parkinsons

Question 1

PD: what

Answer 1

Chronic, progressive neurodegenerative disorder characterized by slowness in the initiation and execution of movement (bradykinesia), increased muscle tone (rigidity), tremor at rest, and gait changes.

Question 2

PD: etiology

Answer 2

*no exact known cause
*Not considered hereditary condition (but genetic risk factors should be evaluated for their interplay with environmental factors). 15% of pts have a family history of PD.

Question 3

PD: risk factors

Answer 3

Well water exposure, pesticides, herbicides, industrial chemicals, wood pulp, rural residence, 4% diagnosed before age 50, Men 1.5 times more likely to have PD

Question 4

PD: brain changes

Answer 4

*Lack of DA (neurotransmitter essential for normal functioning of the extrapyramidal motor system including control of posture, support, and voluntary motion).
*The pathologic process of PD involves degeneration of the DA-producing neurons in the substantia nigra of the midbrain leading to disruption of normal balance between DA and acetylcholine in the basal ganglia.

Question 5

what clumps are found in PD brains

Answer 5

Unusual clumps of protein called Lewy bodies found.

Question 6

PD: long term complications

Answer 6

*Motor symptoms: dyskinesias (spontaneous/involuntary movements), weakness,

*neurologic problems (dementia leading to increased mortality), and neuropsychiatric problems (depression, hallucinations)

*Swallowing problems (dysphagia), malnutrition, aspiration

Question 7

Clinical manifestations

Answer 7

*Gradual onset with ongoing progression
*Tremor, rigidity, akinesia, postural instability

Question 8

Tremor

Answer 8

Often 1st sign, minimal at first, more prominent at rest, worsened by emotional stress, described as “pill rolling” where the thumb and forefinger move in a rotary fashion.

Question 9

Rigidity

Answer 9

increased resistance to passive motion. Jerky quality caused by sustained muscle contraction, resulting in muscle soreness.

Question 10

Akinesia

Answer 10

Absence or loss of control or voluntary muscle movement. Bradykinesia (slowness of movement). Occurs d/t physical and chemical changes of the basal ganglia.

Question 11

POstural instability

Answer 11

Unable to stop oneself from going forward (propulsion) or backward (retropulsion).

Question 12

Diagnostic studies

Answer 12

*No specific test

*Based on pt’s history and clinical features

*Dx requires presence of TRAP and asymptomatic onset

*Confirmation of PD is a positive response to antiparkinsonian drugs (levadopa or DA agonist)

Question 13

deep brain stimulation

Answer 13

Most common surgical intervention, involves placing an electrode into parts of the brain. Aimed to improve motor functions and reduce dyskinesia and medication use.

Question 14

Management: diet

Answer 14

Aimed at treating malnutrition and constipation which can result from poor nutrition. Eat 6 small meals per day

Question 15

Prevent pressure wounds

Answer 15

• satin nightwear and sheets: reduce friction, improve skin integrity, enhance comfort, temperature regulation, moisture management

*physical exercise:

*well-balanced diet

Question 16

hospice criteria for PD (googled cuz literally not in the book…)

Answer 16

*advanced stage of disease: characterized by severe motor symptoms, significant functional decline, and/or complications such as recurrent falls, dysphagia, or aspiration pneumonia

*limited benefit from tx: including meds, PT, and surgical interventions

*significant symptom burden: basically all those symptoms are goin crazy and they can’t do anything essentially

*frequent hospitalization or ER visits: r/t complications such as infections, falls, etc

*decline in functional statue: dependence on caregivers for ADLs

*6 month or less prognosis