2.9 Neurological and Sensory PARKINSON'S Flashcards
Parkinson’s disease
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
Chronic & gradually progressive; classed as movement disorder but sensory S/S occur
Genetic, environmental, and lifestyle factors –cause not understood
Risk factors: age, exposure to toxins, head injury, sex
Accumulation of Lewy bodies
Neurotransmitter problem: death of dopaminergic neurons in substantia nigra
dopamine deficit
lose balance of acetylcholine (excitatory) & dopamine (inhibitory) stimulation of neurons
movement, mood, behavior, & cognitive change
Diverse disorder –individual clinical picture
1 million people in the US
Parkinson’s disease
Dopamine
Dopamine is a chemical messenger (neurotransmitter) that is primarily responsible for controlling movement, emotional responses and the ability to feel pleasure and pain. In people with Parkinson’s, the cells that make dopamine are impaired. As Parkinson’s progresses, more dopamine-producing brain cells die. Your brain eventually reaches a point where it stops producing dopamine in any significant amount. This causes increasing problems with movement.
Parkinson’s disease
Manifestations
MOVEMENT SYMPTOMS
Manifestations
MOVEMENT SYMPTOMS:
Bradykinesia- slow movements
Rigidity – stiffness “cogwheel rigidity”
Tremors - resting (various areas “pill rolling”)
Postural instability
Additional motor manifestations:
Stooped posture & Gait disturbances –no arm swing, shuffling, festinating (tendency to speed up when performing repetitive movements
Dyskinesia, dystonia (involuntary muscle contractions that cause slow repetitive movements or abnormal postures)
Freezing
Facial masking, swallow problems, & drooling – staring & lack of blinking
Micrographia (small handwriting)
Dysphonia (soft, hoarse voice)
Parkinson’s disease
Cramping
Drooling
Cramping (dystonia: involuntary muscle contractions that cause slow repetitive movements or abnormal postures):sustained or repetitive twisting or tightening of muscle.
Drooling (sialorrhea):while not always viewed as a motor symptom, excessive saliva or drooling may result due to a decrease in normally automatic actions such as swallowing.
Parkinson’s disease
Dyskinesia
Festination
Dyskinesia:involuntary, erratic writhing movements of the face, arms, legs or trunk.
Festination:short, rapid steps taken during walking. May increase risk of falling and often seen in association with freezing.
Parkinson’s disease
Freezing
Masked face
Freezing:gives the appearance of being stuck in place, especially when initiating a step, turning or navigating through doorways. Potentially serious problem as it may increase risk of falling.
Masked face (hypomimia):results from the combination of bradykinesia and rigidity.
Parkinson’s disease
Micrographia
Shuffling gait
Soft speech
Micrographia:small, untidy and cramped handwriting due to bradykinesia.
Shuffling gait:accompanied by short steps and often a stooped posture.
Soft speech (hypophonia):soft, sometimes hoarse, voice that can occur in PD
Parkinson’s disease
Manifestations
NON-MOVEMENT SYMPTOMS:
NON-MOVEMENT SYMPTOMS:
Cognitive changes: attention, planning, language, memory, dementia
Constipation
Fatigue
Loss of taste or smell
Urinary urgency, frequency, & incontinence
Sleep problems
Mood disorders: depression, anxiety, apathy, irritability
Early satiety (feeling of fullness after eating small amounts), weight loss
Orthostatic hypotension, dizziness
Vision problems, especially when attempting to read items up close
Parkinson’s disease
diagnosis
diagnosis
No specific test – must have 2 of the 4 symptoms: tremor, bradykinesia, rigidity, postural instability
Neurologist movement disorders specialist – challenging dx, pt’s have variable symptoms
Rule out other conditions that mimic PD
Tests:
-CT scan
-MRI
-DatScan SPECT: shows density of dopamine transporter, qualitative
-PET scan
Parkinson’s disease
DaT scans
The new DaT scans use a substance that “tags” a part of a neuron in the brain where dopamine attaches to it, thus showing the density of healthy dopamine neurons. Thus, the more of the picture that “lights up”, the more surviving brain cells. Dark areas could mean either Parkinson’s disease or parkinsonism.
Parkinson’s disease
Treatment
Treatment
No cure, meds & treatments control symptoms, eventually not effective
Medications
Dopamine replacement – levodopa/carbidopa levodopa converts to dopamine in brain
(carbidopa delays breakdown & ↓N & V;) levodopa can cause dyskinesias; wearing off”
Sometimes give COMT inhibitors to prolong levodopa by blocking its metabolism (entacapone)
Surgical insertion in intestine of gel delivery system for pts with “wearing off”
Dopamine agonists – stimulate the areas of brain where dopamine works (pramipexole, ropinirole)
Anticholinergics – treat tremor by blocking acetylcholine
MAO inhibitors – prevent breakdown of dopamine
Medical marijuana
Surgery – deep brain stimulator
Therapy
Parkinson’s disease
Nursing care
Nursing care
Safety – balance, gait problems, coordination problems
Psychosocial – depression, loss of independence, isolation
Nutrition & fluid balance – swallowing, chewing problems, utensils, soft foods
Risk of aspiration
Impaired mobility – specialized assistive devices
https://www.youtube.com/watch?v=J6g-OjBJ5c0
Education managing freezing episodes (laser point walker)
Constipation/bladder problems
Medication education – strict schedules, foods, side effects, peak
Parkinson’s disease
Deep brain stimulator
The deep brain stimulation system consists of four parts: Leads (thin insulated wires) that end in electrodes that are implanted in the brain, A small pacemaker-like device, called a pulse generator, that creates the electrical pulses
