PREDISPOSIN PRESEN RATIONALE JUSTIFICATION

G T
age - Although there is the occasional case of the disease bein
\developed as a young adult, it generally manifests itself
in the middle to late years of life. The risk continues to
increase
the older one gets. Some researchers assume that people with
Parkinson's have neural damage from genetic or
environmental factors that get worse as they age.
http://www.parkinsons.org/parkinsons-risk-factors.html

The average age of onset of Parkinson's disease is 55.

About 10% of Parkinson's cases are in people younger than
40 years old. Older adults are at higher risk for both
parkinsonism and Parkinson's disease. There is some
evidence, however, that the risk declines significantly after
75 and that the very elderly are at low risk.
http://adam.about.com/reports/000051_2.htm
Sex- Males are more likely to get Parkinson's than females.
Possible
reasons for this may be that males have greater exposure to
other risk factors such as toxin exposure or head trauma.
It has been theorized that estrogen may have neuro-
protective
effects. Or, in the case of genetic predisposition, a
gene predisposing someone to Parkinson's may be
linked to the X chromosome.

http://parkinsons.about.com/od/parkinsonsdiseasebasics/a/risk
_factors.htm
Family history- As the National Institute of Neurological Disorders and
Stroke
 explains, researchers have singled out several genetic
mutations
that are associated with risk for Parkinson's disease.
According
to the Michael J. Fox Foundation for Parkinson's Research,
scientists have determined that in rare cases Parkinson's is
caused by a single gene mutation that is passed down through
a family, resulting in a large number of cases of Parkinson's
in multiple generations. In most cases, however, scientists
believe that genetic factors interact with environmental
factors to produce Parkinson's. This explains why, as the
National Institute of Neurological Disorders and Stroke
points
out, that while having a close family member with
Parkinson's
does increase your risk for Parkinson's, your chance of
getting
the disease is still only about 2 percent to 5 percent unless
there
is a known gene mutation in your family.

http://www.ehow.com/about_5516482_risk-factors-
parkinsons-disease.html
Declining Post menopausal who do not use hormone replacement
oestrogen levels- therapy are at greater risk, as are those who have had
hysterectomies.

http://www.ehow.com/about_5516482_risk-factors-
parkinsons-disease.html
Genetic factors - A Mayo Clinic led international study revealed that the gene
alpha-synuclein may play a role in the likelihood of
developing the disease. Studies showed that individuals with
a more active gene had a 1.5

times greater risk of developing Parkinson's. These findings

support

the development of alpha-synuclein suppressing therapies,

which may in the long run slow or even halt the disease.

PRECIPITATING PRESEN RATIONALE JUSTIFICATION

 T
Head Trauma- Recent research points to a link between damage to the head,
neck, or upper cervical spine and Parkinson's. A 2007 study
of 60 patients showed that all of them showed evidence of
trauma induced upper cervical damage. Some patients
remembered a specific incident, others did not. In some cases
Parkinson's symptoms took decades to appear.

Parkinson's Disease is a rare and curious phenomenon,

affecting approximately 1 in 300 people. Risk factors
mentioned above influence its likelihood to only the tiniest of
degrees. Most individuals will have one or more of the risk
factors above and never experience any of the symptoms. The
one risk factor we all possess is aging, which is a condition
that is currently incurable! However, more and more is
becoming understood as to how and why these various risk
factors influence likelihood of Parkinson's. As knowledge
grows, so does the possibility of a cure.

http://parkinsons.about.com/od/signsandsymptomsofpd/qt
/drooling.htm
Agricultural Exposure to an environmental toxin such as a pesticide or
work- herbicide puts you at greater risk. Some of these toxins inhibit
dopamine production and promote free radical damage. Those
involved in farming and are therefore exposed to such toxins
have a greater prevalence of Parkinson's symptoms.

http://parkinsons.about.com/od/signsandsymptomsofpd/qt/dro
oling.htm

SYMPTOPATHOLOGY
SYMPTOPATH PRESEN RATIONALE JUSTIFICATION
OLOGY T
Tremor One of the fundamental causes of Parkinson’s disease is a .
loss of dopamine in the areas of the brain that support
movements. These movement-related brain sites are
organized into circuits that specialize in producing various
types of movements. One of these circuits involves a
regulatory brain region known as a thalamus. The thalamus
helps to regulate movements by relaying sensory information
about movements from the senses up to the brain. The brain
uses this "sensory feedback" from the thalamus to control
complex movements. Loss of dopamine in the brain circuit
containing the thalamus disrupts operations of the thalamus.
http://parkinsons.about.com/od/parkinsonsdiseasebasics/a/rest
 ing_tremor.htm
Rigidity Rigidity, or a resistance to movement, affects most
parkinsonian patients. A major principle of body movement is
that all muscles have an opposing muscle. Movement is
possible not just because one muscle becomes more active,
but because the opposing muscle relaxes. In Parkinson's
disease, rigidity comes about when, in response to signals
from the brain, the delicate balance of opposing muscles is
disturbed. The muscles remain constantly tensed and
contracted so that the person aches or feels stiff or weak. The
rigidity becomes obvious when another person tries to move
the patient's arm, which will move only in ratchet-like or
short, jerky movements known as "cogwheel" rigidity.

http://www.pdcaregiver.org/Symptoms.html
bradykinesia Slowness of motion is one of the classic symptoms of
Parkinson's disease. Patients may eventually develop a
stooped posture and a slow, shuffling walk. The gait can be
erratic and unsteady and cause a person to fall. After a
number of years, muscles may freeze up or stall, usually when
a patient is making a turn or passing through narrow spaces,
such as a doorway. Intestinal motility -- e.g., swallowing,
digestion, and elimination -- may also slow down, causing
eating problems and constipation. The muscle rigidity
(akinesia) experienced in Parkinson's disease often begins in
the legs and neck. Muscle rigidity in the face can produce a
mask-like, staring appearance. Hand deformities may develop
in late stages, causing severe discomfort and limitation.
Handwriting, for instance, often becomes diminutive.
Normally spontaneous muscle movements, such as blinking,
may need to be done consciously.
http://www.pdcaregiver.org/Symptoms.html
speech difficulty About half of Parkinson's patients develop some speech
difficulty caused by rigidity of the facial muscles, loss of
motor control, and impaired breath control. Tone can become
monotonous, words may be repeated over and over, or the
rate of speech may even be very fast. Swallowing may be
difficult. This is all due to the dopamine receptors that caries
the activities from the brain,
http://www.pdcaregiver.org/Symptoms.html
Postural People with Parkinson's disease often experience instability
instability when standing or impaired balance and coordination. These
symptoms, combined with other symptoms such as
bradykinesia, increase the chance of falling. People with
balance problems may have difficulty making turns or abrupt
movements. They may go through periods of "freezing,"
which is when a person feels stuck to the ground and finds it
difficult to start walking. The slowness and incompleteness of
movement can also affect speaking and swallowing.
http://www.pdf.org/en/symptoms
Depression and Depression is often present as one of the first symptoms and
Mental is probably partially caused by a chemical imbalance in the
Problems brain. Because depression is common in old age or can be
caused by other factors, the patient often does not connect it
with other early symptoms of Parkinson's. Defects in
thinking, memory, language, and problem solving skills often
occur later on. Dementia occurs in almost 30% of Parkinson's
patients, who are usually older individuals who have had
major depression.
http://www.pdcaregiver.org/Symptoms.html
drooling the average person's salivary glands secrete more than a liter
of saliva each day. Usually swallowing reflexes take care of
it. However, people living with Parkinson's often lose that
reflex . Parkinson's may impair the ability to swallow as well,
 only getting the job partially accomplished. As a result many
people with Parkinson's end up with frustrating episodes of
drooling.
http://parkinsons.hopedigest.com/articles/the_saliva_dilema_i
n_parkinsons_disease

PATHOPHYSIOLOGY

Age,Family history,Sex Head Trauma

Declining oestrogen levels Agricultural work
,Genetic factors
 Destruction of the
substancia negra in the
brain

Decreased dopamine
production

Imbalanced acetylcholine
and dopamine

Increased level of
acetylcholine

drooling Depression and Postural speech bradykinesia Rigidity Tremor

Mental Problems instability difficulty

DIAGNOSTIC
TESTS

PARKINSONS DISEASE