Parkinson’s disease is a progressive neurologic disorder that affects a person’s movement.
Quick Facts
- Parkinson’s Disease (PD) is a progressive disorder.
- Almost 10 million people are affected by PD.
- PD occurs in the substantia nigra region in the brain.
- The cause of PD is not known.
- Other names used to refer to PD is paralysis agitans and shaking palsy.
- A person with PD may develop the disease for almost 20 years but for some, it develops faster.
- Telltale symptoms that help doctors diagnose PD right away:
- Tremors
- Rigidity
- Bradykinesia
Stages of Parkinson’s Disease
Stage 1
- Onset
- Tremor on one side of the body
- Change occurs in posture, walking, and facial expressions
Stage 2
- Symptoms such as tremors and rigidity affecting both sides of the body
- Daily tasks are getting difficult but patient may continue to live alone
Stage 3
- Middle stage
- Hallmark symptoms are loss of balance and slow movements
- Common accidents are falls
Stage 4
- Symptoms are limiting and severe
- The person needs help in doing daily activities
- Can’t live alone
Stage 5
- Debilitating stage
- The legs are too stiff that walking is impossible
- At this stage, the person may be in a wheelchair or bedridden
Rating Scales
- Hoehn and Yahr Stages
- Unified Parkinson’s Disease Rating Scale
Risk Factors
- Genetics
- Environment Factors such as:
- Head injury
- Residence
- Exposure to pesticides
- Lifestyle
Signs and Symptoms
Early
- Tremors
- Small handwriting (micrographia): handwriting changes. Handwriting may change (smaller fonts than usual)- sentence structures and words get mixed up
- Loss of smell
- Sleeping problems: there is a change in the way a person sleeps such as sudden movements or acting out in dreams.
Motor and sensory problems
- Low or soft voice: a change in the way the person speaks
- Mask face
- Dizziness or Fainting
- Stooping or Hunching Over
- Constipation
- Cramping
- Dyskinesia
- Festination
- Freezing
- Shuffling gait
Non-motor symptoms
- Cognitive changes
- Early satiety
- Excessive sweating
- Fatigue
- Increase in dandruff
- Delusions and hallucinations
- Lightheadedness otherwise called postural hypotension
- Loss of sense of smell
- Mood disorders
- Pain
- Sexual problems
- Sleep disorders
- Urinary incontinence, urgency, and frequency
- Vision problem
- Weight loss
Diagnosis
The doctor may diagnose a person with PD if signs are present. The person may not show all signs but an experienced doctor may diagnose if a person has PD if they show at least 2 signs. These are:
- Shaking or tremors
- The slowness of movement( bradykinesia)
- Stiffness or rigidity of trunk legs and arms
- Having trouble with their balance may result to fall (postural instability)
Treatment
Medications
- Prescription medications
- Levodopa
- Dopamine Agonists
- Amantadine
- Adenosine A2a antagonists
- COMT inhibitors
- Anticholinergic drugs
- MAO-B inhibitors
There are medicines that may react to other medications once taken. It is advised to inform the person’s doctor about the medications that they take such as levodopa.
Surgical therapy
- Deep brain stimulation (DBS): used to treat PD tremors and other advanced PD symptoms. This is a treatment option for patients with PD for four years that can’t be controlled with medications. Doctors that perform surgery may insert electrodes.
- Duopa: this is a drug therapy that requires surgery on the stomach. The surgeon will make a hole in the stomach so that Duopa can be administered. Duopa is a combination of carbidopa and levodopa. This is in a gel form otherwise called enteral suspension.
Other Surgical Options
- Focused ultrasound: non-invasive since the doctor doesn’t need to cut the person open. All that is needed is the MRI or magnetic resonance imaging. The energy that it releases forms heat. This then destroys a specific area in the brain causing tremors.
- Thalamotomy: this is a brain surgery where part of the thalamus is removed. This is performed to lessen the tremors but can cause some problems in speech and cognition in the future.
- Pallidotomy: a small part of the globus pallidus in the brain is taken. This part controls movement. But doctors rarely perform this surgery.
Other Treatment Options
- Physical therapy
- Occupational therapy
- Lifestyle modification
- Rest and exercise
Nursing Intervention
- Assess the patient’s energy and endurance. Take note of the respiratory status such as the depth, ease of breathing, and respiratory rate.
- Check for unusual lung sounds that show difficulty of breathing. Lung sounds such as crackles, wheezing and rhonchi are signs of breathing problems.
- Give oxygen to the patient as advised. Check oxygen levels through a pulse oximeter.
- Turn patient every 2 hours as ordered.
- Inform the patient how beneficial exercise and rest are.
- Ensure patient’s safety while performing postural drainage.
- Assess the patient if there are signs of depression.
- Encourage patients to verbalize their own feelings and pain.
- Check the patient’s medication schedule. Some medicines taken may affect mood such as levodopa.
