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Parkinson's Disease, Treatments, Diagnostics with Manifestations,…
Parkinson's Disease
Pathogenesis
"...the typical clinical features
involve a movement disorder consisting of
bradykinesia, resting tremor, and rigidity
, with
postural instability
occurring at a later stage." (Kouli, Torsney, & Kuan, 2018)
Due to the body's loss of dopaminergic neurons.
Control voluntary Movement, Mood, Reward, Addiction, Stress
As dopamine receptors are lost, response to dopamine becomes limited and normal body movement becomes impaired.
The Triad
Prodromal Phase
Occurs 12-14 years before a person is diagnosed with PD
Begins at PNS then moves to CNS
Brainstem is affected
Hyposmia: decreased detection of smells
Constipation
REM Sleep Disorders
Best time for clinical intervention
Progression
Tremor Dominant
Tremor is the most prominent of all motor symtpoms
Responds better to dopamine treatment
Non-Tremor Dominant
Akinetic-rigidity is present--->
Stiffness and slow movement
Unstable balance
Lewy Bodies & Lewy Neurites
"intracellular aggregates of α-synuclein,"(Kouli, Torsney, & Kuan, 2018).
Dementia
Incidence/Prevalence
2nd Most Common Neuro Disease
65-69 Yrs
0.5-1%
Over 80 Yrs
1-3%
Risk Factors
Genetic Predisposition
Environmental
Smoking
Caffeine
Pesticides
May be correlated with Parkinson's Disease, but further research is needed to validate these claims.
Treatments
Carbidopa-levodopa (Sinemet)
Converted into dopamine to manage slow movement. Dosage needs to be adjusted based on potential dyskinesia.
Ergot Derivative
Bromocriptine (Parlodel)
Stimulates the production of more dopamine by activating presynaptic dopamine receptors
MAO B Inhibitors
Selective
Selegiline & Rasagiline
Helps improve tremor & muscle stiffness
Nonergot Derivative
Pramipexole (Mirapex)
Given in the early & late stage of PD
Dopamine Modulator
Amantadine
Stimulates release of dopamine and treats dyskinesia related to Cabidopa-levodopa
COMT Inhibitors
Entacapone & Tolocapone
Helps increase the duration of levodopa and prevents "wearing off"
There is no cure, only slower progression of symptoms.
Diagnostics with Manifestations
Based on signs and symptoms
"Pill rolling" tremor
Slow movement
Forward tilt with shuffling gait
Changes in Speech Pattern
Decreased Autonomic Movement
DaTscan
DaTscan drug is injected into the patient and it begins to concentrate in the brain after about 6 hours. Imaging will allow the physician to see dopamine neurons and the level of breakdown. This type of imaging also allows the physician to differentiate between Parkinson's Disease and essential tremor.
Kouli A, Torsney KM, Kuan WL. (2018) Parkinson’s Disease: Etiology, Neuropathology, and Pathogenesis. In: Stoker TB, Greenland JC, editors. Parkinson’s Disease: Pathogenesis and Clinical Aspects [Internet]. Brisbane (AU): Codon Publications. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK536722/
doi: 10.15586/codonpublications.parkinsonsdisease.2018.ch1
Muscle Rigidity
Mayoclinic (2021) Parkinson's disease. Derived from
https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/diagnosis-treatment/drc-20376062
Cedars Sinai (2021) Datscan Procedure Information . Derived from
https://www.cedars-sinai.org/programs/imaging-center/exams/nuclear-medicine/datscan/information.html
American Parkinson Disease Association (2021) Derived from
https://www.apdaparkinson.org/what-is-parkinsons/treatment-medication/medication/
Jessica Rocha Torres