Parkinson's Disease Flashcards
What is the basic physiologic problem that causes Parkinson’s disease?
Parkinson disease is a progressive neurodegenerative disorder resulting from decreased dopamine levels.
Functions of dopamine?
- Motor controls
- Motivation
- Arousal/Pleasure
- Cognition
- Reward Behavior
- Problem-solving
- Attention
Based on the functions of dopamine, what do you expect will occur to those specific functions in Parkinson’s?
Motor
- Dopamine helps to regulate movement.
- When there is a deficiency in dopamine in the brain, movements may become delayed and uncoordinated.
Based on the functions of dopamine, what do you expect will occur to those specific functions in Parkinson’s?
Pleasure
- Dopamine is the chemical that mediates pleasure in the brain.
- It is released during pleasurable situations and stimulates one to seek out the pleasurable activity or occupation.
- Decreased capacity for pleasure
Based on the functions of dopamine, what do you expect will occur to those specific functions in Parkinson’s?
Cognition
- Dopamine in the frontal lobe of the brain controls the flow of information from other areas of the brain.
- Disorders of dopamine in this region lead to decline in neurocognitive functions, especially memory, attention, and problem-solving.
Based on the functions of dopamine, what do you expect will occur to those specific functions in Parkinson’s?
Attention
- Dopamine helps in focus and attention.
- Will lack focus and attention.
Based on the functions of dopamine, what do you expect will occur to those specific functions in Parkinson’s?
Addiction
- Cocaine and amphetamines inhibit the reuptake of dopamine.
- By increasing its presence, there are increased pleasurable feelings and increased risk for addiction.
Low-level functions of dopamine?
- Lactation
- Feelings of attachment/love
- Altruism
Based on the functions of dopamine, what do you expect will occur to those specific functions in Parkinson’s?
Feelings of attachment/love
- Tend to be more cruel
- Less empathetic
- Shows more aggression
Parkinson’s clinical manifestations?
TRAP
- Tremors
- Rigidity
- Akinesia
- Postural instability
What are the characteristics of the tremor associated with Parkinson’s disease?
- Tremor is the most visible manifestation of the disorder.
- It is characterized by rhythmic, alternating flexion and contraction movements that resemble the motion of rolling a pill between the thumb and forefinger.
- The tremor usually is unilateral, occurs when the limb is supported and at rest, and disappears with movement and sleep.
- The tremor eventually progresses to involve both sides of the body.
What are the characteristics of the rigidity associated with Parkinson’s disease?
- Rigidity is defined as resistance to passive motion when the limbs are moved through range of motion.
- It is most evident during passive joint movement and involves jerky, cogwheel-type or ratchet-like movements that require considerable energy to perform.
- This causes soreness and feeling tired/achy.
- Flexion contractures may develop due to the rigidity.
- As with tremor, rigidity usually begins unilaterally but progresses to involve both sides of the body.
What are the characteristics of the bradykinesia associated with Parkinson’s disease?
- Slowness in initiating and performing movements
- Difficulty with sudden, unexpected stopping of voluntary movements.
- Unconscious associative movements occur in a series of disconnected steps rather than in a smooth, coordinated manner.
- This is the most disabling of the symptoms of Parkinson disease.
What are the characteristics of the akinesia associated with Parkinson’s disease?
- Absence or loss of control of voluntary muscle movements.
- This includes blinking of the eyes, swinging arms while walking, swallowing saliva, using facial/hand movements as forms of expression, and making minor adjustments in posture.
- People with the disease have difficulty initiating walking and difficulty turning. While walking, they may freeze in place and feel as if their feet are glued to the floor, especially when moving through a doorway or preparing to turn.
Additional characteristics of akinesia?
- Stooped posture
- Masked face/flat affect
- Drooling of saliva
- Shuffling gait (festination)
- Head and trunk leaning forward
- Slow, monotonous speech without modulation, and poorly articulated
What are the characteristics of the postural instability associated with Parkinson’s disease?
- Inability to stop themselves from going forward (propulsion) of backwards (retropulsion)
- Falls, often backwards
- Pull test
- Neuropsychiatric disorders
How will the RN perform the Pull Test?
Examiner stands behind patient and gives a tug backward on the shoulder, causing the patient to lose his/her balance and fall backward.
What is the purpose of the Pull Test?
To assess postural stability in patients with movement disorders.
What clinical manifestations may be present if the patient has Parkinson’s disease due to damage to the basal ganglia?
- Because the basal ganglia also influence the autonomic nervous system, people with Parkinson’s disease often have excessive and uncontrolled
- Sweating
- Sebaceous gland secretion
- Salivation
What is DaTscan?
A DaTscan is an imaging drug that acts as a radioactive tracer for dopamine transporters within the brain.
acts like a radar that finds dopamine in the brain
Why is DaTscan used?
It may help distinguish the diagnosis of essential tremor from Parkinson-like syndromes, Parkinson’s disease, or Parkinson’s disease dementia.
Explain the rationale of using levodopa and carbidopa in the treatment of Parkinson’s disease.
- Dopamine does not cross the blood-brain barrier.
- Levodopa, a precursor of dopamine that crosses the blood-brain barrier, is converted to dopamine in the basal ganglia.
- Levodopa is given with carbidopa because carbidopa prevents levodopa from being broken down in the bloodstream
Carbidopa acts as a bodyguard
Why are MAO inhibitors used to treat Parkinson’s disease?
Increases the amount of dopamine available to the brain.
Why is Parlodel used to treat Parkinson’s disease?
- Stimulate dopamine receptors
- Not first line because of side effects
- Elevated blood pressure
- Seizure activity
- Stroke
