Parkinson's disease

Question 1

What is Parkinson’s Disease?

Answer 1

Chronic, progressive neurodegenerative disorder
Men > Women
Degeneration of dopamine- producing neurons in substantia Nigeria of the midbrain.
Disrupted Dopamine & ACh (acetylcholine) balance in basal ganglia.

Question 2

Parkinson’s Etiology

Answer 2

book
Degeneration of DA (dopamine) producing neurons in the substantia Nigra of midbrain. This disrupts normal balance of DA & ACh in basal ganglia.
DA neurotransmitter is essential for postural, support, and voluntary motion control. 80% of neurons in substantia nigra have to be lost in order for PD to manifest.

Question 3

Stage 1 (MILD)

Answer 3

UNILATERAL & MILD symptoms

• tremors
• rigidity
• clumsy leg
• odd facial expressions (unilateral)

Question 4

Stage 2 (MILD)

Answer 4

• BILATERAL & worsening
• rigidity of muscles in the trunk
• speech abnormalities
• decreased blinking
• loss of facial expression (bilateral)

Question 5

Stage 3 (MID-STAGE)

Answer 5

• All other PD symptoms present PLUS…
• LOSS of balance & slowness of movement
• can not make rapid, automatic, involuntary adjustments

Question 6

Stage 4 (ADVANCED)

Answer 6

• SEVERLY disabling
• Able to walk or stand w/ assistance
• cannot live alone or independently
• requires help with ADL’s

Question 7

Stage 5 (ADVANCED)

Answer 7

• SEVERE & inability to rise
• impossible to stand or walk
• Wheelchair or bedridden
• requires around the clock help with all activities
• Hallucinations
• Delusions

Question 8

Clinical Manifestations

T.R.A.P

Answer 8

T- Tremor: predominant at rest “pull-rolling”
R- Rigidity
A- Akinesia: absence of loss of voluntary muscle control. Bradykinesia. “Parkinson Shuffle”
P- Postural Instability: unable to stop themselves from going forward or backward.

Question 9

Diagnosing Parkinson’s Disease

Answer 9

• no definite way to diagnose PD
• presence of T.R.A.P
• CONFIRMED PD diagnosis is a positive response to Anti- Parkinson drugs (Levodopa or Dopamine agonist)

Question 10

Pharmacological Management of PD

Answer 10

• Anti-Viral Agent: Amantadine Hydrochloride (Symmetrel)
  Used in early PD in order to save Dopaminergic for later PD.
• Dopaminergics: Carbidopa- Levodopa (Sinemet)
  Carbidopa allows Levodopa to cross blood brain barrier. It increase dopamine and therefore, balancing ACh.

Question 11

PD goals

Answer 11

1. Maximize neurological function
2. Maintain independence of ADL’s as long as possible
3. Optimize psychosocial well-being