Question

CASE STUDY: PARKINSON’S DISEASE

Miss Rose is a 74 year old female, who is a retired widow and lives with her son for the past five years. Both enjoy planting seedlings and own a community agriculture store. She does not suffer with hypertension or diabetes and has an active lifestyle. She is also not known to have any psychiatric illnesses. Over the past six months Miss Rose’s son and herself noticed physical changes and decided to visit her General Practitioner. At her visit she mentioned to the doctor that she was having difficulty rising up from a sitting position after grooming her plants or turning from one table to another when she has customers. Documentation on her clinic file noted that she previously complained of difficulty walking and falling when coming out of bed. She was sent for an X-ray but there were no clinical findings. The physician asked her to describe what happened when she fell. Miss Rose verbalized that when she got up from bed and starting walking she started moving forward and backward then stooped forward with small fast steps and then she fell. Her son mentioned to the doctor that he has noticed that when she is pruning her plants she has abnormal rhythmic movement of the upper and lower limbs. She occasionally has a slight limp and her handwriting has become smaller over the past months. This has stopped her from doing her daily yoga exercises and she has been very disturbed about it. Miss Rose then further explained that the movement started on the distal part of both upper limbs at the same time. She also expressed that during rest she noticed the movement in her limbs and as she started her tasks the movements became more aggravated. Urinary incontinence is also a problem for Miss Rose and she is having difficulty in her swift movements to her bathroom. The patient was later diagnosed with Parkinson’s disease.

After the assessment and interview of Miss Rose the Physician documented the following:

Physical Assessment Vital Signs: BP- 130/74 mmHg Temperature - 36.7 C, Pulse- 78 bpm regular and bounding Respiration- 20 bpm Height- 5ft 7 in Weight- 70 kg Facial expression- Masklike Gait- Shuffling gait with tendency to fall forward and backward CNS Examination Alert and oriented to time, person and place Level of consciousness GCS- 15/15 Sleeping patterns- normal Swallowing gag reflex- normal Cogwheel rigidity present Tremor present Bradykinesia present Dysphonia present Instructions:

a) Briefly discuss the Anatomy and Physiology of this disease.

b) Briefly discuss the pathophysiology of the disease process. .

c) Discuss what home care activities can be implemented to ensure the patient’s health and safety.

d) State the medications used to treat this disease and its therapeutic effects it has on the patient.

Answer 1

a)Briefly discuss the Anatomy and Physiology of this disease.

- it is the disease of basal ganglia(it is a group of nuclei in the base of forebrain)

- The striatum (part of basal ganglia) composed of the caudate and putamen, is the largest nuclear complex of the basal ganglia.

-The striatum receives excitatory input from several areas of the cerebral cortex, as well as inhibitory and excitatory input from the dopaminergic cells of the substantia nigra pars compacta (SNc).

-These cortical and nigral inputs are received by the spiny projection neurons, which are of 2 types:

1. Those that project directly to the internal segment of the globus pallidus (GPi)(major output site of the basal ganglia). The consequence of this pathway is to increase the excitatory drive from thalamus to cortex this results in increased activity in the corticospinal tract and eventually the muscles, so ‘turns up’ the action of the motor system.
2. Those that project to the external segment of the globus pallidus (GPe), establishing an indirect pathway to the GPi via the subthalamic nucleus (STN). The consequence of the indirect pathway is to decrease the excitatory drive from thalamus to cortex. The increase in inhibition of the thalamic neurons in effect ‘turns down’ motor activity from the cortex

The actions of both pathways regulate the neuronal output from the GPi, thus providing tonic inhibitory input to the thalamic nuclei that project to the primary and supplementary motor areas.

b) Briefly discuss the pathophysiology of the disease process. .

- it is a neurodegenerative disease

-idiopathic usually, in some people it may be genetic transfer

- the brain in idiopathic PD shows mild atrophy of the frontal cortex and ventricular dilation

-loss of the darkly pigmented area in the substantia nigra pars compacta (SNpc) and locus coeruleus.

-pigmentation loss directly correlates with the death of dopaminergic (DA) neuromelanin-containing neurons in the SNpc and noradrenergic neurons in the locus coeruleus

- Cell death in the SNpc is mostly restricted to a specific group of neuromelanin-containing dopaminergic neurons

c) Discuss what home care activities can be implemented to ensure the patient’s health and safety.

-walking

-singing

engaging in charity activities

-playing cards

- reading

d) State the medications used to treat this disease and its therapeutic effects it has on the patient.

drug	therapeutic effect
levodopa	increase dopamine
carbidopa	increase dopamine
Selegiline	MAO Inhibitor( irriversible inhibition) Monoamino oxidase inhibitor increase serotonin

They are CNS STIMULANTS,

These neurotransmitters stimulate the brain