Parkinson's Disease By Thomas Viola Summary

L.C. is a 78-year-old white man with a 4-year history of Parkinson’s disease (PD). He is a retired engineer, is married, and lives with his wife in a small farming community. He has 4 adult children who live close by. He is taking carbidopa-levodopa, pergolide, and amantadine. L.C. reports that overall he is doing “about the same” as he was at his last clinic visit 6 months ago. He reports that his tremor is about the same, his gait is perhaps a little more unsteady, and his fatigue is slightly more noticeable. L.C. is also concerned about increased drooling. The patient and his wife report that he is taking carbidopa-levodopa 25/100 mg (Sinemet), 1 tablet an hour before breakfast and 1 tablet 2

The article “Living with Parkinson’s and Looking for Relief”, written by Carla Gantz, was found in RDH magazine as a feature in the February 2013 volume on pages 34,36,38, and 95. It is about a dental hygienist, Carla Gantz, who develops Parkinson’s disease while still in practice, and the various ways she copes with the disease. Gantz had Parkinson’s disease that was only on her right side, hand, arm, and shoulder, classifying her as stage 1 Parkinson’s disease. She started off taking low doses of levodopa to help with her tremors, but as the disease progressed, the medications changed, and the doses increased. Her role as a dental hygienist was also affected as her disease progressed. She couldn’t administer local anesthesia, her manual dexterity with instruments became more difficult, and when polishing or scaling, her hand would come to a halt, a secondary motor symptom of Parkinson’s disease. She should break this “freeze” by allowing her left arm to lift up her right arm, but that only worked for so long. Five years after being diagnosed, Gantz had to give up her career because her tremors got worse and her medication increased; she was taking up to thirteen pills per day.

J.N., a 65-year-old Caucasian female with a history of anxiety and depression, presents for diagnostic testing at Saint Mary Medical Center in Hobart, Indiana to confirm or deny a diagnosis of Parkinson’s Disease, after presenting with recent onset of upper extremity tremor affecting both sides and facial masking. Patient history also includes bradykinesia, restlessness, fatigue, muscle weakness, and poor balance and coordination, all of which are common in a diagnosis of Parkinson’s Disease. J.N. was referred to the Neurology Department of Saint Mary Medical Center after a routine appointment with her Cardiologist, who noted the recent onset of additional signs and symptoms. J.N. is my mother and my inspiration for this assignment.

Sayer begins to consider LDOPA as a possible cure for the patients. Sayer considers LDOPA due to its reputation as a “miracle drug” in Parkinson’s patients. LDOPA functions as a precursor to the catecholamines dopamine, epinephrine, and norepineprine and, as a precursor, serves to treat Parkinson’s patients by increasing their levels of dopamine.

The main symptoms and signs of Parkinson’s are bradykinesia, rigidity and rest tremor. Parkinson’s is mainly seen as a movement disorder, but other areas of health problems are associated with it. These include depression and dementia along with autonomic disturbances and pain, although considered to be rare they can present at a later stage of the condition. These rarer symptoms, as they progress, can lead to substantial disability and handicap which harms quality of life for the person living with Parkinson’s, this also has an impact on families and carer’s.

The most effective drug used in the treatment of Parkinson’s disease is levodopa. When Levodopa is consumed on its own, it evidentially causes nausea and vomiting. Due to this factor a combination therapy with the drug carbidopa is essential in the treatment of Parkinson’s disease to avoid side effect. The most popular carbidopa/levodopa pharmaceutical formulation is called Sinemet®.

The cause of Parkinson disease, defined by Robert Hauser, who is an author of Medscape, is still unclear. Studies state that there is a combination of environmental and genetic factors for this particular disease. Approximately 10% of cases are currently genetic causes of Parkinson disease. Environmental risk factors such as use of pesticides, living in a rural environment, consumption of well water, exposure to herbicides, and proximity to industrial plants or quarries are commonly associated with the development of Parkinson disease (Hauser, 2016). In addition, according to Hauser, “genetic factors in Parkinson disease appear to be very important when the disease begins at or before age 50 years. In a study of 193 twins, overall concordance for MZ and DZ pairs was similar, but in 16 pairs of twins, in whom Parkinson disease was diagnosed at or before age 50 years, all 4 MZ pairs, but only 2 of 12 DZ pairs, was concordant.The identification of a few families with familial Parkinson disease sparked further interest in the genetics of the disease.

Many may not know Parkinson’s disease is the second most common neurodegenerative disorder in the world. This disease is most seen in the elderly starting at 62 years of age although, younger individuals can still have the disease it isn’t common. Parkinson’s make it difficult for its victims to carry out everyday activities that might have once been easy for them. As the disease progresses it makes it hard for the patient to do things like walk, stand, swallow and speak. A great deal of people don’t realize how helpful therapy can be when dealing with such disease!

Parkinson’s disease is a “neurodegenerative disorder of the basal nuclei due to insufficient secretion of the neurotransmitter dopamine” (Marieb & Hoehn, 2013, p. G-17). The cause of Parkinson’s disease is unknown, but many factors play a role in the development of Parkinson’s disease. One factor that has been found in an individual who has Parkinson’s disease causes over activity of targeted dopamine-deprived basal nuclei. This over activity is caused by the breakdown of neurons that release dopamine in the substantia nigra (Marieb & Hoehn, 2013). Another factor that is present in a person who has Parkinson’s disease, is the presence of lewy bodies in the brain stem ("What is lbd?," 2014). Lewy bodies are unusual

Parkinson's Disease has caused problems for many people in this world and plagued the elderly all over the world.Parkinson's disease still puzzles doctors and the causes are unknown. It is known that it is a non-communicable disease and may even be hereditary. Parkinson's disease is thought to be caused by external factors.

The path physiology of Parkinson’s disease is the pathogenesis if Parkinson disease is unknown. Epidemiologic data suggest genetic, viral, and environmental toxins as possible

Parkinson disease (PD) is a progressive neurodegenerative disorder characterized mainly by physical and psychological disabilities. This disorder was named after James Parkinson, an English physician who first described it as shaking palsy in 1817 (Goetz, Factr, and Weiner, 2002). Jean- Martin Charcot, who was a French neurologist, then progressed and further refined the description of the disease and identified other clinical features of PD (Goetz, Factr, and Weiner, 2002). PD involves the loss of cells that produce the neurotransmitter dopamine in a part of the brain stem called the substansia nigra, which results in several signs and symptoms (Byrd, Marks, and Starr, 2000). It is manifested clinically by tremor,

Parkinson’s Disease is a long-term progressive neurodegenerative disease consisting of motor system impairment, neuropsychiatric, and nonmotor features. The disease is characterized by the following key clinical features: bradykinesia, resting tremor, postural instability, and rigidity. These symptoms are due to the diminishing of dopamine in the nigrostriatal pathway and substantia nigra, which causes inhibition of the thalamus decreasing excitatory input to the motor cortex.1 Along with the key manifestations an individual with Parkinson’s Disease will experience problems associated with the disease or the antiparkinson medications. These co-occurring problems are hallucinations, dementia, daytime sleepiness, fatigue, depression, and pyschosis.2 Psychosis is a common problem in Parkinson’s Disease, and is characterized by paranoid delusions and hallucinations that are visual in nature.2 Risk factors for psychosis consists of advancing age, dementia, sleep disorders, and high doses of antiparkinson drugs.1

Parkinson’s Disease is known as one of the most common progressive and chronic neurodegenerative disorders. It belongs to a group of conditions known as movement disorders. Parkinson disease is a component of hypokinetic disorder because it causes a decreased in bodily movement. It affects people who are usually over the age of 50. It can impair an individual motor as well as non-motor function. Some of the primary symptoms of Parkinson’s disease are characterized by tremors or trembling in hands, legs and arms. In early symptoms the tremor can be unilateral, appearing in one side of body but progression in the disease can cause it to spread to both sides; rigidity or a resistant to movement affects most people with Parkinson’s disease,

In recent years statistics have shown that this occurs anywhere from one third for four fifths of patients who have been diagnosed with Parkinson’s disease. According to Rajaei et al. (2014), the statistics are higher, saying that oropharyngeal dysphasia occurs in up to 80% of Parkinson’s patients but increases up to 95-100% of patients in the latter more progressed stages of the disease. This occurs because of the motor loss in the patient’s body from the lack of dopamine being produced in the brain (Ellerston et al., 2016). According to (Argolo et al., 2013), rigidity and brandykinesia formed in the oralpharyngeal muscles, lack of coordination between breathing and swallowing, and the loss or reduction of sensation in the oral cavity and pharynx are all involved in the patients dysphasia. Ellerston et al. (2016) reviewed studies done on Parkinson’s patients diagnosed with dysphasia using videofluoroscopic modified barium swallow (MBS) study. According to Ellerston et al. (2016), these studies revealed that the patients had impaired laryngeal movement, palatal elevation deficits, lack of epiglottic movement, anterior hyoid bone movement, and vocal fold adduction deficits. The modified barium swallowing studies also revealed that the patients with Parkinson’s also showed prolonged pharyngeal transit times (Ellerston et al., 2016). Because of these deficits in the musculature Ellerston et al.(2016), reported that it would lead to vallecular pooling and residue, possible laryngeal penetration, and possible aspiration which could lead to respiratory illnesses or aspiration pneumonia. Ellerston et al. (2016), also revealed from reviewing past literature that when comparing the patients results of the bedside screening to the results of the MBS, almost 80% of the swallowing disorders went unnoticed, including patients who were aspirating. Ellerston et