Parkinson’s Disease

• Definition: A progressive degenerative disease of the central nervous system caused by dopamine depletion, leading to bradykinesia (slowing in the initiation and execution of movement).

Etiology and Pathology

• Pathology: Characterized by degeneration of dopamine-producing neurons in the substantia nigra, disrupting the balance of dopamine and acetylcholine in the basal ganglia.

• Dopamine and Acetylcholine Imbalance: Decreased dopamine leads to an imbalance with acetylcholine, complicating smooth and controlled movements.

• Dopamine's Role: Essential for the extrapyramidal motor system; deficiency causes motor symptoms like tremors and rigidity.

Risk Factors

• Genetic Factors: Genetic predisposition is one of the key risk factors.

• Environmental Exposures: Exposure to pesticides, herbicides, industrial chemicals, and drinking well water.

• Biological Factors: Age over 40, reduced estrogen levels in women, and history of encephalitis.

Onset and Symptoms

• Onset: Typically after age 50.

• Gradual Onset Symptoms: Include tremors, stooped posture, shuffling gait, and muscle rigidity.

• Common Symptoms:

  • Tremors at rest, notably a “pill-rolling” tremor of the hands.

  • Rigidity and bradykinesia (slowness of movement).

  • Cognitive impairment, mask-like facial expression, and softened voice.

• Early Symptoms: Mild tremor, changes in handwriting, slight limp, decreased arm swing, shuffling gait, and speech changes.

• Rigidity: Increased resistance to passive motion in the limbs, with cogwheel rigidity causing jerky movements due to sustained muscle contractions.

• Tremor Characteristics: Often the first sign, minimal initially, becomes more noticeable, especially under stress. It affects handwriting and usually disappears with movement.

Diagnosis

• Criteria: Diagnosis requires at least two out of three classic triad signs: tremor, rigidity, and bradykinesia.

• Diagnostic Process: Based on history and neurologic examination, along with clinical features. A positive response to low-dose antiparkinsonian medication (e.g., carbidopa-levodopa) further confirms diagnosis.

• Stages of Parkinson’s Disease: Five stages from mild symptoms (tremors and stiffness) to severe disability (dependence and difficulty swallowing).

Nursing Care Considerations

• Patient Care: Provide extra time for tasks, assist with daily activities, be aware of aspiration risks in advanced stages.

• Impact on Movement and Behavior: Patients may have difficulty initiating movement, reduced arm swing while walking, and decreased blinking.

• Emotional Impact: Emotional instability, heightened anxiety, and depression are prevalent among patients.

Medications and Treatment Options

• Therapies:

  • Long-term medication therapy: Can lead to tolerance or toxicity, manageable through dose reductions or alternatives.

  • Off Times:

    • Definition: Periods when Parkinson’s symptoms return or lack improvement.

    • Causes: Decreasing dopamine levels between medication doses, ineffective dosages, or delayed relief.

• Off Time Symptoms: Difficulty with balance, exhaustion, and problems with ambulation or speech.

• Medications:

  • Anticholinergics, dopamine agonists (e.g., Levodopa/Carbidopa), and Namenda for treatment.

  • Dopamine Agonists: Stimulate dopamine receptors to inhibit breakdown and delay progression.

  • Carbidopa: Limits levodopa conversion in the intestines, preventing orthostatic hypotension.

  • Amantadine Hydrochloride: Treats medication-induced tremors/extrapyramidal symptoms.

• Surgical Options: Deep Brain Stimulation (DBS), a reversible procedure that helps control symptoms; typically for patients with severe medication side effects or motor complications.

Deep Brain Stimulation (DBS)

• Procedure: Involves electrode placement in the thalamus connected to a chest generator; improves dyskinesia, rigidity, gait, and tremors.

• Patient Monitoring: Discontinuation of medications before surgery helps assess true symptoms.

Nursing Interventions

• Encouragement of Activities: Range of motion exercises, assistance with ADLs, and walking techniques to maintain mobility.

• Therapy Needs: Physical and occupational therapy, alongside exercise, is crucial for strength maintenance.

• Nutritional Considerations: Balanced diet with proteins, fruits, and vegetables to avoid malnutrition and constipation; smaller, more frequent meals are recommended.

• Management of Digestive Issues: Recommendations include high-fiber diets and sufficient fluid intake to address constipation.

Patient Education

• Teaching Tips: Emphasize important care knowledge like medication adherence, methods to manage symptoms, posture techniques, and feeding methods.

• Potential Nursing Diagnoses: Include impaired physical mobility, verbal communication difficulties, altered nutritional status, and disturbed sleep patterns.

Alzheimer’s Disease

• Overview: Progressive degenerative brain disorder leading to dementia, affecting approximately 5.2 million Americans.

• Symptoms: Include memory loss, judgment issues, personality changes, and cognitive decline; detected through imaging and diagnostic tests.

Multiple Sclerosis

• Definition: An autoimmune disorder marked by destruction of myelin sheaths, affecting neurological function.

• Symptoms: Range from vision issues to balance problems, muscle spasticity, and cognitive changes, requiring immunosuppressants and therapy.

Myasthenia Gravis

• Definition: Autoimmune disease causing weakness in skeletal muscles due to impaired nerve impulses.

• Symptoms: Muscle weakness, particularly in the eyes and face.

• Management: Plasmapheresis or medications to improve muscle function and manage crises.

Amyotrophic Lateral Sclerosis (ALS)

• Definition: Terminal neurological disease due to motor neuron degeneration, leading to muscle weakness and wasting.

• Management: Patient care focuses on physical, speech, and nutritional therapies; prognosis is generally poor, with most patients living 3-5 years post-diagnosis.

Huntington’s Disease

• Overview: Genetic disorder resulting in chorea and cognitive decline, requiring comprehensive management strategies including medications and therapy.

Trigeminal Neuralgia

• Management: Focus on pain relief through medications, education about nerve function, and lifestyle adaptations.

Hydrocephalus

• Definition: Excess fluid in the cranial cavity requiring intervention to manage symptoms and pressure.

• Post-Surgical Care: Involves monitoring for ICP, infection signs, and managing neurological stability.

Encephalitis and Meningitis

• Distinct Conditions: Both manifest with acute neurologic symptoms but differ in treatment, with bacterial meningitis requiring urgent antibiotic administration.

Conclusion

• Care and management of neurological disorders like Parkinson’s, Alzheimer’s, and others involve multifactorial approaches related to pharmacotherapy, patient education, and supportive therapies while considering the unique needs based on disease progression and symptoms.