Pathophysiology of Parkinson's disease

Abstract

Parkinson's disease (PD) has classically been considered a disease of motor dysfunction, but it also includes psychiatric symptoms. To better understand the symptoms and signs that accompany PD, the interrelationships of deep brain structures and cortical areas involved with this neurodegenerative disease must be investigated.Current models of basal ganglia/cortical physiology attempt to integrate motor and nonmotor physiology and describe the pathophysiology attributable to PD. The cortical areas comprising basal ganglia/cortical loops include frontal structures involved in motor program as well as more prefrontal structures likely subserving non-motor functions such as cognition. The etiology of PD is not clear, but studies have implicated oxidative stress from exogenous stressors or endogenous neurotoxins. A large number of PD patients have been found to exhibit mitochondrial dysfunction. Lewy bodies are seen within dopaminergic and other neuronal populations affected in PD, and they stain positive for ubiquitin and alpha-synuclein. The small percentage of familial PD has often been found to coincide with dominantly inherited mutations in the gene for alpha-synuclein, or with the recessive gene mutation for parkin, which is involved in the ubiquitination pathway. Selected neuronal populations are affected in PD, and the neurodegeneration may include dopaminergic neurons outside the substantia nigra pars compacta, as well and non-dopaminergic neurons. The loss of these neuronal populations within the basal ganglia-frontal circuits can have a profound effect upon the motor and neurobehavioral symptoms in PD. L-dopa remains the most effective pharmacologic therapy for PD, however as the disease progresses, the drug loses its efficacy and troublesome sideeffects often occur. The renewal of surgical interventions for PD has increased the insight into the pathophysiology of PD,and surgical lesions have shown that motor and cognitive fronto-subcortical circuits are seemingly segregated in patients with PD. Investigation into these circuits helps provides models underlying motor and cognitive pathophysiology of PD.