Parkinson diseases

CNS

1. PARKINSON DISEASES Mr. Binu Babu M.Sc. Nursing Mrs. Jincy Ealias M.Sc. Nursing

2. INTRODUCTION Parkinson's disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement.

3. Parkinson’s disease (PD) Parkinson’s disease (PD) is a chronic, progressive neurodegenerative disorder characterized by slowness in the initiation and execution of movement (bradykinesia), increased muscle tone (rigidity), tremor at rest, and gait changes.

4. ETIOLOGY Exact cause is unknown Heredity Family History: Having one or more close relatives with the disease increase the rise of getting. Advancing age : Above 60 years mostly seen Sex: male are more likely to get than female. Low Estrogen Level: most menopausal women who don’t use hormone replacement therapy are more risk of getting the disease. Medications like metoclopramide, reserpine, methyldopa, lithium, haloperidol, and chlorpromazine Agricultural work: exposure to environmental toxin such as pesticide, herbicides H ead injury.

5. PATHOPHYSIOLOGY

6. CLINICAL MANIFESTATIONS Rigidity:- Defined as increased resistance to passive motion. Cogwheel rigidity : jerky, ratchet like resistance to passive movement and muscles alternately tense and relax. Tremor:- It is an involuntary oscillation of body part. Parkinsonian tremor is described as resting tremor, as it is typically present at rest and disappears with voluntary movement. Manifests as pill-rolling tremor of hand .

7. Akinesia:- absence of movement. Moments of freezing may occur and are characterized by a sudden break or block in movement. Hypokinesia : reduced amplitude of the movement Postural Instability Postural instability is common. Patients may describe being unable to stop themselves from going forward (propulsion) or backward ( retropulsion ).

8. Hypomimia Drooling of saliva Low volume speech. Dysarthria . Problem with swallowing and Involuntary flow of saliva . Longer time to complete a task. Stiff face in advanced PD. Altered cognitive function – Dementia . Disorder of intellectual function.

9. COMPLICATIONS These include motor symptoms Dyskinesia Dementia Depression, hallucinations, psychosis Dysphagia Malnutrition Aspiration – pneumonia Orthostatic hypotension Risk for fall

10. DIAGNOSIS Diagnosis is based on the clinical features . CT scan or MRI of head to rule out secondary cause. PET-scan to evaluate levodopa uptake and conversion to Dopamine in the corpus Striatum.

11. ANTI-PARKINSONISM MEDICATION S LEVEDOPA (L-Dopa): it is the most effective agents and the mainstay of treatment, for controlling the symptoms. SINEMET : it is made up of Levodopa and carbidopa. Levodopa enters the brain and is converted to Dopamine while carbidopa increase its effectiveness and prevents the side effects of levodopa such as nausea, vomiting.

12. DOPAMINE RECEPTOR AGONISTS : This are the drugs that activate or stimulate the dopamine receptors Ergot derivatives : bromocriptine or pergolite . Non-ergot derivatives: ropinirole , pramipexole MONOAMINE OXIDIZED INHIBITORS: It blocks the breakdown of dopamine , and are used primarily to treat motors fluctuation associated with levodopa treatment most commonly drugs used are Seligiline and Rosagiline .

13. DRUG MECHANISM OF ACTION Dopaminergics Dopamine Precursors levodopa (L- clopa ) levodopa/carbidopa ( Sinemet ) Converted to dopamine in basal ganglia Dopamine Receptor Agonists Pramipexole Ropinirole Rotigotine Stimulate dopamine receptors Dopamine Agonists Amantadine Binds NMDA type glutamate receptors, increase dopamine release and blocks dopamine reuptake Apomorphine Stimulates postsynaptic dopamine receptors Anticholinergics Benztropine Trihexyphenidyl Block cholinergic receptors, thus helping to balance cholinergic and dopaminergic activity Antihistamine Diphenhydramine Has anticholinergic effect Monoamine Oxidase Inhibitors Rasagiline Safinamide Selegiline Block breakdown of dopamine Catechol O-Methyltransferase (COMT) inhibitors Entacapone Tolcapone Block COMT and slow the breakdown of levodopa, thus prolonging the action of levodopa

14. Surgery Surgery is optional only when medicine doesn't make the symptoms better. Thalatomy - is a surgical procedure in which an opening is made into the thalamus to improve the overall brain function. Deep brain stimulation – pulse generator, high frequency electrical impulses to the thalamus and block the nerve pathway to control tremors

15. Deep Brain Stimulation Deep brain stimulation (DBS) can be used to treat tremors and uncontrolled movements of Parkinson’s disease. Electrodes are surgically placed in the brain and connected to a neurostimulator ( pacemaker device ) in the chest. cereals.

16. Physiotherapy A combined approach of physical therapy and pharmacological intervention plays a key role in management of the patient. Physical therapist should be fully aware of the medications the patient is taking and its potential adverse effects. Optimal performance can be expected at peak dosage (on-state) whereas worsening performance is associated with end of dose cycle. Exercise training Strength training Balance training Correcting eating impairments. Verbal skills practiced with breath control.

17. NURSING MANAGEMENT Nursing Assessment: Obtain a history of symptoms and their effect on functioning, mobility, feeding, communication, and self-care difficulties. Assess cranial nerves, cerebellar function (co-ordination) and motor function. Observe gait and performance of activities. Assess speech for clarity and space. Assess for sign of depression . Assess family supports and access to social service.

18. NURSING ASSESSMENT General Blank (masked) facial expression, slow and monotonous speech, infrequent blinking Integumentary Seborrhea , dandruff; ankle Oedema Cardiovascular Postural hypotension Gastrointestinal Drooling Neurologic Tremor at rest, first in hands (pill rolling), later in legs, arms, face, and tongue. Aggravation of tremor with anxiety, absence in sleep. Poor coordination, cognitive impairment and dementia, impaired postural reflexes Musculoskeletal Cogwheel rigidity, dysarthria, bradykinesia, contractures, stooped posture, shuffling gait Possible Diagnostic Findings No specific tests. Diagnosis based on history and physical findings and ruling out of other diseases

19. NURSING DIAGNOSIS Impaired physical mobility related to Bradykinesia , rigidity and tremors Imbalance nutrition less than body requirement related to motor difficulties with feeding, chewing and swallowing Impaired verbal communication related to decreased speech volume Constipation related to diminished motor function and inactivity Ineffective coping related to physical limitation and loss of independence. Risk for fall-related injury Impaired sleep pattern

20. THANK YOU