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 Parkinson's Disease :


Definition

Parkinson's Disease (PD) is a chronic, progressive neurological disorder primarily affecting movement due to the degeneration of dopamine-producing neurons in the substantia nigra, a region of the brain. It is characterized by motor symptoms such as tremors, rigidity, bradykinesia, and postural instability, along with non-motor symptoms.

Causes

The exact cause of Parkinson's Disease is unknown, but it is believed to result from a combination of genetic, environmental, and lifestyle factors. Key causes include:

  • Genetic Mutations: Mutations in genes such as LRRK2, PARK7, and SNCA.

  • Environmental Triggers: Exposure to pesticides, herbicides, and industrial toxins.

  • Oxidative Stress: Damage to neurons due to free radicals.

  • Aging: Increased vulnerability to neuronal degeneration with age.

Types

  1. Idiopathic Parkinson's Disease: Most common type with no identifiable cause.

  2. Secondary Parkinsonism: Caused by medications (antipsychotics), toxins, or brain injuries.

  3. Atypical Parkinsonism: Associated with other neurodegenerative conditions such as Multiple System Atrophy (MSA) or Progressive Supranuclear Palsy (PSP).

Signs and Symptoms

Motor Symptoms:

  1. Tremors: Resting tremors, often beginning in one limb.

  2. Rigidity: Muscle stiffness, leading to resistance during movement.

  3. Bradykinesia: Slowness of movement, difficulty initiating actions.

  4. Postural Instability: Impaired balance, leading to falls.

Non-Motor Symptoms:

  1. Cognitive decline and memory problems.

  2. Depression, anxiety, and apathy.

  3. Sleep disturbances (REM behavior disorder).

  4. Autonomic dysfunction: Constipation, urinary retention, and hypotension.

Pathophysiology

  1. Dopaminergic Neuron Loss: Degeneration of neurons in the substantia nigra reduces dopamine levels in the basal ganglia.

  2. Lewy Bodies: Abnormal protein aggregates (alpha-synuclein) in neurons impair cellular function.

  3. Disrupted Neural Communication: Dopamine deficiency disrupts motor control and coordination.

  4. Progression: As the disease advances, other neurotransmitters (like serotonin and norepinephrine) are also affected, worsening symptoms.

Investigations

  1. Clinical Diagnosis: Based on symptoms and history.

  2. Imaging Studies:

    • MRI: Rules out structural brain abnormalities.

    • DaTSCAN: Assesses dopamine transporter activity.

  3. Laboratory Tests: Rule out other conditions (e.g., thyroid dysfunction).

  4. Neuropsychological Testing: Evaluates cognitive and emotional health.

Medications

  1. Dopaminergic Agents:

    • Levodopa-Carbidopa: Converts to dopamine in the brain.

    • Dopamine Agonists: Pramipexole, Ropinirole.

  2. MAO-B Inhibitors: Selegiline, Rasagiline (inhibit dopamine breakdown).

  3. COMT Inhibitors: Entacapone (extend the effect of Levodopa).

  4. Anticholinergics: Trihexyphenidyl (reduce tremors).

  5. Amantadine: Improves dyskinesia and motor symptoms.

Nursing Management

Assessment:

  • Monitor motor and non-motor symptoms.

  • Assess risk of falls and injury.

  • Observe for side effects of medications.

Interventions:

  1. Mobility:

    • Encourage regular physical therapy and exercises.

    • Use assistive devices for walking and transfers.

  2. Nutrition:

    • Provide a high-fiber diet to manage constipation.

    • Small, frequent meals to prevent fatigue.

  3. Medication Management:

    • Administer medications on time to maintain therapeutic levels.

    • Educate about side effects and adherence.

  4. Psychological Support:

    • Provide counseling to manage depression and anxiety.

    • Encourage participation in support groups.

  5. Prevent Complications:

    • Turn the patient frequently to prevent pressure ulcers.

    • Monitor for aspiration during meals.

Rehabilitation

  1. Physical Therapy: Enhances motor function and reduces stiffness.

  2. Occupational Therapy: Aids in daily living activities and use of adaptive devices.

  3. Speech Therapy: Improves speech clarity and addresses swallowing difficulties.

  4. Social Support: Connect patients with community resources and support groups.

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