Parkinson’s Disease: Causes, Symptoms, And Treatment

Causes of Parkinson’s disease

Discuss about Parkinson’s Disease.

Parkinson’s disease is a movement disorder, associated with degeneration of neurons in the Central Nervous System In this case study, John Magill, a 75 year old male has been admitted to the hospital following a fall at home. He has been diagnosed with Parkinson’s disease and suffering from the same for the past five years that caused generalized tremors and diminished mobility. Upon admission, he complained of hip and back pain. An X-ray analysis revealed no fractures in lower limbs. However, sustained generalized bruising was observed in hips and buttocks alongside skin tear in right hip. John’s vital parameters were found to be within normal range with the exception of respiratory rate that might have escalated due to suddenness of the situation following fall. The normal breathing rate for a person falls within the range of 14-20 that deviated for John (Wallin, 2013). A thorough analysis of his medical records reveals that he is under medications for the chronic ailment condition. Further acquisition of his social information represented that he is dependent on his wife who takes care of him and she herself is survived with multiple myeloma like disease condition. Moreover he is also found to be a non-smoker and on raer occasions indulge in drinking alcohol.

A combination of neurological, genetic and environmental factors is responsible for manifestation of the disease. A neurotransmitter dopamine is present in the corpus striatum and substantia nigra regions of the basal ganglia. It produces controlled movements. Loss of motor activity in the disease occurs due to loss of dopamine producing cells from the substantia nigra. This reduces the amounts fo dopamine. The reduction in the levels of the neurotransmitter hinders effective communication between the two regions of the basal ganglia (Benazzouz et al., 2014). This leads to movement impairment. Some genetic mutations are also associated with prevalence of the disease. Several research studies have provided evidence for the association of mutations in the PINK1, parkin, DJ-1 and LRRK2 genes with Parkinson’s disease (Sanders et al., 2014). Certain environmental factors like exposure to pesticides and toxins also predispose a person to the disease.

Several risk factors have been distinctly linked with the onset of Parkinson’s disease. Some of them are heredity, age, toxin exposure and sex. Prevalence of the disease in a close relative increases the likelihood of getting affected with the condition. The disease rarely develops in young adults. It is more common ion advanced age beyond 60 years. The disease conditions worsen as the age progresses (Reeve, Simcox & Turnbull, 2014). Research has shown that men are more likely to get affected with the disease than females. Furthermore, prolonged exposure to pesticides, herbicides and other toxins may also increase the risk of the disease.  

Risk factors related to health condition

Parkinson’s disease is a progressive neurological degeneration, the symptoms of which worsen as the disease advances. Tremor in hands is common manifestation of the disease with additional symptoms related to stiffness, slow movement and loss of balance. Tremors in limbs, hands or due to postural difficulties might occur. Cognitive impairments might occur, depicted through difficulty in understanding, thinking, amnesia and dementia like condition. Till date no specific diagnostic examination has been put forth to detect the disease. However, neurological examinations are routinely performed to detect the disease. In case a person exhibits any two of the symptoms associated with rigidity, tremor and bradykinesia or slow and retarded movement, the presence of Parkinsonism is usually confirmed (Adler & Beach, 2016).

Physical assessment studies confirm that the essential feature of Parkinsonism is display of tremor at rest. Muscular stiffness in combination with contraction lead to rigidity in the muscles. Other diagnostic symptoms are body fatigue, sleep disturbances, speech impairment and masked facial expression. Certain sensory disturbances like depression or anxiety related mood disorders and urine inconsistency may also occur. The handwriting of the affected person gets changed (Micrographia). Other related symptoms encompass swallowing difficulty, constipation, weight loss and falls (that lead to injury). Some physical examinations also reveal the presence of oily skin and postural hypotension in patients. (Lee & Koh,2015).

Treatment concerning Parkinsonism is often related to relieving the signs and symptoms of the disease rather than focusing on eliminating the chief causes. It may be achieved in the following three ways:

Pharmacological: Restoration of supply of dopamine neurotransmitter to the brain is promoted through administration of certain medications that include drugs like Levodopa, Benzhexol (Artnae), Selegiline (Eldepryl) and others. Following prolonged application of the drug, potency of the drug might be decreased and side effects might occur that may be reverted on withdrawing the medicine for some time and restarting the drug regime at later hour (Agúndez et al., 2013).

Non-pharmacological: Non-drug therapies are significant in providing treatment. These interventions include educating and counselling the caregivers and the patients. Information is generally provided on drugs like riswperidone, metoclopramide and prochlorperazine, which should be avoided owing to their dopamine blocking activity. Physiotherapy and physical training programs are promoted among patients to increase their fitness, gait, posture and wellbeing (Bloem, de Vries & Ebersbach, 2015). 

Surgical: Deep brain stimulation approach is directed to stimulate through delivery of specific current and cause destruction of the brain tissues that are responsible for generating abnormal functions through placement of electrodes in areas such as thalamus or subthalamic nuclei or globus pallidus (Szlufik et al., 2016). Another novel technique include the introduction of human foetal dopamine cell transplants in the basal ganglia region to induce the production of viable dopamine producing cells to the brain (Hallett et al., 2015). More recently repeated transcranial magnetic stimulation (rTMS) therapy is utilized to apply the magnetic field strength for stimulating the nerve cells in the brain for the purpose of improving the symptoms of the disease (Flamez et al., 2016)

Nursing Diagnosis	Goal	Intervention	Rationale	Evaluation
Impaired speech with soft voice that causes the slurring of speech making it incoherent and difficult to understand	Improved response for better communication and expression of thoughts	·         Introduction of speech improvement exercises ·         Customized speech therapy program in consultation with the speech therapist through referral	·         Analysis of the efficiency of treatment on speech impairment progression through examination of text reading, syllable repetition, phonation and monologs (Rusz et al., 2013).	Improvement in voice quality, pitch, variability and articulation was observed after 2 years of the therapy.
Restricted mobility due to tremors	Improved mobility	·         Educating the patient to maintain erect posture with feet separated and arms swinging ·         Observation of simple stretching and strengthening exercises such as walking, performing aerobic exercise and swimming	·         Conscious efforts to maintain normal gait minimize the chance of loss of balance and fall ·         Complications and adversities such as pain and loss of coordination due to Parkinsonism may be curtailed following exercise regime (Rafferty et al., 2017)	Slight but significant improvement in mobility is noticed within 1 week

Clinical manifestations of health condition

A proper discharge plan for John will cater to addressing the essential needs pertinent to his condition. Management and effective operation of the activities of daily living must be ensured through proper education and cascading of information to the patient as well as his caregiver at home. John must be made aware of the precautions he needs to take to prevent further fall accidents.  He must be taught to adhere to the prescribed medications and conform to proper diet to maintain his health and wellbeing. A written chart may be provided to him mentioning the schedule of taking the medicines for ease of understanding. It is also imperative to keep the home environment proper so that hazards and risks may be avoided largely. Small renovations should be made to assist the patients. Such changes include removal of any potential obstacles form the room that can lead to a fall, having nonslip mats in bathrooms, installing more lights in the house and building railings along the walls to help the patient maintain balance (Canning et al., 2015). Expert opinion and customized recommendations from concerned experts related to maintenance of mobility, diet and speech may be sought from physical therapist, dietician and speech therapist respectively.

Conclusion

Parkinson’s disease is referred to as a debilitating neuro-degenerative disease that exacerbates with progressive age. Tremors in the limbs are the commonest detectable symptoms of the disease although the root cause has not yet been unraveled. Restricted mobility significantly thwarts daily activities of the patient thereby posing challenges to his quality of life. Therefore, conduct of proper nursing diagnosis to drive necessary interventions is imperative to offer prudent treatment options for the concerned patient. Moreover, comprehensive discharge plan might render benefits by suggesting strict compliance to prescribed medications, conforming to personal care, safety and seeking intervention from allied healthcare experts that in turn will aid in holistic improvement of the patient.

References

Adler, C. H., & Beach, T. G. (2016). Neuropathological basis of nonmotor manifestations of Parkinson’s disease. Movement Disorders, 31(8), 1114-1119.

Agúndez, J. A., García-Martín, E., Alonso-Navarro, H., & Jiménez-Jiménez, F. J. (2013). Anti-Parkinson’s disease drugs and pharmacogenetic considerations. Expert opinion on drug metabolism & toxicology, 9(7), 859-874.

Benazzouz, A., Mamad, O., Abedi, P., Bouali-Benazzouz, R., & Chetrit, J. (2014). Involvement of dopamine loss in extrastriatal basal ganglia nuclei in the pathophysiology of Parkinson’s disease. Frontiers in aging neuroscience, 6.

Bloem, B. R., de Vries, N. M., & Ebersbach, G. (2015). Nonpharmacological treatments for patients with Parkinson’s disease. Movement Disorders, 30(11), 1504-1520.

Canning, C. G., Sherrington, C., Lord, S. R., Close, J. C., Heritier, S., Heller, G. Z., … & O’Rourke, S. D. (2015). Exercise for falls prevention in Parkinson disease A randomized controlled trial. Neurology, 84(3), 304-312.

Flamez, A., Cordenier, A., De Raedt, S., Michiels, V., Smetcoren, S., Van Merhaegen-Wieleman, A., … & Baeken, C. (2016). Bilateral low frequency rTMS of the primary motor cortex may not be a suitable treatment for levodopa-induced dyskinesias in late stage Parkinson’s disease. Parkinsonism & related disorders, 22, 62-67.

Hallett, P. J., Deleidi, M., Astradsson, A., Smith, G. A., Cooper, O., Osborn, T. M., … & Schumacher, J. M. (2015). Successful function of autologous iPSC-derived dopamine neurons following transplantation in a non-human primate model of Parkinson’s disease. Cell stem cell, 16(3), 269-274.

Lee, H. M., & Koh, S. B. (2015). Many faces of Parkinson’s disease: non-motor symptoms of Parkinson’s disease. Journal of movement disorders, 8(2), 92.

Rafferty, M. R., Schmidt, P. N., Luo, S. T., Li, K., Marras, C., Davis, T. L., … & Simuni, T. (2017). Regular exercise, quality of life, and mobility in Parkinson’s disease: a longitudinal analysis of national parkinson foundation quality improvement initiative data. Journal of Parkinson’s disease, 7(1), 193-202.

Reeve, A., Simcox, E., & Turnbull, D. (2014). Ageing and Parkinson’s disease: why is advancing age the biggest risk factor?. Ageing research reviews, 14, 19-30.

Rusz, J., ?mejla, R., R?ži?ková, H., Klempí?, J., Majerová, V., Picmausová, J., … & R?ži?ka, E. (2013). Evaluation of speech impairment in early stages of Parkinson’s disease: a prospective study with the role of pharmacotherapy. Journal of Neural Transmission, 120(2), 319-329.

Sanders, L. H., Laganière, J., Cooper, O., Mak, S. K., Vu, B. J., Huang, Y. A., … & Langston, J. W. (2014). LRRK2 mutations cause mitochondrial DNA damage in iPSC-derived neural cells from Parkinson’s disease patients: reversal by gene correction. Neurobiology of disease, 62, 381-386.

Szlufik, S., Szumilas, M., Dutkiewicz, J., Koziorowski, D., Mandat, T., & Slubowska, E. (2016). The impact of STN DBS on kinetic tremor in Parkinson’s disease patients. Parkinsonism & Related Disorders, 22, e109-e110.

Takizawa, C., Gemmell, E., Kenworthy, J., & Speyer, R. (2016). A systematic review of the prevalence of oropharyngeal dysphagia in stroke, Parkinson’s disease, Alzheimer’s disease, head injury, and pneumonia. Dysphagia, 31(3), 434-441.

Wallin, B. G. (2013). Intraneural recordings of normal and abnormal sympathetic activity in humans. Autonomic Failure: A Textbook of Clinical Disorders of the Autonomic Nervous System, 323-331.