amaro Moratelli J, Alcantara Garcia Meliani A, et al. Effects Of Mat Pilates On Range Of Motion, Balance, Flexibility And Functional Mobility In People With Parkinson's: A Randomized Controlled Trial Efectos Del Mat Pilates En. Retos [Internet]. 2024;54:255-63. Available from: https://recyt.fecyt.es/index.php/retos/index https://doi.org/10.47197/retos.v54.102220
Syezri F, Jaafar A, Aizuddin AN, Ahmad N, Yaacob J, Razak BT, et al. Environmental Risk Factors of Parkinson ' s Disease : A Scoping. 2024;14(1).
Sivagurunathan N, Gnanasekaran P, Calivarathan L. Mitochondrial Toxicant-Induced Neuronal Apoptosis in Parkinson's Disease: What We Know so Far. Degener Neurol Neuromuscul Dis. 2023;Volume 13:1-13. https://doi.org/10.2147/DNND.S361526 PMid:36726995 PMCid:PMC9885882
Sayyaed A, Saraswat N, Vyawahare N, Kulkarni A. A detailed review of pathophysiology, epidemiology, cellular and molecular pathways involved in the development and prognosis of Parkinson's disease with insights into screening models. Bull Natl Res Cent [Internet]. 2023;47(1). https://doi.org/10.1186/s42269-023-01047-4 11. Aljarbou EFA, Alosayfir ZAS, Johali AAM, Alabdulmuhsin FMA, Aljulajle AA, Al Sharbi AAH, et al. Parkinson Disease, Recent Updates: Literature Review. 2020;11:122-6.
Krüger R, Klucken J, Weiss D, Tönges L, Kolber P, Unterecker S, et al. Classification of advanced stages of Parkinson's disease: translation into stratified treatments. J Neural Transm. 2017;124(8):1015-27. https://doi.org/10.1007/s00702-017-1707-x PMid:28342083 PMCid:PMC5514193
Hauser RA, Hsu A, Kell S, Espay AJ, Sethi K, Stacy M et al. Extended-release carbidopa-levodopa (IPX066) compared with immediate-release carbidopa-levodopa in patients with Parkin son's disease and motor fluctuations: a phase 3 randomised, dou ble-blind trial. Lancet Neurol. 2013;12(4):346-56. https://doi.org/10.1016/S1474-4422(13)70025-5 PMid:23485610
Pahwa R, Lyons KE, Hauser RA, Fahn S, Jankovic J PE, Al. E. Randomized trial of IPX066, carbidopa/levodopa extended release, in early Parkinson's disease. Park Relat Disord. 2014;20(2):142-8. https://doi.org/10.1016/j.parkreldis.2013.08.017 PMid:24055014
Silver DE TR. Physicians' experience with RYTARY (carbidopa and levodopa) extended-release capsules in patients who have Parkinson disease. Neurology. 2016;86(14 Supp:S25-35. https://doi.org/10.1212/WNL.0000000000002511 PMCid:PMC4844241
Stocchi F, Rascol O, Kieburtz K, Poewe W J, J T, E, Et, Al. Initiating levodopa/carbidopa therapy with and without entacapone in early Parkinson disease: the STRIDE PD study. Ann Neurol,. 2010;68:18-27. https://doi.org/10.1002/ana.22060 PMid:20582993
Ferreira JJ, Lees A, Rocha JF, Poewe W RO, Soares-da-Silva P et al. Opicapone as an adjunct to levodopa in patients with Parkinson's disease and end-of-dose motor fluctuations: a randomised, double-blind, controlled trial. Lancet Neurol,. 2016;15:154-65. https://doi.org/10.1016/S1474-4422(15)00336-1 PMid:26725544
Lees AJ, Ferreira J, Rascol O, Poewe W RJ, McCrory M et al. Opicapone as Adjunct to Levodopa Therapy in Patients With Parkinson Disease and Motor Fluctuations: A Randomized Clinical Trial. JAMA Neurol,. 2017;74:197-206. https://doi.org/10.1001/jamaneurol.2016.4703 PMid:28027332
Pahwa R, Tanner CM, Hauser RA et al. ADS-5102 (amantadine) extended-release capsules for levodopa-induced dyskinesia in Parkinson disease (EASE LID study): a randomized clinical trial. JAMA Neurol. 2017;74:941-9. https://doi.org/10.1001/jamaneurol.2017.0943 PMid:28604926 PMCid:PMC5710325
Hauser RA, Mehta SH, Kremens D, Chernick D FA. Effects of Gocovri (amantadine) extended-release capsules on motor aspects of experiences of daily living in people with Parkinson's disease and dyskinesia. Neurol Ther. 2021;10:739-51. https://doi.org/10.1007/s40120-021-00256-1 PMid:34024025 PMCid:PMC8571461
Jenner P, Mori A, Hauser R, Morelli M FB, JF C. Adenosine, adenosine A 2A antagonists, and Parkinson's disease. Park Relat Disord,. 2009;15:406-13. https://doi.org/10.1016/j.parkreldis.2008.12.006 PMid:19446490
Mizuno Y, Kondo T JISG. Adenosine A2A receptor antagonist istradefylline reduces daily OFF time in Parkinson's disease. Mov Disord,. 2013;28:1138-41. https://doi.org/10.1002/mds.25418 PMid:23483627 PMCid:PMC3842830
Trenkwalder C, Chaudhuri KR, Garcia Ruiz PJ, LeWitt P K, zenschlager R, Sixel-Doring F et al. Expert Consensus Group report on the use of apomorphine in the treatment of Parkin son's disease--Clinical practice recommendations. Park ism Relat Disord. 2015;21(9):1023-30. https://doi.org/10.1016/j.parkreldis.2015.06.012 PMid:26189414
G. PS. Effects of tocopherol and deprenyl on the progression of disability in early Parkinson's disease. N Engl J Med,. 1993;328:176-83. https://doi.org/10.1056/NEJM199301213280305 PMid:8417384
Chou KL, Stacy M ST et al. The spectrum of "off" in Parkinson's disease: What have we learned over 40 years? Park Relat Disord. 2018;51:9-16. https://doi.org/10.1016/j.parkreldis.2018.02.001 PMid:29456046
Kipps C, Fung V, Grattan-Smith P de MG, J. M. Movement disorder emergencies. Mov Disord. 2005;20:322-34. https://doi.org/10.1002/mds.20325 PMid:15584031
Gazewood JD, Richards DR, Clebak K. Parkinson disease: An update. Am Fam Physician. 2013;87(4):267-73.
Mathis MV, Muoio BM, Andreason P, Avila AM FT, Atrakchi A et al. The US Food and Drug Administration's Per spective on the New Antipsychotic Pimavanserin. J Clin Psy chiatry. 2017;78(6):e668-73. https://doi.org/10.4088/JCP.16r11119 PMid:28493654
Citrome L, Norton JC, Chi-Burris K DG. Pimavanserin for the treatment of Parkinson's disease psychosis: number needed to treat, number needed to harm, and likelihood to be helped or harmed. CNS Spectr. 2017;1-11. https://doi.org/10.1017/S1092852918000469
Palma JA KH. Treatment of autonomic dysfunction in Parkinson disease and other synucleinopathies. Mov Disord,. 2018;33:372-90. https://doi.org/10.1002/mds.27344 PMid:29508455 PMCid:PMC5844369
Ozekmekci S, Apaydin H KE. Clinical features of 35 patients with Parkinson's disease displaying REM behavior disorder. Clin Neurol Neurosurg. 2005;107(4):306-9. https://doi.org/10.1016/j.clineuro.2004.09.021 PMid:15885389
Schenck CH MM. Long-term, nightly benzodiaze pine treatment of injurious parasomnias and other disorders of disrupted nocturnal sleep in 170 adults. Am J Med. 1996;100(3):333-7. https://doi.org/10.1016/S0002-9343(97)89493-4 PMid:8629680
Schenck CH, Bundlie SR, Patterson AL MM. Rapid eye movement sleep behavior disorder: a treatable parasomnia affecting older adults. JAMA. 1987;257(13):1786-9. https://doi.org/10.1001/jama.1987.03390130104038 PMid:3820495
Boeve BF, Silber MH FT. Melatonin for treatment of REM sleep behavior disorder in neurologic disorders: results in 14 patients. Sleep Med. 2003;4(4):281-4. https://doi.org/10.1016/S1389-9457(03)00072-8 PMid:14592300
Devos D, Dujardin K, Poirot I et al. Comparison of desipramine and citalopram treatments for depression in Parkinson's disease: a double blind, randomized, placebo-controlled study. Mov Disord. 2008;23:850 857. https://doi.org/10.1002/mds.21966 PMid:18311826
Ha AD JJ. Pain in Parkinson's disease. Mov Disord. 2012;27:485 491. https://doi.org/10.1002/mds.23959 PMid:21953990
Van Blercom N, Lasa A, Verger K et al. Effects of gabapentin on the motor response to levodopa: a double-blind, placebo-controlled, crossover study in patients with complicated Parkinson disease. Clin Neuropharmacol. 2004;27:124-128. https://doi.org/10.1097/00002826-200405000-00007 PMid:15190235
Smilowska, K.; van Wamelen, D.J.; Pietrzykowski T. C, A.; Rodriguez-Blazquez, C.; Martinez-Martin, P.; Odin P., Chaudhuri KR. Cost-effectiveness of device-aided therapies in Parkinson's disease: A structured review. J Park Dis,. 2021;11(2):475-89. https://doi.org/10.3233/JPD-202348 PMid:33386813 PMCid:PMC8150660
Prakash, N.; Simuni T. Infusion therapies for Parkinson's disease. Curr Neurol Neurosci Rep,. 2020;20(9):44. https://doi.org/10.1007/s11910-020-01062-2 PMid:32740768
Antonini, A.; Stoessl, A.J.; Kleinman, L.S.; Skalicky AM. M, shall, T.S.; Sail, K.R.; Onuk, K.; Odin PLA. Developing consen sus among movement disorder specialists on clinical indicators for identification and management of advanced Parkinson's disease: a multi-country Delphi-panel approach. Curr Med Res Opin,. 2018;34(12):2063-2073. https://doi.org/10.1080/03007995.2018.1502165 PMid:30016901
Krack P, Martinez-Fernandez R, Del Alamo M OJ. Current applications and limitations of surgical treatments for movement disorders. Mov Disord. 2017;32(1):36-52. https://doi.org/10.1002/mds.26890 PMid:28124435
You Z etal. Efforts of subthalamic nucleusdeepbrainstimulationon cognitive spectrum: From explicit to implicit changes in the patients with Parkinson's disease for 1 year. CNS Neurosci Ther. 2020;26,:972-980. https://doi.org/10.1111/cns.13392 PMid:32436660 PMCid:PMC7415202
A. Antonini, E. Moro, C. Godeiro HR. Medical and surgical management of advanced Parkinson's disease,. Mov Disord. 2018;33 (July (:900-908. https://doi.org/10.1002/mds.27340 PMid:29570862
C. L. Continuous levodopa for advanced Parkinson's disease. Neuropsychiatr Dis Treat. 2007;3:335-48.
D. N. Enteral levodopa/carbidopa gel infusion for the treatment of motor fluctuations and dyskinesias in advanced Parkinson's disease. Expert Rev Neurother. 2006;6:1403-11. https://doi.org/10.1586/14737175.6.10.1403 PMid:17078781
Nyholm D, Askmark H, Gomes-Trolin C et al. Optimizing levodopa pharma cokinetics: intestinal infusion versus oral sustained-release tablets. Clin Neuropharmacol. 2003;26:156-63. https://doi.org/10.1097/00002826-200305000-00010 PMid:12782919
Antonini A TE. Apomorphine and levodopa infusion therapies for advanced Parkinson's disease: selection criteria and patient management. Expert Rev Neurother. 2009;9:859-67. https://doi.org/10.1586/ern.09.48 PMid:19496689
Sensi M, Cossu G, Mancini F, Pilleri M, Zibetti M M, N et al. Which patients discontinue? Issues on Levodopa/carbi dopa intestinal gel treatment: Italian multicentre survey of 905 patients with long-term follow-up. Park Relat Disord. 2017;38:90-2. https://doi.org/10.1016/j.parkreldis.2017.02.020 PMid:28238650
Virhammar J ND. Levodopa-carbidopa enteral suspen sion in advanced Parkinson's disease: clinical evidence and ex perience. Ther Adv Neurol Disord. 2017;10(3):171-87. https://doi.org/10.1177/1756285616681280 PMid:28344656 PMCid:PMC5349373
Ortí-Pareja M, Jiménez-Jiménez FJ, Vázquez A et al. Drug induced tardive syndromes. Park Relat Disord. 1999;5:59-65. https://doi.org/10.1016/S1353-8020(99)00015-2 PMid:18591121
PR. B. Acute and subacute drug-induced movement dis orders. Park Relat Disord. 2014;20(1 Suppl:S108-12. https://doi.org/10.1016/S1353-8020(13)70027-0 PMid:24262159
Nicholson G, Pereira AC HG. Parkinson's disease and anaesthesia. Br J Anaesth. 2002;89:904-16. https://doi.org/10.1093/bja/aef268 PMid:12453936
Carapellotti AM, Stevenson R DM. The efficacy of dance for improving motor impairments, non motor symptoms, and quality of life in Parkinson's disease: A systematic review and meta analysis. PLoS One . 2020;15:e023682. https://doi.org/10.1371/journal.pone.0236820 PMid:32756578 PMCid:PMC7406058
Zhang Q, Hu J, Wei L, Jia Y JY. Effects of dance therapy on cognitive and mood symptoms in people with Parkinson's disease: A systematic review and meta analysis. Complement Ther Clin Pr. 2019;36:12 7. https://doi.org/10.1016/j.ctcp.2019.04.005 PMid:31383428
Emmanouilidis S, Hackney ME, Slade SC, Heng H JD, ME. M. Dance is an accessible physical activity for people with Parkinson's disease. Park Dis 2021; 2021;7516504. https://doi.org/10.1155/2021/7516504 PMid:34721836 PMCid:PMC8556098
Porter G, Gupta J. Parkinson's Disease. Prim Care Occup Ther a Quick Ref Guid. 2023;319-29. https://doi.org/10.1007/978-3-031-20882-9_31
Sharma, A.; Moon, E.; Kim, G.; Kang SU. Perspectives of Circadian-Based Music Therapy for the Pathogenesis and Symptomatic Treatment of Neurodegenerative Disorders. Front Integr Neurosci. 2021;15:769142. https://doi.org/10.3389/fnint.2021.769142 PMid:35153687 PMCid:PMC8825343
Matziorinis, A.M.; Koelsch S. The Promise of Music Therapy for Alzheimer's Disease: A Review. Ann N Y Acad Sci. 2022;1516:11-17. https://doi.org/10.1111/nyas.14864 PMid:35851957 PMCid:PMC9796133
Huang X, Dong K, Gan C, Zhiqin Xu BS, Lei D, Dong X, et al. Effect of Rhythmically Cued Exercise Interventions on Functions in Patients with Parkinson Disease: A Meta-Analysis. Phys Ther. 2023; https://doi.org/10.1093/ptj/pzad158 PMid:37962936
KP. R. Applications of yoga in Parkinson's disease: A systematic literature review. Res Rev Park. 2014;4:1 8. https://doi.org/10.2147/JPRLS.S40800
Singh, A.; Tripathi, P.; Yadawa, A.K.; Singh S. Promising Polyphenols in Parkinson's Disease Therapeutics. Neurochem Res. 2020;45:1731-1745. https://doi.org/10.1007/s11064-020-03058-3 PMid:32462543
Yin, R.; Xue, J.; Tan, Y.; Fang, C.; Hu, C.; Yang, Q.; Mei, X.; Qi D. The Positive Role and Mechanism of Herbal Medicine in Parkinson's Disease. Oxidative Med Cell Longev. 2021;2021:e9923331. https://doi.org/10.1155/2021/9923331 PMid:34567415 PMCid:PMC8457986
Kujawska, M.; Jodynis-Liebert J. Polyphenols in Parkinson's Disease: A Systematic Review of In Vivo Studies. Nutrients. 2018;10:642. https://doi.org/10.3390/nu10050642 PMid:29783725 PMCid:PMC5986521
Goldman JG, Volpe D, Ellis TD, Hirsch MA, Johnson J, Wood J, et al. Delivering Multidisciplinary Rehabilitation Care in Parkinson's Disease: An International Consensus Statement. J Parkinsons Dis. 2024;14(1):135-66. https://doi.org/10.3233/JPD-230117 PMid:38277303 PMCid:PMC10836578
Published
Abstract Display: 490 
PDF Downloads: 450 PDF Downloads: 62 How to Cite
Issue
Section
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
How to Cite
.