Parkinson’s DiseaseParkinson’s Disease(PD)(PD)

Dopamine depletion- Dopamine depletion- Substantia NigraSubstantia Nigra

Parkinson’s DiseaseParkinson’s Disease

Degenerative disorder Degenerative disorder

resulting in dysfunction of resulting in dysfunction of extrapyramidal system extrapyramidal system caused by dopamine caused by dopamine

depletion which interferes depletion which interferes with inhibition of with inhibition of

excitatory impulses. excitatory impulses.

Extrapyramidal pathways: cerebral cortex, thalamus, cerebellum and brain stem.

Historical PerspectiveHistorical Perspective

Dr. James Parkinson (1755-1828)Dr. James Parkinson (1755-1828) 18171817

““involuntary tremulous motion”involuntary tremulous motion”

““pass from a walking to a running pace”pass from a walking to a running pace”

““shaking palsy”shaking palsy”

London home London home

Substantia Nigra Substantia Nigra

EpidemiologyEpidemiology

Ave. age of onset 60Ave. age of onset 60

Men and women affected equally but Men and women affected equally but more prevalent in malesmore prevalent in males

Genetic Link—Genetic Link—chromosomes 4chromosomes 4

Environmental Toxin (MPTP)Environmental Toxin (MPTP)

African-Americans and Asians less likely African-Americans and Asians less likely than Caucasians to develop Parkinson’sthan Caucasians to develop Parkinson’s

PathogenesisPathogenesis

Four TheoriesFour Theories Oxidative damageOxidative damage

Impaired protection (Impaired protection (↓↓gluthatione, gluthatione, ↑↑reactive iron)reactive iron) Environmental toxinsEnvironmental toxins

MPTP-Methyl-phenyl tetrahydropyridine--> MAO B–MPTP-Methyl-phenyl tetrahydropyridine--> MAO B–> MPP--> death in nigrostriatal neurons> MPP--> death in nigrostriatal neurons

Genetic predispositionGenetic predisposition Mutations in the gene for the protein alpha- Mutations in the gene for the protein alpha-

synuclein located on chromosome 4synuclein located on chromosome 4 Accelerated agingAccelerated aging

PathophysiologyPathophysiology

Imbalance of dopamine and acetylcholine Imbalance of dopamine and acetylcholine

Loss of 80 to 90% of dopaminergic Loss of 80 to 90% of dopaminergic production in the substantia nigra pars production in the substantia nigra pars compacta. compacta.

Lewy BodiesLewy Bodies

PD’s Pathophysiology PD’s Pathophysiology

Death of dopamine

cells

Risk factors Aging 60 Gender: Male Race: Caucasian Genetic Exposure toxins free radicals

Striatal dopamine depletion

Degeneration substantia nigra pars compacta neurons

Reduce thalamic excitation of motor cortex

Imbalance Dopamine - Acetylcholine

Mechanism

T – remor R - igidity A - kinesia/Bradykinesia P- ostural instability

Four Cardinal SignsFour Cardinal Signs T- remorT- remor R igidityR igidity A kinesia and bradykinesiaA kinesia and bradykinesia P ostural instabilityP ostural instability

Diagnostic FeaturesDiagnostic Features

Characteristic ProblemsCharacteristic Problems

Hypophonia-soft speechHypophonia-soft speech

Dysarthria-unclear pronunciation Dysarthria-unclear pronunciation

Festination-shuffling gaitFestination-shuffling gait

Characteristic ProblemCharacteristic Problem

Characteristic ProblemCharacteristic Problem

Characteristic ProblemCharacteristic Problem

Characteristic ProblemCharacteristic Problem

Hoehn and Yahr Staging of Hoehn and Yahr Staging of Severity of Parkinson’s DiseaseSeverity of Parkinson’s Disease

StageStage DescriptionDescription

00 No clinical signs evidentNo clinical signs evident

II Unilateral involvementUnilateral involvement

IIII Bilateral involvement but no postural abnormalitiesBilateral involvement but no postural abnormalities

IIIIII Bilateral involvement with mild postural imbalance on Bilateral involvement with mild postural imbalance on examination or history of poor balance or falls; patient examination or history of poor balance or falls; patient leads independent lifeleads independent life

IVIV Bilateral involvement with postural instability; patient Bilateral involvement with postural instability; patient requires substantial helprequires substantial help

VV Severe, fully developed disease; patient restricted to Severe, fully developed disease; patient restricted to bed or wheelchairbed or wheelchair

Nursing Diagnosis Nursing Diagnosis

1. Impaired Physical Mobility r/t increase 1. Impaired Physical Mobility r/t increase resistance to passive motion with generalized resistance to passive motion with generalized rythmic flexion and extension of the limbsrythmic flexion and extension of the limbs

2. Risk for Fall r/t Loss control of movements2. Risk for Fall r/t Loss control of movements

3. Self Care Deficit r/t loss of muscle tone and 3. Self Care Deficit r/t loss of muscle tone and coordination coordination

4. Impaired (verbal, written) communication 4. Impaired (verbal, written) communication

r/t loss of motor control r/t loss of motor control

r/t loss of oral muscle tone controlr/t loss of oral muscle tone control

5. Activity intolerance r/t neuromuscular 5. Activity intolerance r/t neuromuscular

impairmentimpairment

6. Bathing/hygiene, dressing/grooming self-6. Bathing/hygiene, dressing/grooming self-care deficit r/t neuromuscular impairmentcare deficit r/t neuromuscular impairment

7. Risk for aspiration related to impaired 7. Risk for aspiration related to impaired muscles of swallowingmuscles of swallowing

8. Risk for falls related to impaired gait and 8. Risk for falls related to impaired gait and balance. balance.

DiagnosisDiagnosis

History and Physical examinationHistory and Physical examination

Bradykinesia must be present with atBradykinesia must be present with at least two of the following: limb muscle least two of the following: limb muscle

rigidity, resting tremor, or postural rigidity, resting tremor, or postural instability. instability.

Diagnostics Diagnostics

No specific diagnostic available No specific diagnostic available

(PET) Positron Emission tomography(PET) Positron Emission tomography

- - Computerize tomographic technique that Computerize tomographic technique that

uses radioactive substance uses radioactive substance to examine to examine metabolic activity of various structure. metabolic activity of various structure.

- given by inhalation or injection. - given by inhalation or injection.

- Radioactive - Radioactive (FDG) Fluoro-2- deoxy-D-glucose. (FDG) Fluoro-2- deoxy-D-glucose.

Radiologic study Radiologic study

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