Parkinsons Disease

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Parkinsons Disease
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Definition Of Parkinsons

• A disorder of the brain characterized by shaking
  and difficulty with walking, movement, and
  coordination. The disease is associated with
  damage to a part of the brain that controls
  muscle movement.

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Definition Of Parkinsons Disease In More Detail
And More Info.

• Parkinsons disease is an age-related neurologic
  disease that affects movement, balance, speech
  swallowing, walking, and muscle tone. Parkinsons
  disease affect a region of the brain known as the
  basil ganglia. One-half to one million persons in
  the United States are affected with this chronic
  debilitating disease. Parkinsons disease was the
  first neurologic disease to be associated with
  the loss of a specific neurotransmitter, in this
  case, dopamine. The cardinal manifestations of
  Parkinsons disease include tremor that usually
  occurs at rest and can affect any part of the
  body, bradykinesia that is a slowness of
  movement, akinesia or obsence of certain
  movements, and increased muscle tone.

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Alternative Names

• Paralysis Agitans
• Shaking Palsy

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History

• It appears both in female and male
• Ages 50 - 79
• This disease is more prominent on the Pacific
  Island of Guam and Thekii Peninsula of Japan than
  anywhere else in the world.(they are trying to
  find out why)
• Caucasians get Parkinsons disease just a little
  bit more than black people.(less pigment is
  suspected.

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Cont.. Of History

• Parkinsons disease reduces life expectancy due
  to increased incidence of infection associated
  with chronic immobility

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Causes, incidence, and risk factors

• Parkinson's disease was first described in
  England in 1817 by James Parkinson. The disease
  affects approximately 2 out of 1,000 people, and
  most often develops after age 50.
• It affects both men and women and is one of the
  most common neurologic disorders of the elderly.
• The term "parkinsonism" refers to any condition
  that involves a combination of the types of
  changes in movement seen in Parkinson's disease,
  which happens to be the most common condition
  causing this group of symptoms.
• Parkinsonism may be caused by other disorders or
  by external factors Secondary Parkinsonism.

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Cont..

• Parkinson's disease is caused by progressive
  deterioration of the nerve cells of the part of
  the brain that controls muscle movement (the
  basal ganglia and the extrapyramidal area).
• Dopamine, which is one of the substances used by
  cells to transmit impulses (transmitters), is
  normally produced in this area. Deterioration of
  this area of the brain reduces the amount of
  dopamine available to the body.
• Insufficient dopamine disturbs the balance
  between dopamine and other transmitters, such as
  acetylcholine. Without dopamine, the nerve cells
  cannot properly transmit messages, and this
  results in the loss of muscle function.
• The exact reason that the cells of the brain
  deteriorate is unknown. The disorder may affect
  one or both sides of the body, with varying
  degrees of loss of function.

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Cont..

• In addition to the loss of muscle control, some
  people with Parkinson's disease become severely
  depressed.
• Although early loss of mental capacities is
  uncommon, with severe Parkinson's the person may
  exhibit overall mental deterioration (including
  dementia , hallucinations , and so on). Dementia
  can also be a side effect of some of the
  medications used to treat the disorder.
• Parkinson's disease is rare in children. When
  present, it appears to be due to decreased
  sensitivity of the nerves (post-synaptic) to
  dopamine rather than deterioration of the area of
  the brain that produces dopamine.

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Another Type Of Parkinsonism
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Secondary Parkinsonism

• There are different stages of Parkinsons but
  Secondary is one of them.
• Conditions which do not usually affect the
  midbrain that involve the substantia nigra
• ex.-Trauma such as head injuries from boxing can
  damage the substantia nigra and lead to
  Parkinsons Disease (this is what happen to
  Mohammed Ali).
• Or trauma, Ischemia (stroke), Hemorrhage
  (stroke), Neoplasma (cancer), Neurosyphilis,
  Tuberculosis..

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The Clinical Picture
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Trap

• Tremor (at rest)
• Rigidity (cogwheel)
• Akinesia
• Postural Instability

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5- Stages

• Schwab England ADL Scale
• Miscellaneous Symptoms
• Paradoxical Kinesia

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Tremor

• An involuntary movement which may affect the
  head, limbs, or entire body.
• Most apparent when limb is related and supported
• Increased with stress
• Ceased during sleep

• Decreased with intentional movements
• Pill rolling tremor if most prominent in
  fingers and hand
• Most bothersome, yet least disabling of all
  symptoms

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Rigidity

• Muscular stiffness and increased muscle tone
• Patients usually unaware of rigidity but troubled
  with slowness

• More apparent to doctor than patient
• Cogwheeling (affect when moving arms)

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Bradykinesia/Akinesia

• Akinesia inability to move
• Bradykinesia slowness of movement

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Most Disabling Feature

• Decrease in
• eye blinking
• facial expression
• eating and chewing
• walking speed

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Postural Instability

• Impaired righting ability
• Toe-first walk develops
• Decreased arm swing when walking

• Posture stooped, knees flexed while walking
• Unsteadiness while turning
• Falls will occur

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Stage 1

• Mild one sided tremor or rigidity
• Affected arm in semiflexed position with tremor
• Patient leans to affected side

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Stage 1.5

• One sided disease plus axial (waist) involvement

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Stage 2

• Bilateral involvement
• Early postural changes

• Slow, shuffling gait
• Decreased stride length

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Stage 2.5

• Mild bilateral involvement
• Recovery on pull test

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Stage 3

• Pronounced gait disturbances
• Moderate generalization disability

• Balanced is a major problem
• Server tremor, rigidity and/or brandykinesia

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Stage 4

• Significant disability
• Limited ambulation with assistance

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Stage 5

• Loss of ability to function independently
• Brandykinesia very severe
• Independent mobility impossible

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Schwab England Activities of Daily Living Scale

• 100 completely independent. Able to do al chores
  without slowness, difficulty or impairment.
  Essentially normal. Unaware of any difficulty
• 80 Completely independent in most chores, but
  exceeding slowly and with much effort. Errors
  sometimes impossible.

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Treatments

• There is no known cure for Parkinson's disease.
  Treatment is aimed at controlling the symptoms.
  Medications control symptoms primarily by
  controlling the imbalance between the
  transmitters.
• The medications used vary, depending on the case.
  The type of medication, the dose, and the amount
  of time between doses, or the combination of
  medications used may need to be adjusted as
  symptoms change.
• Many of the medications can cause severe side
  effects, so monitoring and follow-up by the
  health care provider is important.

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Cont..

• Deprenyl may be started early in the disorder to
  slow progression of symptoms and reduce the need
  for other medications.
• Amantadine and/or anticholinergic medications
  may be used to reduce early or mild tremors.
• Levodopa is a medication that the body converts
  to dopamine. (It may be used to increase the
  body's supply of dopamine, which may improve
  movement and balance.)
• Carbidopa is a medication that reduces the side
  effects of Levodopa and makes the Levodopa work
  better.

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Cont..

• Additional medications to help reduce symptoms or
  control side effects of primary treatment
  medications include antihistamines,
  antidepressants, bromocriptine, monoamine oxidase
  inhibitors, and others.
• Good general nutrition and health are important,
  such as exercise, regular rest periods,avoid
  stress and tiredness because this can make
  symptoms worse.
• Physical therapy, speech therapy, and
  occupational therapy may help promote
  functioning, positive attitude, and
  independence.

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Complications

• disability, varying degrees
• difficulty swallowing/eating
• difficulty performing daily activities
• injuries from falls
• side effects of medications

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Additional Information

• Experimental or less common treatments may be
  recommended. For example, surgery to destroy
  tissues responsible for tremors may reduce
  symptoms in some people. Transplantation of
  adrenal gland tissue (and fetal brain tissue) to
  the brain has been attempted, with variable
  results.
• Untreated, the disorder progresses to total
  disability, often accompanied by general
  deterioration of all brain functions. It may
  result in an early death if untreated.