Parkinson's Disease
Parkinoson’s disease (PD) is a progressive disorder of the central nervous system(CNS) with motor and non_ motor symptoms.
MOTOR SYMPTOMS include the cardinal features of RIGIDITY, POSTURAL INSTABILITY.
NON_ MOTOR SYMPTOMS may precede the onset of motor symptoms by years.
EARLY SYMPTOMS CAN INCLUDE:
LOSS OF SMELL.
CONSTIPATION.
RAPID EYE MOVEMENT(REM).
SLEEP BEHAVIOR DISORDER.
MOOD DISORDERS.
ORTHOSTATIC HYPERTENSION.
OTHER NON_ MOTOR SYMPTOMS INCLUDES:
ALTERED BLADDER FUNCTION.
EXCESSIVE SALIVA.
INTEGUMENTARY CHANGES.
DIFFICULTY SPEAKING & SWALLOWING.
COGNITIVE PROBLEMS ( slowed thinking, confusion and in some cases dementia ).
The term parkinsonism is a genetic term used to describe a group of disorders with primary disturbances in the dopamine systems of basal ganglia.
Both genetic and environmental influences have been identified.
Parkinson’s disease or Idiopathic parkinsonism is the most common form affecting approximately 78% of patients.
Secondary parkinsonism results from a number of different identifiable causes including virus , toxins, drugs , tumors, and forth.
Parkinson’s disease was 1st described as the shaking.
2 distinct clinical subgroups have been identified.
1 group includes individuals whose dominant symptoms include postural instability, gait disturbances.
Another group includes individuals with tremor as the main feature tremor predominant. patients who are tremor predominant typically demonstrate few problems with bradykinesia/ postural instability.
Secondary Perkinsonism:
Post encephalitis parkinsonism.
Toxic parkinsonism.
Drug induced parkinsonism (DIP)
Parkinson’s plus syndrome.
Stages of Perkinsonism Disease:
PD is a widely dispersed neurodegerative disease that demonstrates a progression through different stages. Early on
Stage 1: Lesions are found in the medulla ablongata ( Dorsal lx/x nucleus or intermediate reticulated zone).
Stage 2 : pathology is expanded to involve lesions of the caudal rather nuclei, Giganto cellular reticulated nucleus ,coerulerus_ subcoeruleus complex.
Stage 3: Involvement of the substantia nigra.
Stage 4: Lesions are also found in the cortex ( temporal mesocortex, allocortex).
Stage 5: pathology is extended to involve the sensory association areas of the neo_cortex and pre_frontal neocortex.
Stage 6: pathology is extended to involve the sensory association areas of the neo cortex and premoter areas.
Primary Motor Symptoms:
● One of the clinical hallmarks of PD and is defined as increased resistance to passive motion. Patients frequency complain of heaviness and stiffness of their limbs.
● Rigidity is fairly constant regardless of the tasks , amplitude, (or) speed of movement.
● Rigidity is 2 types: cogwheel rigidity , lead pipe rigidity.
Cogwheel rigidity :
● Is a jerky,_ ratchet like resistance to passive movement as muscle alternately tense and relax .
Lead pipe rigidity:
Sustained resistance to passive movement with no fluctuations .
● Reffers to slowness of movement and is one the cardinal features of PD.
● weakness , tremors , and rigidity.
● Akinesia refers to a poverty of spontaneous movement.
● Patient with significant social consequences.
● The absence of associated movements (e.g. arm swing during walking) (or) Freezing ( e.g.sudden stops in movement as in Freezing of gait (FOG).
● Hypokinesia slowed and reduced movements.
● Micrographia moderate (or) severe PD typically present with hand writing that may start out strong but becomes smaller and smaller as writing proceeds.
● Tremor , a third cardinal feature of PD , involves involuntary shaking (or) oscillating movements of a part (or) parts of the body resulting from contractions of opposing muscles.
● The tremor is known as a resting tremor because it is present at rest, suppressed briefly by voluntary movements, and disappears with sleep.
● Postural tremor can be seen when muscles are used to maintain a upright posture against gravity.
● Postural instability ( abnormalities of posture and balance , resulting in postural instability).
Secondary Motor Symptoms:
1) Muscle performance
2) Motor function
3) Gait ( abnormal stooped posture contributes to development of festinating gait patterns)
SENSORY SYMPTOMS:
● Patients also typically experienced excessive drooling (sialorrhea) as a result of increased saliva production , and decreased spontaneous swallowing.
● Hypokinetic dysarthria__ Decreased voice volume , monotone / mono pitch speech.
● Vocal quality is degraded with speech described as hoarse , breathy, and harsh.
● Impairments in cognitive function can be mild. mildly impaired memory (or) severe.
● PD dementia occurs in approximately 20%__40% of the patients.
● Bradyphrenia, slowed thinking.
● Depression: is common in patients with parkinson's disease.
● Patients demonstrate a variety of symptoms, including feelings of guilt, hopelessness ,worthlessness, loss of energy, poor concentration, deficits in short tem memory, loss of ambition / enthusiasm, disturbances in appetite and sleep.
● Hypomimia: reduction in facial expressions.
● Anxiety: is a common symptom in PD symptoms of a panic attack, (e.g. palpitations, sweating, trembling, shortness of breath, as well as social fhobia( social withdrwal)) , agoraphobia.
● Thermo regulatory dysfunction includes excessive sweating and abnormal / uncomfortable sensations of warmth and coldness .
● Patients in the "off" state experienced impaired peripheral vaporization with difficulty dissipating body heat.
● Seborrhea ( increased oil secretion of the sebaceous glands of the skin).
● Seborrhea dermatitis ( oily, chafing, and reddened skin).
● Individuals with parkinson's disease can experience excessive Day time somnolence ( sleepiness).
● At night ,INSOMNIA( disturbed sleep pattern) may occur.
● This includes problems in falling a sleep , staying a sleep, and good quality of sleep.
