Parkinson Disease And Study Of Its Differences Between China And Pakistan

Objective:Idiopathic PD has a worldwide occurrence. It is seen in all ethnic groups and socioeconomic classes. The incidence and prevalence of PD increase with advancing age, being present in1%of people over the age of65years. PD, along with other neurodegenerative diseases (Alzheimer’s disease and motor neuron disease), is expected to surpass cancer as the second most common cause of death by the year2040. The frequency of PD will increase fourfold by the year2040. In United States approximately1million people suffer from PD and there are65000newly diagnosed cases of PD every year. Estimated cost of PD is$27billion/Year. There are several cost-of-illness studies for PD from Western Europe and the USA, however, data about the costs associated with PD in Pakistan are still lacking. The progressive nature of PD and its increasing prevalence have resulted in a substantial economic burden to society, health care providers, individual patients and their families. Zhang and Roman reviewed the worldwide occurrence of PD and reported that Chinese, Japanese and African populations have significantly lower prevalence rates than those of Western countries. Data from door to door surveys in three different regions of Pakistan would suggest a low prevalence of PD among Pakistan. There are no uniform, large scale, nationwide epidemiological data on the incidence and prevalence of PD from Pakistan. Medical treatment and management of patients with PD has primarily aimed at preserving life expectancy and limiting motor disabilities. Health care professionals are now convinced that the objective of medical care is not only the care of disease or increased survival but also the enhancement of health related quality of life (QoL). QoL is increasingly recognized as a critical measure in health care as it incorporates the patients’own perspective of their health. The quality of life (QoL) of patients with a chronic disease like PD includes the patient’s symptoms and physical functioning as well as psychosocial variables I have chosen two different races and evaluated and compared the Parkinson disease patients between two races Chinese and Pakistanis, studied their differences regarding clinical features, age of onset, treatment comparison and cost of management and quality of life.Setting and design:The patient studies and reports were taken from two countries China and Pakistan. The PD patients observed were from Qilu Hospital Jinan, Shandong province China and Services Hospital Lahore. Demographical characteristics, clinical features, laboratory investigations and other investigations were recorded and were analyzed in the outdoor department. After the study50patients were choose from each country. After complete examination the prescription details were given and cost of management was recorded. A total of100patients were observed.50patients from China and50patients from Pakistan out of which in Pakistan we choose42patients male and8female and in China44male and6patients were female. The mean age of onset of the disease was56years in Pakistan and in China the mean age was51.18years.Results In our studies we found that86%of patients had onset of illness during the fifth or sixth decade of their life which is common in China. The mean duration of illness at the time of presentation was6.9years in China and that of Pakistan was7.15years. The mean cost of management for the patient in China is53.51dollars while that of Pakistan is26.79Dollars. Rigidity, Bradykinesia, tremors, hypomimia, difficulty in performing fine work and walking difficulty were the most common clinical signs in Pakistan and China. Patients had stage Ⅰ or Ⅱ (Hoehn-Yahr staging) at the time of presentation in China whereas in Pakistan patients had mean stage of2.0-2.5. Patients had predominantly unilateral symptoms in China which is uncommon in Pakistan.Conclusion:Tremor, rigidity, walking difficulty, Bradykinesia and difficulty in performing fine work are the most common clinical features. Disease severity increases with duration of the disease. Although the cost of management in Pakistan was less as compared to china but the quality of life was better in China. Cognitive impairment is not uncommon in these patients and is associated with disease duration and age of onset of the illness. In China the average life span of people is higher due to good quality of life and social condition as compared to the social condition of the patients in Pakistan is poor mainly because the patients coming to the hospital are often farmers or retired people, so the patients show irresponsive behavior while taking medication. Parkinson’s disease patient in Pakistan is a disease of late middle age, usually affecting people over the age of50. The average age of onset is60years. However, some physicians in Pakistan have reportedly noticed more cases of "early-onset" Parkinson’s disease in the past several years, and some have estimated that5to10percent of patients are under the age of40. The treatment prescription includes Sinomet (75%of Levodopa+25%of benserazide) remains the only medicine in treatment of PD in Pakistan. The management of PD also demands treatment of associated problem and complications which are swallowing difficulty, constipation, sexual dysfunction, orthostatic hypotension, patients usually remain careless in sorting out these symptoms.