Немоторные проявления болезни Паркинсона

Parkinson's disease a chronic degenerative disease of the central nervous system, clinically manifested by a combination of hypokinesia and postural disorders with rigidity and resting tremor, and autonomic disorders and mental functions. The pathogenesis of Parkinson's disease is inhibition of the functions of dopaminergic systems of the central nervous system (stria negroid, tuberoinfundibular, olfactory, retinal, and so on). With a comprehensive defeat of dopaminergetic systems associated with the appearance not only of motor disorders, but also a wide variety of autonomic, endocrine, emotional and cognitive, that is, non-motor symptoms. The frequency and severity of non-motor disorders correlated with the duration of Parkinson's disease and the severity of motor disorders. It is important to note that many non-motorized violations appear already at the preclinical stage of Parkinson's disease, ahead of the manifestation of the classic symptoms of Parkinson's disease hypokinesia, rigidity, tremor and postural disorder. As the disease progresses, some of them become the dominant clinical significance, having a negative impact on the quality of life of patients, leading to their disability and reducing life expectancy. The period before the movement disorder can be quite long, sometimes up to 10 years, and is characterized by the appearance of non-motor symptoms. Typical non-motor symptoms of Parkinson's disease are impaired sense of smell, sleep disorders, depression, constipation, change in color perception, less pain, restless leg syndrome, apathy, fatigue, anxiety. Already in the early stages of Parkinson's disease can be detected as a violation of neurodynamic bradiphrenia and disorders of attention. For the first stage Parkinson characteristic lesion olfactory bulb, olfactory nucleus anterior, dorsal motor nucleus of the vagus nerve, peripheral ganglia, autonomic nervous system, as well as pre-and post-ganglionic sympathetic and parasympathetic structures intestinal, heart and pelvic plexus that clinically hypoosmia, constipation, the sympathetic innervation of the myocardium as vasodilation, reducing the strength of heart contractions, disorders of the heart rate variability, orthostatic hypotension. In the second stage of the disease in the degenerative process involves the nucleus of the medulla oblongata and pons, including the core of the nuclei raphe, the locus coeruleus and reticular formation. The second stage is manifested clinically disturbed sleep and wakefulness rapid eye movements during sleep, daytime sleepiness, falling asleep as well as a violation of emotional disorders as depression and apathy. Join a moderate or severe cognitive impairment, and autonomic dysfunction. For the third stage is characterized by loss of the substantia nigra, the tonsils, the basal forebrain is shown connecting motor symptoms such as distortion of fine motor skills. At the fourth step involves the degeneration of the hippocampus and temporal mesokortex. The fourth stage of Parkinson's disease is characterized by a loss of 60% of the dopaminergic neurons of the substantia nigra and a decrease in dopamine production by 80%. Symptomatology complemented tremor, rigidity, hypokinesia, different manifestations of autonomic dysfunction. In the fifth stage of the disease have shown an interest associative zones prefrontal, temporal and parietal cortex. Degeneration of the motor and sensory cortical areas is characteristic of the sixth stage of Parkinson's disease, is characterized by increasing cognitive, behavioral and psychotic disorders. Patient J. 57 years, was admitted with complaints of persistent sleep disturbances, memory loss, fatigue, darkening of the eyes, frequent urge to urinate, especially at night ( up to 4 times), constipation, stiffness and clumsiness, excessive salivation, sweating. From history, we know that the above complaints bother with 2011, while growing gradually in intensity. Indication of exposure to toxic substances: carbon monoxide poisoning, neuroleptic administration, repeated head injuries, and the presence of extrapyramidal disorders in relatives there. In the neurological status: general cerebral and meningeal signs are not present, the field of view at an indicative study of preservation. Eye slits are symmetrical, the pupils round, medium-sized, direct and friendly photoreaction saved. Synchronous movement of the eyeballs, a few jerky: hypometria arbitrary saccades. The weakness of convergence without diplopia. The sensitivity of the face is not reduced. Celebrated a rare blinking several frozen look, hypomimia. It disprosodii with elements determined bradilalia moderate and mild dysarthria. No dysphagia. Paresis not pay attention total depletion of the motor pattern. Bilateral effects of oligobradykinesia, with an emphasis on the left. Formed a supplicant posture of the foot while standing parallel to each other, arms bent at the elbow a few joints and given to the body. When walking is determined by the tendency to mikrobasia, aheyrokinesis on both sides. Coordination tests perform adeguately. Caused by retropulsion not overcome. The tendon and periosteal reflexes were brisk and symmetrical, no signs of pathological Iambic. Muscle tone is increased by plastic type in the axial muscles and muscles of the extremities, with an emphasis on the right. Akrohypergidrosis. Scale UPDRS: Part I = 12, Part II = 17, Part III = 43, Part IV = 0 Total score = 72. Hyun scale Yar = 3. Tilt test in the supine position for 5 minutes BP (D, S) 157/90 mm ​​Hg. Art. Ps 84 beats / min, standing for 5 minutes, blood pressure (D, S) 126/78 mm Hg. Art. Ps 78 beats / min. Schirmer test was conducted to determine production of tears 0.5mm. The amount of saliva released within 5 minutes was 6.5gr. Patient have quantified cognitive impairment using the following tests and scales: Mini Mental State Examination (MMSE) a brief assessment of mental status scale – 27 points, Frontal Assessment Batter (FAB) battery of tests on the frontal dysfunction 15 points, the test is 5 Words – 10 points, clock drawing test 9 points. To assess mood disorders questionnaire used Beck 12 points, Spielberger anxiety scale: 37 situational anxiety, trait anxiety 48. The level of Toronto Alexithymia Scale is 82 points. Autonomic symptoms were assessed using questionnaires and autonomic manifestations was 42 points. Symptom Index of the American Urological Association (AUA) was 8 points. Non-motor symptoms questionnaire Parkinson's disease was 10 points. Thus, on the basis of complaints, medical history, neurological status, clinical and imaging studies of the patient 's disease, Parkinson's akinetic rigid form, 3st by Hyun Yar with affective and autonomic disturbances (orthostatic hypotension, sialoreya, overactive bladder, constipation).

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