Question

A 67-year-old man presents to the HCP with chief complaint of tremors in his arms. He also has noticed some tremors in his leg as well. The patient is accompanied by his son, who says that his father has become “stiff” and it takes him much longer to perform simple tasks. The son also relates that his father needs help rising from his chair. Physical assessment demonstrates tremors in the hands at rest and fingers exhibit “pill rolling” movement. The patient’s face is not mobile and exhibits a mask-like appearance. His gait is uneven, and he shuffles when he walks and his head/neck, hips, and knees are flexed forward. He exhibits jerky or cogwheeling movement. The patient states that he has episodes of extreme sweating and flushing not associated with activity. Laboratory data unremarkable and the HCP has diagnosed the patient with Parkinson’s Disease.

Explain both the neurological and musculoskeletal pathophysiologic processes of why the patient presents these symptoms. Explain how the highlighted processes interact to affect the patient. Explain any racial/ethnic variables that may impact physiological functioning.

Answer 1

Parkinson's disease is a slowly progressive chronic neurological disorder which disturbs muscle control, movement and balance characterized by muscle rigidity, tremor, a slowing of physical movement (bradykinesia) and loss of physical movement (akinesia).

The causes of this Parkinson's disease is unknown in most of the cases. But the risk factors may include -

- some genetic factors,

- family history,

- atherosclerosis,

- viral infection,

- head trauma,

- chronic use of antipsychotic drugs,

- deficiency of dopamine in brain,

- metal or pesticides toxicity.

Pathophysiology =

Due to the etiologucal factors the destruction of Dopaminargic neuron cells in the substantial niagra in the basal ganglia. So, the dopamine deficiency occurs in brain. The reduced level of dopamine causes the nurve cells to fire out of control and this causes loss of control in smooth and controlled muscle activity.

Also the imbalance of excitatory (Acetylcholine) and inhibitory (dopamine) in corpus stratum occurs due to etiologucal causes. This leads to impairment of extrapyramidal tracts to control complex body movements.

Both of these leads to improper stimulation to the muscles. So impair postural movement, tromor, rigidity and bradykinesia occurs.

The relationship with races ans ethnicity with physiological functioning is controversial. But Parkinson's disease is more occurs in the African - American than the whites. This more occurs in men than the women. And the rate of occurance of PD is more in Hispanic's is 13.6 and in non- hispanic's is 10.3 per 100000 population.