Parkinsons

Question 1

Define Parkinson’s disease.

Answer 1

A progressive condition resulting in neuro degeneration of the CNS, the degeneration of the basal ganglia and dopamine secreting cells results in a lack of the neurotransmitter dopamine. It is more common with age.

Question 2

Stages of PD

Answer 2

Haehn and Yahr scale:

1. Stage One Signs and symptoms on one side only Symptoms mild Symptoms inconvenient but not disabling Usually presents with tremor of one limb Friends have noticed changes in posture, locomotion and facial expression.
2. Stage Two Symptoms are bilateral Minimal disability Posture and gait affected.
3. Stage Three Significant slowing of body movements Early impairment of equilibrium on walking or standing Generalized dysfunction that is moderately severe.
4. Stage Four Severe symptoms Can still walk to a limited extent Rigidity and bradykinesia No longer able to live alone Tremor may be less than earlier stages
5. Stage Five Cachectic stage Invalidism complete Cannot stand or walk Requires constant nursing care

Question 3

Pathology of PD.

Answer 3

Dopamine neuron cell death in the pars compacta region of the substantia Nigra, leading to reduction in secretion of neurotransmitter dopamine. Motor system affected the most, the basal ganglia normally exert a constant inhibitory influence preventing inappropriate movement. Dopamine acts to facilitate release of this inhibition(acetylcholine). High levels of dopamine promote motor activity, low levels of dopamine demands greater exertion of effort for any given movement resulting in bradykinesia.

Question 4

Signs and symptoms of PD

Answer 4

1. Bradykinesia
2. Rigidity
3. Temor
4. Postural instability
5. Parkinsonian gait

Question 5

Features of Parkinsonian gait

Answer 5

1. Shuffling gait - paces become short and shuffling
2. Festinating gait - lean too far forwards so have to chase centre of gravity
3. Stooped/ flexed posture
4. Unable to initiate walking/ unable to stop
5. Freezing episodes (especially obstacles)
6. Difficulty turning
7. Loss of balance/postural reactions
8. Lack of arm swing

Question 6

PD affected activities

Answer 6

1. Unsteady (falls)
2. Concern about being left alone
3. Stairs becoming a challenge
4. Dressing/getting in and out of bath
5. Rolling over in and getting out of bed is hard
6. Sit to stand
7. Dizziness

Question 7

Management of PD

Answer 7

1. Levadopa - crosses blood brain barrier and metabolises into dopamine, temporarily diminishing symptoms of PD
2. MOA-B inhibitors - inhibit metabolisation of dopamine in basal ganglia
3. Physio - improve mobility, flexibility, strength, gait and quality of life Exercise programme