Parkinsons Flashcards
What is Parkinson’s?
- Complex progressive degenerative disorder characterised by rigidity, tremor and bradykinesia (slowness and hesitancy)
- Most common neurodegenerative disease after Alzheimer’s (AD)
- May have a prodromal phase of up to 14 years, involving symptoms such as anosmia (loss of smell), aches and pains and depression
- 1% people aged over 65 (Kouli, Torsney & Kwan, 2018)
What is the pathophysiology of Parkinson’s?
- Unknown aetiology
- Progressive degenerative changes in dopaminergic neurones in substantia nigra in the basal ganglia (responsible for fine- tuning voluntary movements)
- Presence of Lewy bodies (tangles of proteins α- synuclein and ubiquitin) which spread from lower brainstem to midbrain to cortex
- ~70% dopaminergic nigrostriatal cells have to be lost before symptoms occur
- Dopamine is an inhibitory neurotransmitter - excitation and inhibition becomes imbalanced - muscles start being unable to relax
What are the signs and symptoms of Parkinson’s?
- Starts with fatigue, muscle weakness, aches, reduced flexibility, small restrictions in facial expression
- Tremors at rest (cease on voluntary movement and during sleep) and ‘pill rolling’ of hands
- Progressively increases muscle rigidity with slow and difficult movements
- Loss of involuntary movements so difficulties chewing and swallowing, may drool, may get blank facial expression.
- Autonomic dysfunction e.g. urinary retention, constipation, orthostatic hypotension. UTIs and RTIs common complications
- Affects sense of smell
- Shuffling steps which can increase falls risk
- 20% people develop Parkinson’s dementia in later stages
What causes or triggers Parkinson’s?
Unknown cause but risk factors include
* Age (>60)
* Smoking - is actually protective!!
* Caffeine
* Family history (minority)
* Pesticides and heavy metals
Prognosis - Course of 10 -20 years
* Leads to increased care needs
* Eventually immobility and pneumonia occur
* Reduced response to treatment
* Parkinson’s dementia occurs later, usually after age 75, ACHEIs used if so (Jarman & Vivekananda, 2021), common in a ten year period but small cause of dementia overall.
* Can be co-morbid with AD.
How is Parkinson’s diagosed and conventially treated?
Diagnosis
* Made on the basis of symptoms and signs; no specific test
* Generally diagnosed by a specialist
* May not be surprising to patient if symptoms of tremor; might be if younger
Pharmacological treatment (NICE, 2017)
* Main treatment is Levodopa: crosses the blood-brain barrier and is converted to dopamine. First line treatment where motor symptoms impact quality of life – most patients will need this at some point. Spaced out as needed continuously. Effective.
* Wider choice where not interfering with quality of life (can consider dopamine agonists or MAO-B inhibitors too)
* Adjuvant treatment may be needed for stronger effects e.g. if medicines wearing off
* May need to pharmacologically treat non-motor symptoms such as daytime sleepiness, restless leg syndromes, nocturnal akinesia, orthostatic hypotension, depression.
How can holistic care/ herbs help with the treatment of Parkinson’s?
Non-pharmacological treatment
* Support symptoms and adapting to these
* Depression and saliva control also need addressing if issues
* Protein-rich meals interfere with levodopa absorption (Jarman & Vivekananda, 2021) – eat most of protein in final meal of day (NICE, 2017)
* NICE recommends vit D but not creatine
Also:
* Physiotherapy
* Occupational therapy
* Nutrition support
* Speech and language therapy
