Parkinson’s Disease

Question 1

Pathophysiology of Parkinson’s Disease

Answer 1

Chronic, terminal disease caused by a decreased in dopamine

Question 2

Risk Factors

Answer 2

1. Exact cause is unknown
2. Exposure to pesticides, herbicides and industrial
3. Chemicals and metals
4. Being over the age of 40 years old

Primary Risk Factor:
1. Male
2. Over 40 years of age
3. Family History

Secondary Risk Factors:
1. Traumatic Brain Injury
2. Brain tumor or other lesion

Question 3

Signs and Symptoms

Answer 3

THINK TRAP

• Tremors
• Rigidity of Muscles
• Akinesia/bradykinesia
• Postural Instability

Question 4

Stage 1 of Parkinson’s Disease

Answer 4

INITAL STAGE
1. Mild symptoms that do not interfere with ADLs
2. S/Sx:
> Unilateral limb involvement
> Minimal Weakness
> Hand and arm trembling

Question 5

Stage 2 of Parkinson’s Disease

Answer 5

MILD STAGE
1. Bilateral Limb Involvement (started unilateral, progress to bilateral as disease progresses)
> Tremors: Resting tremors worsen
> Rigidity
2. Mask like face
> Difficulty swallowing
> Dysphagia (speech consult)
3. Slow, shuffling gait
> PT
> OT
> Generally can live alone but daily task can be difficult
> Mild slumping in shoulders

Question 6

Stage 3 of Parkinson’s Disease

Answer 6

MODERATE DISEASE
1. Postural Instability (may experience problems with balance and coordination. Difficult maintaining upright posture
2. Increased gait disturbances

Question 7

Stage 4 of Parkinson’s Disease

Answer 7

SEVERE DISABILITY
1. Akinesia
2. Rigidity

Question 8

Stage 5 of Parkinson’s Disease

Answer 8

COMPLETE ADL DEPENDENCE
1. Stiffness of legs (wheelchair bound)
2. Hallucinations, Delusions (dementia)
3. Excessive perspiration
4. Orthostatic hypotension
5. Uncontrolled drooling
6. Difficulty chewing and swallowing (small, frequent meals, risk for impaired nutrition)
7. Anxiety
8. Irritability
9. SPEAK SOFT, SLURRED or REPEAT THEIR WORDS (monotone voice or halting speech, hesitate before speaking, or exhibit a rapid speech pattern)
10. Bowel and Bladder Incontinence (urinary retention, constipation)

Question 9

Diagnostic Test Indicative of Parkinson’s Disease

Answer 9

1. No specific diagnostic test
2. Analysis of Cerebrospinal fluid
3. SPECT
4. MRI

Question 10

Interventions for Promoting Mobility

Answer 10

1. Drug Therapy
2. Exercise Program (yoga, tai chi)
3. Interprofessional Collaboration (PT, OT, Speech Language Specialist)
4. Adequate Rest/Sleep
5. Nutrition (soft diet, thick, cold liquids, small frequent meals [elevate the patient’s head to prevent choking/aspiration)

Question 11

Interventions for promoting Cognitive Dysfunction

Answer 11

PRIORITY: SAFETY!!!!

> Goal is to maintain memory and cognition for as long as possible
-Keep clients safe and increase quality of life

> Specific Pharmacological Therapy
- Pimavanserin (for disease-related hallucinations and delusions)
- Venlafaxine (for disease-related depression)

> Patient/Family Teaching
- Positive reinforcement, emphasize client’s abilities and strengths

Question 12

Self-Management Education

Answer 12

> Teach patient and families about safe drug administration
>Report adverse effects (dizziness, falls, acute confusion and hallucinations)
Maintain or improve quality of life
>Ex. Constipation (increase fluids, a high fiber diet and regular bowel-training program).
>Ex. Sleep Disorder (good sleep-hygiene program, avoiding alcohol and caffeine, darkening the bedroom and bedtime rituals

Question 13

Types of Rigidity

Answer 13

Cogwheel - a type of rigidity when the muscle responds with jerky movements when attempting to use the extremity

Plastic - a type of rigidity where the movement is slow and uniform, stiff and tight, throughout the entire range of motion

Lead pipe - a type of rigidity that shows as a constant resistance to any type of motion or range of movement