Abstract:
PD was first formally described in “An essay on the shaking palsy”, published in 1817 by a London physician named James Parkinson. It is a chronic progressive, neurodegenerative disorder that may appear at any age, but it is most common in people over 50, effecting 1 to 2% of the population and is rare in those under 30. It is the second most common neurodegenerative disease after Alzheimer’s disease (AD). It is not contagious nor is it usually inherited.
Clinically, PD patients suffer from severe motor dysfunction characterised by three cardinal symptoms: resting tremor (most common initial symptom, predominant at rest), akinesia (inability to initiate movement, poverty and slowness of movement e.g. “mask face”) and rigidity (increased muscle tone subjectively experienced as muscle pain or stiffness, passive movement reveals “cogwheel phenomenon”). Beside the motor disturbance PD patients suffer from motor habit learning and non-motor habit learning deficit (Schmidt, 2000). Phenomenologically the clinical features of depression and PD overlap psychomotor retardation, attention deficit, day-night sleep reversal, hypophonia, impotence, weight loss, fatigue, preoccupation with health and reduced facial expression are seen in both disorders (Gotham et al., 1986, Poewe, 1999).
As deficits in procedural learning and working memory are a frequent finding in non demented patients with PD, it can be difficult in practice, to determine whether depression is contributing to cognitive impairment. Severity of depression has been associated with the severity of cognitive impairment in PD and depression has been associated with a significantly increased risk of developing dementia in PD (Marden et al.,1995, Giladi et al., 2000).
Four surveys, one world-wide, have concluded that depression, disability, postural instability, age and cognitive impairment are the major factors having the greatest influence on the quality of life in PD.
The disabling symptoms in PD are primarily due to profound deficit in striatal DA content that result, from the degeneration of DA-ergic neurons in the SNpc and the consequent loss of their projecting nerve fibres in the striatum. DA-ergic cell loss is associated with the presence of eosinophilic intraneuronal inclusions, called LB composed of neuro filaments in SNpc. Neurodegeneration and LB are also found in the locus coeruleus, nucleus basalis, hypothalamus, cerebral cortex and peripheral component of the autonomic nervous system.
The cause of neuro-degeneration in PD remains unknown. Epidemiological studies indicate that there is no relation with one specific factor but there are perhaps a number of factors which increase the risk of developing PD.