INTRODUCTION:
Parkinsonism, as a clinical syndrome, is characterized by tremor, rigidity, bradykinesia, akinesia and postural abnormalities. Parkinson's disease (PD) is the most common variant of parkinsonism syndrome and is the most common disorder among the movement disorder diseases after essential tremor. PHis distinguished by its specific pathology, clinical picture and distinct response to dopaminergic treatment. This situation makes treatability an important criterion for the diagnosis of PH, and also makes the correct diagnosis of PH the most important condition for treatment success. Because PH is the neurodegenerative disease for which pharmacological treatment is most successful.
EPIDEMIOLOGY:
PH is typically a disease of middle and older ages, with an average age of 50-60 years. It starts and progresses progressively over a period of approximately 10 - 20 years. Although different results have been reported in studies conducted in various countries, it is generally known that the annual incidence of parkinsonism varies between 4.5-21/100000. In different studies conducted between 1935 and 1990 in Rochster, Minnesota, where the most reliable incidence values were obtained, it was observed that the incidence of parkinsonism varied between 18.2-20.5/105 without showing any major changes. Studies conducted in different societies report figures ranging from 18-328/100000 for the prevalence of parkinsonism. As the most common form of Parkinsonism, approximately 75-80% of these cases are PD cases. In a study conducted in Eskişehir, the prevalence value for Turkey was reported as 111/100000. In a joint study conducted in 5 different countries in Europe (EUROPARKINSON Collaborative Study), the prevalence of total parkinsonism over the age of 65 was found to be 2.3/100 and the prevalence of PH was 1.6/100.
CLINICAL FEATURES:
PH is the prototype condition for hypokinetic diseases and is characterized by parkinsonian motor findings, namely tremor, rigidity, bradykinesia, akinesia and postural abnormalities. The gold standard in the diagnosis of PH is still neurological examination. PH is characterized by isolated parkinsonian findings without any other signs of neurological involvement. It is characterized by the presence of Other features of PD that help distinguish it clinically from other parkinsonism conditions are the asymmetry of parkinsonian findings, pronounced resting tremor, the presence of a clinically significant response to levodopa, and little or no balance problems in the early stage of the disease.
Although PD has traditionally been considered a motor system disease, today it is considered a much more complex syndrome with a motor and nonmotor (autonomic, behavioral, cognitive and sensory) involvement pattern. The fact that PD shows such a rich and diverse symptomatology can lead to diagnostic confusion and delayed treatment in the early stages of the disease.
In PD, the symptoms begin insidiously and the condition gradually worsens over the years. The disease is usually vague and progresses with non-specific symptoms. It begins with a prodrome period. During this period, fatigue, weakness or personality changes may be observed, and motor findings may also be in the form of vague complaints (such as feeling of weakness, moderate incoordination, difficulty in writing). Patients may only experience stiffness, difficulty in writing, slowness or may also consult a physician complaining of pain. In most patients, symptoms occur in one half of the body, and approximately 50% of them start as tremor. Although the findings transfer to the opposite half of the body over time, an asymmetrical involvement is remarkable, usually on the first side affected. The fact that PH begins in one half of the body and usually in one extremity, and nonmotor signs and symptoms are features that increase the difficulty of diagnosis. In the group that does not start with tremor, parkinsonian symptoms in the early stages can often be interpreted as simple arthritis, bursitis, depression, normal aging, Alzheimer's disease or stroke. Sometimes the diagnosis can only be made when motor findings become bilateral, that is, within months or years.
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