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Definition:
PARKINSON'S DISEASE
slowly progressing neuro movement disorder that eventually leads to disability
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Two Types of Parkinson's Disease
- Degenerative or idiopathic-most common
- Secondary, known or suspected cause
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Pathophysiology
- Decreased levels of dopamine
- NTs--ACH (excitatory) and Dopamine (inhibitory) relay messages to higher motor centers that control and refine motor movement.
- Loss of dopamine results in more excitatory NTs.
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Clinical Manifestations
- Gradual onset
- Symptoms progress slowly
- Cardinal Signs: Tremor (pill rolling), Rigidity, Bradykinesia, Postural inability
- Other: dementia, microphagia (small handwriting), dysphonia (slurr)
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Diagnostics
- Hx
- Presence of 2 of 4 cardinal signs
- Family members often notice changes.
- Neuro exam
- Response to meds
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Medical Management is directed at controlling symptoms and maintaining functional independence.
- 1) increase dopamine
- 2) reduce excitatory cholinergic neurons
- 3) act on NT pathways other than dopamine
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Pharmacological Treatments
- Levodopa- most effective & mainstay treatment, converts to dopamine
- Cogentin- controls tremor
- Symmetrel- antiviral agent used early to reduce 4 cardinal signs
- Parlodel & Permax: postpones the use of carbidopa or levodopa therapy
- MAOIs: inhibits dopamine breakdown
- Antidepressants: Elavil, Prozac, Wellbutrin
- Antihistamines: Benadryl, reduces tremors
- Requip & Mirapex: 1st line, dopamine agonists
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Surgical Treatment
- Candidates: pts with disabling tremors, rigidity, etc.
- Surgery does not alter the course, only provides relief.
- Stereotactics (Thalamotomy/Pallidotomy): pts with max doses of meds
- Neural Transplant: stem cells, fetal cells
- Deep Brain stimulation- pacemaker like device
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Assessment:
- Do you have arm/leg stiffness?
- Have you experienced irregular arm/leg jerking?
- Have you ever been "frozen" and unable to move?
- Does your mouth water excessively?
- Have you noticed yourself grimacing or making faces?
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Nursing Diagnoses
- Fall risks
- Impaired physical mobility
- Self care deficit
- Constipation r/t medication or reduced activity
- Imbalanced nutrition
- Impaired verbal communication
- Ineffective coping
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