Parkinson’s disease, Alzheimer’s disease and multiple sclerosis are degenerative neurological conditions where the patient may suffer from progressive loss of normal motor functioning, mental changes, and a gradual but relentless course leading to loss of cognitive abilities. Despite some similar signs and symptoms, these conditions, however, are different in many ways and in their presentation. At times, there is confusion among people who are not familiar with these conditions.
Parkinson’s Disease (PD)
Parkinson’s disease is a neurodegenerative disorder where there is degeneration of the cells of a part of the brain known as the substantia nigra, resulting in dopamine deficiency. Dopamine is a chemical transmitter which is involved in transmitting signals within the brain that help to coordinate movements. Loss of dopamine produces problems with movement and coordination that is the characteristic of PD.
PD usually affects older persons, usually over the age of 60, but it can also occur in younger people. The typical symptoms are tremor, rigidity, bradykinesia (slowness of movement), and loss of postural reflex, frequent falls and freezing of gait, which develop gradually over time. Other associated features may develop as the disease progresses and may include an expressionless face, drooling, soft indistinct speech, short shuffling steps, difficulty in performing fine rapid movements such as writing, or fastening buttons. Memory loss, dementia, depression, behavioral and personality changes, sleep problems, difficulty with speech, eye problems, and a host of other complications may follow. Certain pre-motor symptoms appear long before the occurrence of these grossly incapacitating motor symptoms and include diminished sensation or total loss of the sensation to smell and taste, and constipation.
Although there is no definite cure, medicines to restore the normal dopamine levels are the mainstay of treatment in PD and help to control symptoms. Of these, levodopa, in combination with a peripheral acting dopa-decarboxylase inhibitor, seems to give best results. The other commonly used drugs are pramipexole, ropinirole, rotigotine, selegiline, entacapone, benztropine, and amantadine. Although, the use of anti Parkinson’s medications have debilitating side effects in the long run. In lieu of this, other treatment options are being continually explored, which includes stem cell culture, gene therapy, ayurveda, homeopathy, traditional chinese medicine, mind-body, energy-body techniques, complementary techniques, and natural remedies to treat and provide symptomatic relief against Parkinson’s disease.
Alzheimer’s Disease (AD)
Alzheimer’s disease is a chronic, neurodegenerative age-related, slow but relentlessly progressive disease of the brain cells for which there is no cure. Microscopic changes in the brain start to develop long before the first physical manifestation of symptoms. It is the most common form of dementia in the elderly. It is a generalized term for memory loss and other intellectual disabilities and account for 60% to 80% cases of dementia. It usually occurs after the age of 60, but the risk increases as a person gets older. People live an average life of 8 years after the symptomatic diagnosis of Alzheimer’s disease. However, the survival rate can range anywhere from 4 years to 20 years depending upon the age of the affected individual and other associated health conditions.
Destruction of the brain cells result in problems with memory, thinking and behavior. The development of symptoms is usually slow but they get worsen with time, enough to interfere with the daily household tasks. Memory loss in the early stages is mild, but, people with late stage Alzheimer’s, lose their ability to carry out a normal conversation or respond to their environment. It constitutes to be the sixth leading cause of death in the United States.
Initially, a person with AD has problems with remembering recent events or names of known people. As the disease progresses, they may have difficulty in recognizing family members and forgetting how to do normal activities such as brushing their teeth. There may be behavioral and personality changes, disorientation, mood swings, deep confusion about various events, time and place, difficulty in speaking, walking, and swallowing, inability to take simple decisions, and loss of mental functions.
Currently Alzheimer’s disease has no cure, but symptomatic treatment is available and the research process is in continuation. However, the current medications are not being able to stop the disease from progression, but can temporarily retard the debilitating dementia symptoms and improve the overall quality of life for the patients and their caregivers. Drugs such as donepezil, rivastigmine, galantamine and memantine are used in AD patients to treat symptoms but this cannot slow down the progression of the disease.
Multiple Sclerosis (MS)
Multiple sclerosis (MS) is an unpredictable autoimmune disease where there is damage to the protective covering of the nerve fibers (myelin sheath) of the central nervous system (brain, spinal cord and optic nerves) affecting over 400,000 people in the United States, and 100,000 people in the United Kingdom.
The central nervous system is attacked by the individual’s own immune system. This can result in damage to the fibers itself and conduction of electrical impulses through the nerve fibers is hampered. Nerve fibres remain surrounded by myelin sheath, which helps the nerve to conduct the impulses quickly and efficiently. Due to the autoimmune activity, the myelin sheath around nerve fibres disappears in multiple areas, leaving behind a sclerotic scar in multiple areas. The region with scanty or deficient myelin sheath is called Plaques or lesions. This leads to slow delivery of messages from brain to the muscle tissues.
MS usually starts at a young age, often between 20 and 40 years of age, with women being more often affected than men. Age should not be the only criteria in trying to identify a degenerative neurological condition because in early-onset Parkinson’s disease, the condition may begin in the 40’s or rarely, even younger.
Sometimes the milder symptoms might go undetected in certain individuals until much later in the course of disease. Symptoms of Multiple Sclerosis include
- Bladder Problems: The patient might also develop bladder problem as they have difficulty emptying their bladder completely and experience urge incontinence and nocturia.
- Constipation: Constipation is a common symptom and can sometimes lead to fecal impaction or even bowel incontinence if left untreated.
- Cognitive function and Depression: The patient experience problems with memory, attention, and word finding. Also, the Ms patient has a 50% chance of getting depression.
- Fatigue, Dizziness, and Vertigo: It also constitutes one of the most common symptom and involves about 90% of the affected individuals.
- Muscle weakness, difficulty with balance and coordination, visual problems, numbness or “pins and needles” sensation, Problems with thought and memory may be some of the symptoms.
- Spasticity and muscle Spasms: Painful muscular contraction or spasms occur and the muscles go into spasticity ( resistant to movement) due to the damaged nerve fibres in the brain and spinal cord.
- The symptoms are unpredictable and may vary from person to person and from time to time. In most cases the symptoms may be mild and often remit spontaneously. A person’s ability to speak or walk may become impaired in severe forms of the disease.
There is no cure for MS but drugs such as beta interferon, glatiramer, natalizumab, novantrone, cannabis extract, and corticosteroids may help to slow down the progress of the disease or control some of the symptoms. Rehabilitation is designed to help the MS patients improve and maintain their ability to work at home and office.
Having said that, it is to be noted that Parkinson’s disease, Alzheimer’s disease, and Multiple sclerosis are chronic progressive neurodegenerative disorders of the old age and cause gross debilitating disabilities to the affected individual. Since there is no specific and complete cure for any of the three illnesses, hence, in addition to the conventional medications, certain complementary therapies like yoga, meditation, pool technique, acupuncture, group discussions, and social play activities can help improve the quality of life of the affected individual.