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*Only for medical professionals to read and refer to World Parkinson's Day, let's learn how to prevent and treat Parkinson's disease together! Parkinson's disease (PD) is a common degenerative disease of the nervous system, with a prevalence of about 1700/100,000 in people over 65 years of age in my country [1].
According to data, my country is in a stage of rapid increase in the number of patients with PD.
As a central nervous system disease with low mortality and high disability, the economic and social burden it brings should attract the attention of all sectors of society.
On the occasion of the 25th World Parkinson’s Disease Day (April 11), "Medical Neurology Channel" is honored to invite Professor Liu Yiming from the Department of Neurology of Qilu Hospital of Shandong University to share her on the prevention and treatment of PD the opinion of.
012 keywords, analysis of PD prevention strategies.
Aging is an important cause of PD and affects the quality of life of the elderly.
The improvement of living conditions has caused many elderly people to pay attention to their own health.
Professor Liu Yiming said: "In the past, people always thought that trembling of the hands of the elderly was not considered a disease, but in recent years, the number of elderly patients in outpatient clinics has obviously increased.
We can even see 80 or 90-year-old patients with primary PD.
" The elderly, young and middle-aged patients with early-onset PD have also increased.
Therefore, the prevention of PD has become the focus of the academic circle.
Professor Liu Yiming mentioned two key words: ▌ Lifestyle adjustment: Professor Liu Yiming pointed out that in recent years, there has been a lot of PD prevention.
Research on the cause of the disease has suggested some possible protective factors and risk factors.
Protective factors such as: physical exercise; intake of caffeine and tea (tea polyphenols); healthy eating patterns such as the Mediterranean diet [3].
Risk factors such as: pesticide exposure (including paraquat, rotenone, etc.
), organochlorine pesticide exposure, etc.
[4].
"Avoiding these risk factors, adding protective factors, and improving the body's anti-stress and anti-strike ability are the first steps to prevent PD.
"Professor Liu Yiming concluded.
▌ Psychological state adjustment: "There must be many unsatisfactory things in one's life.
Some people can face an unexpected blow.
Some people can face it calmly, and some people are depressed.
The occurrence and development of depression are related to changes in neurotransmitters (serotonin, etc.
), and the level of dopamine will also be affected.
Depression may be a precursor to PD and a risk factor for PD.
Of course, there are also some patients who experience depression after being diagnosed with PD.
"Professor Liu Yiming believes that psychological state adjustment is mainly divided into pre-symptoms and post-symptoms.
The psychological state adjustments before the onset of motor symptoms are macroscopic, while the psychological adjustments after the onset of symptoms are specific: "There are many patients who encounter If you have prodromal symptoms such as tremor, hyposmia, and constipation, you think you must be suffering from PD, and living in panic all day long.
This is a bad mood and a risk factor for PD.
"What are the special features of 02PD treatment? After talking about the topic of prevention, Professor Liu Yiming shared with the "medical community" her personal experience in clinical treatment of PD patients.
Professor Liu Yiming believes that patient education is the first thing to do after the initial diagnosis.
Event: "First, the patient has to establish a correct understanding of the disease.
PD is a chronic disease that requires long-term, standardized treatment; since it is a chronic disease, physical therapy, drug therapy, surgical treatment, and psychotherapy need to run through the entire disease management process.
"For patients with very mild early symptoms, Professor Liu Yiming is more inclined to recommend exercise rehabilitation therapy, combined with lifestyle changes and social contact to observe the progress of the disease.
In terms of medication, Professor Liu Yiming pays more attention to the patient's personal situation and family care:" For the young and middle-aged who are working, considering the impact on their working status, I prefer to choose dopamine drugs.
For the elderly, we will choose drugs based on the accompanying diseases and pay more attention to the care of family members, such as accompanying patients.
Participate in outdoor activities, understand the needs of patients, change the home environment to prevent patients from falling, etc.
"In general, the treatment of PD is comprehensive and individualized.
For clinicians, the management of PD patients is not a small challenge. What should I do if the effect of the 03PD drug becomes worse? Professor Liu Yiming is here to help! At the end of the sharing, the "medical community" selected a patient's most concerned issue-"The medicine is not as effective as before.
It used to take a medicine for 4 hours, but now the medicine is useless after 2 hours.
What should I do? ?" Professor Liu Yiming, please help me out.
Professor Liu Yiming said that the "end-of-dose phenomenon" of this kind of medication is common.
The vast majority of patients will experience the "end-of-dose phenomenon" after 4 to 5 years of medication, and a small number of patients may occur within 2 to 3 years.
In the face of "dose end phenomenon", dressing change is not the only option.
"Faced with the'end-of-dose phenomenon', we first need to judge whether the drug is ineffective or the effect is not good due to changes in diet and lifestyle.
" Professor Liu Yiming said: "Too much protein in a single day and prolonged non-exercise affect drug absorption.
It may lead to poor efficacy of the drug.
In the face of this type of patient, I personally do not change the medicine, adjust the diet, and do not increase the single dose.
Instead, I increase the number of times the patient takes the drug daily and give the patient continuous dopaminergic stimulation.
It can also make the patient's dopamine level relatively stable, cutting peaks and flat valleys. "Professor Liu Yiming, director of the Department of Neurology, Qilu Hospital of Shandong University, doctor of medicine, doctoral supervisor, deputy director of the Parkinson’s Disease and Movement Disorders Rehabilitation Professional Committee of the Chinese Rehabilitation Medicine Association, member of the Parkinson’s Disease and Movement Disorders Group of the Neurology Branch of the Chinese Medical Association Vice Chairman of the Neurology Branch of Shandong Medical Association Chairman of the Neurology Professional Committee of Shandong Health Management Association Chairman of the Parkinson’s Disease and Movement Disorders Group of the Neurology Branch of Shandong Medical Association Reference: [1] Neurology Branch of the Chinese Medical Association Parkinson's Disease and Movement Disorders Group, Parkinson's Disease and Movement Disorders Specialty of the Neurologist Branch of the Chinese Medical Doctor Association.
Chinese Parkinson's Disease Diagnostic Criteria (2016 Edition)[J].
Chinese Journal of Neurology,2016,49(4) :268-271.
DOI:10.
3760/cma.
j.
issn.
1006-7876.
2016.
04.
002.
[2]Liu Shuying,Chen Biao.
Prevalence status of Parkinson's disease[J].
Chinese Journal of Modern Nervous Diseases,2016,016( 002):98-101.
[3]Song Yanan, Yu Jintai, Tan Lan.
Risk factors and prevention of Parkinson's disease[J].
Chinese Journal of Behavioral Medicine and Brain Science,2019,28(2):188-192.
DOI:10.
3760/cma.
j.
issn.
1674-6554.
2019.
02.
017.
[4]Belvisi D, Pellicciari R, Fabbrini G, et al.
Modifiable risk and protective factors in disease development, progression and clinical subtypes of Parkinson's disease: What do prospective studies suggest?[J].
Neurobiol Dis.
2020 Feb;134:104671.
According to data, my country is in a stage of rapid increase in the number of patients with PD.
As a central nervous system disease with low mortality and high disability, the economic and social burden it brings should attract the attention of all sectors of society.
On the occasion of the 25th World Parkinson’s Disease Day (April 11), "Medical Neurology Channel" is honored to invite Professor Liu Yiming from the Department of Neurology of Qilu Hospital of Shandong University to share her on the prevention and treatment of PD the opinion of.
012 keywords, analysis of PD prevention strategies.
Aging is an important cause of PD and affects the quality of life of the elderly.
The improvement of living conditions has caused many elderly people to pay attention to their own health.
Professor Liu Yiming said: "In the past, people always thought that trembling of the hands of the elderly was not considered a disease, but in recent years, the number of elderly patients in outpatient clinics has obviously increased.
We can even see 80 or 90-year-old patients with primary PD.
" The elderly, young and middle-aged patients with early-onset PD have also increased.
Therefore, the prevention of PD has become the focus of the academic circle.
Professor Liu Yiming mentioned two key words: ▌ Lifestyle adjustment: Professor Liu Yiming pointed out that in recent years, there has been a lot of PD prevention.
Research on the cause of the disease has suggested some possible protective factors and risk factors.
Protective factors such as: physical exercise; intake of caffeine and tea (tea polyphenols); healthy eating patterns such as the Mediterranean diet [3].
Risk factors such as: pesticide exposure (including paraquat, rotenone, etc.
), organochlorine pesticide exposure, etc.
[4].
"Avoiding these risk factors, adding protective factors, and improving the body's anti-stress and anti-strike ability are the first steps to prevent PD.
"Professor Liu Yiming concluded.
▌ Psychological state adjustment: "There must be many unsatisfactory things in one's life.
Some people can face an unexpected blow.
Some people can face it calmly, and some people are depressed.
The occurrence and development of depression are related to changes in neurotransmitters (serotonin, etc.
), and the level of dopamine will also be affected.
Depression may be a precursor to PD and a risk factor for PD.
Of course, there are also some patients who experience depression after being diagnosed with PD.
"Professor Liu Yiming believes that psychological state adjustment is mainly divided into pre-symptoms and post-symptoms.
The psychological state adjustments before the onset of motor symptoms are macroscopic, while the psychological adjustments after the onset of symptoms are specific: "There are many patients who encounter If you have prodromal symptoms such as tremor, hyposmia, and constipation, you think you must be suffering from PD, and living in panic all day long.
This is a bad mood and a risk factor for PD.
"What are the special features of 02PD treatment? After talking about the topic of prevention, Professor Liu Yiming shared with the "medical community" her personal experience in clinical treatment of PD patients.
Professor Liu Yiming believes that patient education is the first thing to do after the initial diagnosis.
Event: "First, the patient has to establish a correct understanding of the disease.
PD is a chronic disease that requires long-term, standardized treatment; since it is a chronic disease, physical therapy, drug therapy, surgical treatment, and psychotherapy need to run through the entire disease management process.
"For patients with very mild early symptoms, Professor Liu Yiming is more inclined to recommend exercise rehabilitation therapy, combined with lifestyle changes and social contact to observe the progress of the disease.
In terms of medication, Professor Liu Yiming pays more attention to the patient's personal situation and family care:" For the young and middle-aged who are working, considering the impact on their working status, I prefer to choose dopamine drugs.
For the elderly, we will choose drugs based on the accompanying diseases and pay more attention to the care of family members, such as accompanying patients.
Participate in outdoor activities, understand the needs of patients, change the home environment to prevent patients from falling, etc.
"In general, the treatment of PD is comprehensive and individualized.
For clinicians, the management of PD patients is not a small challenge. What should I do if the effect of the 03PD drug becomes worse? Professor Liu Yiming is here to help! At the end of the sharing, the "medical community" selected a patient's most concerned issue-"The medicine is not as effective as before.
It used to take a medicine for 4 hours, but now the medicine is useless after 2 hours.
What should I do? ?" Professor Liu Yiming, please help me out.
Professor Liu Yiming said that the "end-of-dose phenomenon" of this kind of medication is common.
The vast majority of patients will experience the "end-of-dose phenomenon" after 4 to 5 years of medication, and a small number of patients may occur within 2 to 3 years.
In the face of "dose end phenomenon", dressing change is not the only option.
"Faced with the'end-of-dose phenomenon', we first need to judge whether the drug is ineffective or the effect is not good due to changes in diet and lifestyle.
" Professor Liu Yiming said: "Too much protein in a single day and prolonged non-exercise affect drug absorption.
It may lead to poor efficacy of the drug.
In the face of this type of patient, I personally do not change the medicine, adjust the diet, and do not increase the single dose.
Instead, I increase the number of times the patient takes the drug daily and give the patient continuous dopaminergic stimulation.
It can also make the patient's dopamine level relatively stable, cutting peaks and flat valleys. "Professor Liu Yiming, director of the Department of Neurology, Qilu Hospital of Shandong University, doctor of medicine, doctoral supervisor, deputy director of the Parkinson’s Disease and Movement Disorders Rehabilitation Professional Committee of the Chinese Rehabilitation Medicine Association, member of the Parkinson’s Disease and Movement Disorders Group of the Neurology Branch of the Chinese Medical Association Vice Chairman of the Neurology Branch of Shandong Medical Association Chairman of the Neurology Professional Committee of Shandong Health Management Association Chairman of the Parkinson’s Disease and Movement Disorders Group of the Neurology Branch of Shandong Medical Association Reference: [1] Neurology Branch of the Chinese Medical Association Parkinson's Disease and Movement Disorders Group, Parkinson's Disease and Movement Disorders Specialty of the Neurologist Branch of the Chinese Medical Doctor Association.
Chinese Parkinson's Disease Diagnostic Criteria (2016 Edition)[J].
Chinese Journal of Neurology,2016,49(4) :268-271.
DOI:10.
3760/cma.
j.
issn.
1006-7876.
2016.
04.
002.
[2]Liu Shuying,Chen Biao.
Prevalence status of Parkinson's disease[J].
Chinese Journal of Modern Nervous Diseases,2016,016( 002):98-101.
[3]Song Yanan, Yu Jintai, Tan Lan.
Risk factors and prevention of Parkinson's disease[J].
Chinese Journal of Behavioral Medicine and Brain Science,2019,28(2):188-192.
DOI:10.
3760/cma.
j.
issn.
1674-6554.
2019.
02.
017.
[4]Belvisi D, Pellicciari R, Fabbrini G, et al.
Modifiable risk and protective factors in disease development, progression and clinical subtypes of Parkinson's disease: What do prospective studies suggest?[J].
Neurobiol Dis.
2020 Feb;134:104671.
