Question

Case Study

Neurologic System: Chronic

Case Study: Parkinson's Disease

approx 30 min

Mr. Nimmo, age 66, has noticed excessive fatigue, muscle aches, and weakness in his legs for some time. His hands were shaking slightly, although his wife reported that the shaking appeared to stop when he fell asleep. Some unintentional head movements were also apparent. He remembers that his grandfather died in his mid-60s after suffering for years from a condition with similar symptoms. After several tests and the elimination of some other neuromuscular conditions, a diagnosis of Parkinson's disease was made for Mr. Nimmo.

Q1 : Discuss the pathophysiology of Parkinson’s disease and how it differs from other neuromuscular conditions affecting older adults.

Q2: Discuss the usual progression of the disease as the pathophysiology develops further. Indicate additional manifestations that will be noticeable.

Q3: Describe the complications that frequently develop, including the rationale for each and the early indications of each problem.

Q4: Discuss the treatments available to this patient.

Answer 1

Ans ;

Parkinson's disease -  

1. Pathophysiology :

Smooth and coordinated muscle movements of the body are made possible by a substance in the brain called dopamine. Dopamine is produced in a part of the brain called the “substantia nigra.”

In Parkinson’s, the cells of the substantia nigra start to die. When this happens, dopamine levels are reduced. When they have dropped 60 to 80 percent, symptoms of Parkinson’s start to appear.

  The exact cause of Parkinson’s is unknown. It may have both genetic and environmental components. Some scientists think that viruses can trigger Parkinson’s as well.

Low levels of dopamine and norepinephrine, a substance that regulates dopamine, have been linked with Parkinson’s.

Abnormal proteins called Lewy bodies have also been found in the brains of people with Parkinson’s. Scientists don’t know what role, if any, Lewy bodies play in the development of Parkinson’s.

While there’s no known cause, research has identified groups of people who are more likely to develop the condition. These include:

Sex: Men are one and a half times more likely to get Parkinson’s than women.

Race: Whites are more likely to get Parkinson’s than African Americans or Asians.

Age: Parkinson’s usually appears between the ages of 50 and 60. It only occurs before the age of 40 in 5-10 percent of cases.

Family history: People who have close family members with Parkinson’s disease are more likely to develop Parkinson’s disease, too.

Toxins: Exposure to certain toxins may increase the risk of Parkinson’s disease.

Head injury: People who experience head injuries may be more likely to develop Parkinson’s disease.

Each year, researchers are trying to understand why people develop Parkinson’s. Learn more about what’s been discovered and what’s known about Parkinson’s risk factors

2. Progression of the disesase :

  

Stage 1

Stage 1 Parkinson’s is the mildest form. It’s so mild, in fact, you may not experience symptoms that are noticeable. They may not yet interfere with your daily life and tasks.

If you do have symptoms, they may be isolated to one side of your body.

Stage 2

The progression from stage 1 to stage 2 can take months, or even years. Each person’s experience will be different.

At this moderate stage, you may experience symptoms such as:

muscle stiffness

tremors

changes in facial expressions

trembling

Symptoms may appear on both sides of the body. Changes in posture, gait, and facial expressions may be more noticeable.

Stage 3

At this middle stage, symptoms reach a turning point. While you’re unlikely to experience new symptoms, they may be more noticeable. They may also interfere with all of your daily . But people with stage 3 Parkinson’s can usually maintain their independence and complete activities without much assistance.

Stage 4

The progression from stage 3 to stage 4 brings about significant changes. At this point, you will experience great difficulty standing without a walker or assistive device.

Reactions and muscle movements also slow significantly. Living alone can be unsafe, possibly dangerous.

Stage 5

In this most advanced stage, severe symptoms make around-the-clock assistance a necessity. It will be difficult to stand, if not impossible. A wheelchair will likely be required.

Also, at this stage, individuals with Parkinson’s may experience confusion, delusions, and hallucinations. These complications of the disease can begin in the later stages.

3. Complications and treatment ;

Treatment - drugs  

Levodopa

Anti cholinergics

COMT inhibitors

Amantadine

MAO B inhibitors