Although it is commonly associated with the elderly, about 10% to 20% of Parkinson’s disease cases happen in people around age 50 or younger. The so-called early-onset Parkinson’s is already well known in the medical literature, but the subject gained prominence after journalist Renata Capucci, 49, told the public that she has the disease and that she was diagnosed at age 45.
“Although these cases in younger people are not exactly new to medicine, there is no doubt that there is a marked increase in diagnoses in people between the ages of 40 and 50 years. I have a patient who was diagnosed at 36” , said Andre Felício, a neurologist and researcher at Hospital Israelita Albert Einstein.
According to Felício, one of the possible explanations for more Parkinson’s diagnoses in young adults would be environmental issues – such as chronic exposure to pollutants, for example, or even factors associated with substances present in food. “Of course, the environment alone does not justify the increase in cases. But it is an important factor,” she says.
genetic factors
Parkinson’s disease is characterized by the progressive degeneration of neurons that produce dopamine – a substance related to the control over our body’s movements. The process causes a progressive destruction of these nerve cells and manifests itself with several symptoms, the best known being muscle rigidity and involuntary tremor.
The problem, emphasizes Felicio, is that by the time these “classic” symptoms appear and the person is diagnosed with Parkinson’s, the disease was probably already installed at least a decade earlier. That’s because the first signs are non-specific and can go unnoticed: decreased sense of smell, constipation, depression and sleep disorder.
“It is very unlikely that a 40-year-old who has a sleep disorder will suspect that he has Parkinson’s. When she makes the diagnosis, usually he has already lost 60% of the neurons that produce dopamine”, exemplifies the doctor.
Most cases are multifactorial and happen sporadically, but there is a percentage of diagnoses in which the patient may have genetic mutations.
According to Felício, there are more than a dozen mutations associated with the development of the disease (PARK 1, PARK 2, PARK3, etc.), although the presence of the mutation does not mean that the person will have the disease at some point in life. The most common mutation in young adults is PARK 2, while in the elderly it is PARK 8.
Molecular examination to identify mutations, however, is not a routine procedure, as, in practice, the development of the disease and the conduct of the patient’s treatment do not change.
“At least for now, the treatment for genetic cases and the treatment for traditional Parkinson’s, which is multifactorial, is exactly the same, so there is no recommendation for carrying out the molecular test,” said Felicio, adding that he asks for the test. for some of its patients for study and scientific research purposes.
The expectation, says Felício, is that in the future treatment via gene therapy will be an alternative cure and a reality for patients who have the disease of genetic origin.
“The younger the patient, the greater the chance that he will have Parkinson’s of genetic origin. There are several studies under development in an attempt to discover possible specific drugs for these cases, so I imagine that the genetic cases will be the ones that have a chance of heal first,” he said.
Symptoms, diagnosis and treatment
Although common sense associates Parkinson’s only with tremor, there is a percentage of patients who will not even have these symptoms. According to Felício, the diagnosis is usually clinical and complemented by imaging tests, such as MRI and ultrasound.
The main motor symptoms are slowness and resting tremor; muscle sluggishness and stiffness; or slowness and imbalance. Slowness is present in all cases and does not only involve walking: it is characterized by the loss of automatism of movements.
“It takes time to blink your eyes, keep your mouth open for a long time, walk with small steps, difficulty making pinching movements, not swing your arms when you walk. All this is a reflection of slowness”, explains the neurologist.
The basis of treatment is to offer exogenous dopamine or to stimulate the dopamine itself that the person is deficiently producing by the body, using drugs that stimulate this production, in addition to other peripheral drugs that help to improve symptoms. Another possible treatment, depending on the case, is surgery for deep brain stimulation, which has advanced a lot.
“Parkinson, whether early onset or not, is the only neurodegenerative disease that has an effective treatment. A person with Parkinson’s can have a great clinical evolution and live very well. With the drugs it is possible for the patient to improve, there is no doubt. patient has his disease and it is not possible to generalize”, said Felício, who stressed the importance of physical exercise as a neuroprotective factor.
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