Parkinson's Disease (PD)

Maryclare Kastelic, Meghan Mays, Kimberly Luebbe, and Madison Stout

Clinical Manifestations

Tremors at rest, muscle stiffness, bradykinesia/akinesia, postural disturbance, and dysphagia are all classic manifestations of this disease. These symptoms can develop alone but more tend to develop as the disease progresses. The symptoms are always bilateral. Early on in the disease, reflexes, senses, and mental status are normal. Gradually, weakness and difficulty walking may develop and speech can become slurred. A person with this disease cannot make appropriate postural adjustments to tilting or falling and thus falls like a “post”. The Parkinsonian gait is described as small, shuffling steps. Individuals struggle to change positions from a seated or reclining position to a standing position. Sleep issues are also common along with sensory disturbances, and difficulty concentrating.

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Diagnosing Parkinson's Disease

There are many ways to diagnose Parkinson’s disease (PD). The most important tool used to diagnose a patient with PD is the bedside examination performed by a neurologist. A neurologist will begin by collecting a detailed medical history and performing a thorough physical exam. A neurologist will ask patients to perform certain actions that assess agility, muscle tone, gait and balance. Many neurologists use the United Parkinson’s Disease Rating Scale to record results from the physical exam. After completing a physical exam, a neurologist may order more extensive tests to determine whether or not a patient has Parkinson’s disease. Some of these tests include PET scans as well as DAT scans. DAT scans allow a neurologist to differentiate between Parkinson’s disease and general tremors that a patient may be experiencing as a result of medication or other abnormal processes in the body.

Treating Parkinson's Disease

Although there is not a cure for Parkinson’s disease, there are plenty of treatment options for patients living with the disease. Options such as medication and surgery can improve the quality of life for those with Parkinson’s. Other treatment options include exercise and physical therapy to improve balance, coordination, and strength in those living with Parkinson’s. The purpose of prescription medications is to help individuals balance dopamine levels. Parkinson’s causes low levels of dopamine in the brain. Medications such as Carpidopa-levodopa, Dopamine agonists, MAO-B inhibitors, COMT inhibitors, anticholinergics, and amantadine help regulate and mimic the effects of dopamine in the body. Surgical procedures such as deep brain stimulation involve implanting electrodes into different parts of the brain that send electrical pulses to the brain and aim to reduce the symptoms associated with Parkinson’s. Surgery is recommended for individuals who have advanced Parkinson’s and negative responses to prescription medication for the disease.

Pathogenesis

Although the pathophysiology of Parkinson's disease is unknown, scientists suggest that it could be caused by genetics and several environmental toxins. In a healthy individual, neurons produce dopamine, an important neurotransmitter in the brain. Dopamine connects the substantia nigra to areas of the brain such as the corpus striatum which is responsible for producing purposeful movements. In people with Parkinson's disease, these neurons die. People with Parkinson's also have damaged nerve endings that produce norepinephrine. The loss of norepinephrine can explain symptoms of Parkinson's such as fatigue and irregular blood pressure. Lastly, clumps of a protein, alpha-synuclein, accumulate in the brain and are called Lewy bodies. These accumulations prevent brain cells from functioning normally and lead to the manifestations of Parkinson's.

Risk Factors

Advancing age- although the disease sometimes develops at an early age, it is usually diagnosed in the middle to late years or life and the risk increases the older you get

Sex- Males have a much greater chance of developing Parkinson’s disease. This may be because they are more exposed to other risk factors such as toxins and head trauma

Heredity- a person that has a family member that has Parkinson’s has increased chance to have the disease as well

Toxin exposure- those who have been more frequently exposed to toxins such as carbon monoxide, herbicides or pesticides have a slightly higher risk of development than those who have not

Some medications- some drugs such as antipsychotics and used to treat severe paranoia and schizophrenia have been shown to cause Parkinson’s

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Sources

National Parkinson Foundation: Believe in Better. (n.d.). Retrieved December 3, 2015, from http://www.parkinson.org/understanding-parkinsons/diagnosis



Parkinson's disease. (n.d.). Retrieved December 3, 2015, from http://www. Mayoclinic.org/diseases-conditions/parkinsons-disease/basics/treatment/con-20028488