Parkinson's Disease

• Parkinson's Disease is also known as Paralysis Agitans.
• Parkinson's Disease 


  A degenerative disease that affects the extrapyramidal system (EPS). This causes decreased dopamine production.
• PD: Manifestations

  • The initial sign is tremors - pill rolling tremors, to and fro tremors of the head.
  • Resting tremors (non - intention tremors). Shakings are more severe when the client is not performing physical activities.
• PD: Manifestations

  • Rigidity occurs due to decreased dopamine production. Dopamine is a neurotransmitter that promotes muscle relaxation.
  • Cogwheel rigidity and absence of arm swing when walking.
• PD: Manifestations

  Bradykinesia - slow muscle movement
• PD: Manifestations

  The characteristic gait of the client is shuffling, festinating gait. This is tiptoe walking, starting at a slow pace which keeps on increasing until the client assumes a running pace. The client is unable to stop until obstruction is met.
• PD: Manifestations

  Others:

  • Flattened effect (mask - like facial expression)
  • Stooped posture
  • Soft, monotonous voice (microphonia)
  • Shaky, small handwriting (micrographia)
• PD: Management

  • Thickened liquid diet to soft diet for dysphagia.
  • Firm bed to prevent contractures
  • Aspiration precaution
  • Increase fluid intake and fiber in the diet to prevent constipation
• PD: Pharmacotherapy

  1. Anticholinergic (dopa choli balance) - reduce the rigidity and some of the tremors

  • NR: Clients with glaucoma should not take anticholinergics.
• PD: Pharmacotherapy

  Dopaminergics - these drugs improve muscle flexibility.
• PD: Pharmacotherapy

  • Levodopa
  • Carbidopa with Levodopa (Sinemet).
  • Dopamine cannot cross blood - brain barrier.
  • Levodopa, a precursor of dopamine can cross the blood - brain barrier.
  • The enzyme dopa decarboxylase converts levodopa to dopamine in the brain. However, this enzyme is also found in the peripheral nervous system, thereby allowing 99% of levodopa to be converted to dopamine before it reaches the brain (1% reaches the brain).
  • Carbidopa and Levodopa (Sinemet). Carbidopa reduces destruction of levodopa at the periphery.
• PD: Pharmacotherapy

  Dopamine Agonists - these medications act on the dopamine receptors and produce improvement in symptoms of Parkinsonism.

  Example: Symmetrel (Amantadine HCI)