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Parkinson's Disease (Diagnostics (no specific diagnostic test for PD,…

- - - - Late Stage
        
        -Shuffling gait
        -Propulsive gait; arms flexed and loss of postural reflexes
        -In some, slight change in speech patterns
        
        Bradykinesia
        
        -Loss of automatic movements
        -Doesn't execute automatic movements such as blinking of the eyelids, swinging of the arms while walking, swallowing of saliva, self-expression with facial and hand movements, and minor movement
        of postural adjustment.
        
        -Stooped posture
        -Masked face (deadpan expression)
        -Drooling of saliva
        -Shuffling gait (Festination)
        -Posture of an "old man"
        -Head and trunk bent forward
        -Legs constantly flexed
        -Postural instability: tested by "pull test" → examiner stands
        behind the patient and gives a tug backward on the shoulder,
        causing the patient to lose his or her balance and fall backward.
        -Can't stop themselves from going forward (propulsion) or back (retropulsion)
        #
      - Early Stages
        
        -Mild tremor
        -Slight limp
        -Decreased arms swing
        
        Tremor
        
        :star: First Sign
        -Usually only noticed by the patient if minimal
        -Affects handwriting → trail off toward ends of words
        -Prominent at rest
        -Aggravated by emotional stress or increased concentration
        -Described as "Pill rolling"
        -Thumb and forefinger move in a rotary fashion
        -Involves diaphragm, tongue, lips, and jaw #
        
        Rigidity
        
        -Increased resistance to passive motion
        -Cogwheel rigidity, or a jerky quality, as if there were intermittent catches in the movement of a cogwheel, when the joint is moved passively.
        -Muscle contraction→ muscle soreness, tired and achy, or pain in the head (upper body, spine, and legs most affected)
        -Slowness of movements
        
        Complications
        
        -Dyskinesias (spontaneous, involuntary movements)
        -Weakness
        -Akinesia (total immobility)
        -Neurologic problems (dementia)
        -Neuropsychiatric problems (depression, hallucinations, psychosis)
        -Swallowing problems (dysphagia, malnutrition, or aspiration)
        -Pneumonia
        -Urinary tract infections
        -Skin breakdown
        -Orthostatic hypotension
        -Loss of postural reflexes (falls or other injury)
- - - - -fetal neural tissue into the basal ganglia is designed to provide
        DA-producing cells in the brains of patients with PD
        -Still in experimental stages
    - - -involves stereotactic ablation of areas in the
        thalamus (thalamotomy), globus pallidus (pallidotomy), and
        subthalamic nucleus (subthalamic nucleotomy)
    - - -Most common
        -placing an electrode in either the thalamus,
        globus pallidus, or subthalamic nucleus and connecting it to a generator placed in the upper chest (like a pacemaker)
        -deliver a specific current to the targeted brain location
        -adjusted to control symptoms better and is reversible
        -work by reducing the increased neuronal activity produced by DA depletion
        -shown to improve motor
        function and reduce dyskinesia and medication usage
- - - - -trihexyphenidyl (Artane)
        -benztropine (Cogentin)
        -biperiden (Akineton)
        
        Block cholinergic receptors, thus
        helping to balance cholinergic
        and dopaminergic activity
    - - -diphenhydramine (Benadryl)
        
        Has anticholinergic effect
        
        -Used to manage tremors
    - - Dopamine Precursors
        
        -levodopa (L-dopa)
        -levodopa/carbidopa (Sinemet, Parcopa [orally dissolving tablet])
        
        -First drug used
        -Prolonged use can often result in dyskinesias and “off/on” periods when the medication will unpredictably start or stop working.
        -Help with akinetic symptoms, tremor, rigidity
        
        DRUG ALERT: Carbidopa/Levodopa (Sinemet)
        • Monitor for signs of dyskinesia.
        • Effects may be delayed for several weeks to months.
        • Instruct patient or caregiver to report any uncontrolled movement of
        face, eyelids, mouth, tongue, arms, hands, or legs; mental changes;
        palpitations; severe nausea and vomiting; and difficulty urinating.
      - Dopamine Receptor Agonists
        
        -bromocriptine (Parlodel)
        -pergolide (Permax)
        -pramipexole (Mirapex)
        -ropinirole (Requip, Requip XL)
        -rotigotine (Neupro [skin patch])
        
        Stimulate dopamine receptors
        
        -Preferred initial therapy
        
        DRUG ALERT: Bromocriptine (Parlodel)
        • Patient may become dizzy or faint due to orthostatic hypotension,
        especially after the first dose.
        • Notify physician immediately if a severe headache develops that does
        not let up or continues to get worse.
      - Dopamine agonists
        
        -amantadine (Symmetrel)
        -apomorphine (Apokyn)
        
        Blocks reuptake of dopamine
        into presynaptic neurons
        Stimulates postsynaptic
        dopamine receptors
        
        -amantadine effective antiviral antiparkinsonian drug
    - - -selegiline (Eldepryl, Carbex)
        -rasagiline (Azilect)
        
        Block breakdown of dopamine
        
        -Sometimes used with Sinemet
        -Increase the half-life of levodopa
    - - -entacapone (Comtan)
        -tolcapone (Tasmar)
        
        Block COMT and slow the
        breakdown of levodopa, thus
        prolonging the action of
        levodopa