Parkinson’s Disease

PRESENTED BY: Okumu Jeremiah Valley

Outline Definition and causes Epidemiology and predisposing factors Pathophysiology Signs and symptoms Management Applied pharmacology

PARKINSON'S DISEASE (PD)

CLINICAL OVERVIEW. Progressive Neurodegenerative disorder of the dopaminergic neurones in the substantia nigra. Parkinsonism is a clinical syndrome consisting of four cardinal features: Bradykinesia (slowness and poverty

of movement) Muscular rigidity Resting tremor (which usually abates

during voluntary movement) Impairment of postural balance

leading to disturbances of gait and falling .

Epidemiology Most common neurologic disorder

affecting approximately 1% of the population of individuals above 60years of age

7.5 million people world wide

Etiology The most common cause of

parkinsonism is idiopathic PD, first described by James Parkinson in 1817 as paralysis agitans, or the "shaking palsy." The pathological hallmark of PD is a loss of the pigmented, dopaminergic neurons of the substantia nigra pars compacta, with the appearance of intracellular inclusions known as Lewy bodies.

Etiology Contd Progressive loss of dopamine-

containing neurons is a feature of normal aging; however, most people do not lose the 70% to 80% of dopaminergic neurons required to cause symptomatic PD.

Risk Protective Genetic

factors(PARK2/7,PINK1)

Environmental factors - manganese and pesticides

Drugs - antipsychotics (clozapine)

Cerebrovascular disease (stroke)

Smoking Coffee

Pathophysiology The primary deficit in PD is a loss of the

neurons in the substantia nigra pars compacta that provide dopaminergic innervation to the striatum (caudate and putamen).since dopamine facilitates the inhibiton on a wide range of motor activities, release of this inhibiton causes in appropriate activation of these motor activities

The presence of lewy bodies

Pathophysiology

Stages Stage 1 - Mild symptoms such as

tremors Stage 2 - Symptoms are bilateral Stage 3 - Inability to walk straight or

stand Stage 4 - Rigidity and bradykinesia Stage 5 - Unable to take care of

themselves and requires a contant one on one nursing care

Presentation Cardinal Features-Resting tremors -Rigidity-Bradykinesia-Postural instability

Presentation Other features -Hypomimia-Dysphagia-Hypohonia-Shuffling gait-Festinations

.

Management Medical-Gene therapy-Dietary consideration-Deep brain stimulation-Neural transplantation-Speech therapy-Exercise and physical therapy-Pharmarcological therapy

Cntd Nursing -Assessment1. •Do you have leg or arm stiffness?

2. •Have you experienced any irregular jerking of your arms or legs

3. • Have you ever been “frozen” or rooted to the spot and unable to move

4. • What specific activities do you have difficulty doing?

Cntd During this assessment, the nurse

observes the patient for quality of speech, loss of facial expression, swallowing deficits,tremors

slowness of movement, weakness, forward posture, rigidity and evidence of mental confusion

Cntd Diagnosis 1. • Impaired physical mobility related to

muscle rigidity and motor weakness2. • Self-care deficits (feeding, dressing,

hygiene, and toileting) related to tremor and motor disturbance

3. • Imbalanced nutrition, less than body requirements, related to tremor, slowness in eating, difficulty in chewing and swallowing

4. • Impaired verbal communication related to decreased speech volume, slowness of speech, inability to move facial muscles

Cntd

Planning and goals Improving functional mobility Maintaining independence in activities

of daily living Achieving adequate bowel elimination,

attaining and maintaining acceptable nutritional status

Achieving effective communication

Cntd InterventionsMobility - range-of-motion exercisespromote joint flexibility - Warm baths and massage to relax musclesSelf care - Teaching, supporting and encouraging the patient during activitiesof daily living promote self-care

CntdNutrition - Monitoring weight on a weekly basis indicates whether caloric intake is adequate - Nasogastric tube maybe necessary as the disease progressesCommunication - A speech therapist may be helpful in designing speech improvementexercises and assisting the family and health care personnel to develop and use a method of communication to meet the patient’s needs

Pharmacological mngmt Dopamine Agonists- levodopa combined with a peripheral decarboxlase inhibitor e.g cardidopa Anticholinergics- benztropine mesylate for treatment of motor symptoms MAO-Inhibitors- selegiline block the breakdown of dopamine

Contd Acetylcholinesterase inhibitors (central)-Donepazil treatment of dimentia COMT Inhibitors-Tolcapone inhibit COMT the major catecholamine degrader

References Medscape,wikipedia,katzung.

THE END O.J