| Abstract | Parkinsonova bolest je jedan od najčešćih neurodegenerativnih poremećaja u svijetu. S porastom prevalencije, koja se povećava sa starenjem populacije, bolest zahtijeva bolje i ranije dijagnosticiranje, odgovarajuće liječenje, ali i poboljšanje kvalitete života oboljelih. S tim primarnim ciljevima, ali i s ciljem optimizacije dijagnostike i liječenja, te racionalizacije troškova dugotrajnog liječenja, potiče se formiranje integriranih, multidisciplinarnih programa skrbi za pacijente. Otkriveni su mnogi genetski i okolišni čimbenici koji doprinose povećanom ili smanjenom riziku razvoja bolesti. Ipak, točan patofiziološki mehanizam koji rezultira nezaustavljivom progresijom bolesti i dalje se istražuje. Degeneracija dopaminergičkih neurona u crnoj jezgri dovodi do ispada u motoričkim živčanim putovima između korteksa, talamusa i bazalnih ganglija. Prepoznatljive kliničke značajke su progresivna bradikineza, tremor u mirovanju, rigidnost i oštećeni posturalni refleksi. Ništa manje važni su i raznovrsni nemotorički simptomi: depresija, kognitivna deterioracija, autonomne disfunkcije i drugi. Prepoznavanje prodromalnih simptoma naglašava važnost rane dijagnoze i posljedično ranog početka intervencije. S obzirom na razne organske sustave zahvaćene bolešću, u dijagnostici i liječenju je važan multidisciplinarni pristup. Multidisciplinarni tim trebao bi uključivati neurologa specijaliziranog za ekstrapiramidne poremećaje, medicinsku sestru specijaliziranu za ovu bolest, fizioterapeuta, psihijatra, psihologa, radnog terapeuta, farmaceuta, nutricionista, gastroenterologa, dermatologa, urologa i somnologa, te druge stručnjake ovisno o specifičnim potrebama bolesnika. Koncept se temelji na individualiziranom, pacijentu-orijentiranom pristupu, koji rezultira boljom suradljivošću i sveukupno značajno poboljšava dugoročne terapijske ishode i kvalitetu života. |
| Abstract (english) | Parkinson's disease is one of the most common neurodegenerative disorders worldwide. With an increase in prevalence, which corresponds with ageing of the population, this disease requires an even better and earlier diagnosis, adequate treatment, as well as improvement of patient’s quality of life. Considering those primary goals, the formation of integrated, multidisciplinary patient-care programs has been encouraged, while also having in mind the optimization of treatment and diagnostic, and the rationalization of the costs arising from a long-term treatment. Many genetic and environmental factors that contribute or reduce the risk for development of the disease have been discovered. However, the precise pathophysiological mechanism that results in unstoppable progression of the disease still awaits further studies. Degeneration of dopaminergic neurons of the substantia nigra leads to dysfunction of the cortico-thalamo-basal ganglia motor pathway. Distinguishing clinical characteristics are progressive bradykinesia, resting tremor, rigidity and postural reflexes dysfunctions. No less important are protean non-motor symptoms: depression, cognitive deterioration, autonomic dysfunctions etc. Recognition of prodromal symptoms emphasise the importance of early diagnosis and thus early intervention. Regarding the various organ systems affected by the disease, multidisciplinary treatment is important in diagnostics and treatment. The multidisciplinary team should consist of a neurologist specialized in extrapyramidal disorders, a nurse specialized in the disorder in question, physiotherapist, psychiatrist, psychologist, occupational therapist, pharmacist, nutritionist, gastroenterologist, dermatologist, urologists and somnologist and other professionals, depending on the specific needs of the patient. The concept relies on an individualized, patient-centred approach, which results in better compliance and altogether significantly improves long term treatment results and quality of life. |
