Parkinson's disease 

is a progressive, neurodegenerative disorder that affects movement, muscle control,

and balance as well as numerous other functions. It is part of a group of conditions known asmotor
systems disorders. Parkinson's disease was named for James Parkinson, a general practitioner in London
during the 19th century who first described the symptoms of the disease. Symptoms describing
Parkinson's disease are mentioned in the writings of medicine in India dating back to 5,000 BCE as well
as in Chinese writings dating back approximately 2500 years. Parkinson's disease is the most common
movement disorder and the second most common neurodegenerative disorder, the most common being
Alzheimer's disease.
The hallmark symptoms of Parkinson's disease (PD) are asymmetric tremors at rest, rigidity,
andbradykinesia (slowness in movement). There is currently no cure for Parkinson's disease; it is always
chronic and progressive, meaning that the symptoms always exist and always worsen over time. The rate
of progression varies from person to person, as does the intensity of the symptoms. Parkinson's disease
itself is not a fatal disease and many people live into their older years. Mortality of Parkinson's disease
patients is usually related to secondary complications, such as pneumonia or falling-related injuries.
There are three types of Parkinson's disease and they are grouped by age of onset:

 Adult-Onset Parkinson's Disease - This is the most common type of Parkinson's disease. The
average age of onset is approximately 60 years old. The incidence of adult onset PD rises noticeably
as people advance in age into their 70's and 80's.
 Young-Onset Parkinson's Disease - The age of onset is between 21-40 years old. Though the
incidence of Young-Onset Parkinson's Disease is very high in Japan (approximately 40% of cases
diagnosed with Parkinson's disease), it is still relatively uncommon in the U.S., with estimates ranging
from 5-10% of cases diagnosed.
 Juvenile Parkinson's Disease - The age of onset is before the age of 21. The incidence of Juvenile
Parkinson's Disease is very rare.
Parkinson's disease can significantly impair quality of life not only for the patients but for their families as
well, and especially for the primary caregivers. It is therefore important for caregivers and family
members to educate themselves and become familiar with the course of Parkinson's disease and the
progression of symptoms so that they can be actively involved in communication with health care
providers and in understanding all decisions regarding treatment of the patient.

According to the American Parkinson's Disease Association, there are approximately 1.5 million people
in the U.S. who suffer from Parkinson's disease - approximately 1-2% of people over the age of 60 and 3-
5% of the population over age 85. The incidence of PD ranges from 8.6-19 per 100,000 people.
Approximately 50,000 new cases are diagnosed in the U.S. annually. That number is expected to rise as
the general population in the U.S. ages. Onset of Parkinson's disease before the age of 40 is rare. All races
and ethnic groups are affected.

Knowledge is Critical when Dealing with a Life-Altering Condition such as Parkinson's Disease
If you or a loved one has been diagnosed with Parkinson's disease, it's critical to learn everything you
possibly can about this condition so that you can make informed decisions about your treatment. That's
 why we created the Medifocus Guidebook on Parkinson's Disease, a comprehensive 157 page patient
Guidebook that contains vital information about Parkinson's disease that you won't find anywhere in a
single source.
The Medifocus Guidebook on Parkinson's Disease starts out with a detailed overview of the condition and
quickly imparts fundamentally important information about Parkinson's disease, including:
 The theories regarding the underlying causes of Parkinson's disease.
 The risk factors that may increase a person's chances for developing Parkinson's disease.
 The early signs and symptoms of Parkinson's disease that are often overlooked by both patients
and doctors because the symptoms are subtle and the progression of the disease is typically slow.
 A detailed overview of the Unified Parkinson's Disease Rating Scale that is used by doctors to
follow the course of disease progression and evaluate the extent of impairment and disability.
 How Parkinson's disease is diagnosed based on factors such as signs/symptoms, patient history,
physical examination, and a thorough neurological evaluation.
 A comprehensive overview of the major non-motor complications that are often associated with
Parkinson's disease, including:
o Cognitive impairment
o Dementia
o Psychosis
o Depression
o Fatigue
o Sleep disturbances
o Constipation
o Sexual dysfunction
o Vision disturbances
Understanding the Standard Treatments...and the Treatment Options
Because currently there is no known cure for Parkinson's disease, understanding the standard
treatments - and the treatment options - is critical for better controlling the symptoms and preserving
the patient's overall functional capacity and quality of life. As you read through the section of the
Guidebook that focuses on the treatments for Parkinson's disease, you will specifically learn about:
 The medications that are commonly used to increase the levels of dopamine in the brain of
patients with Parkinson's disease in an attempt to slow down the progression of the disease.
 Lifestyle modifications that have been shown to be effective for controlling motor symptoms in
the early stages of Parkinson's disease.
 The surgical treatment options that are available for Parkinson's patients with severe motor
symptoms that cannot be controlled with medications. These surgical techniques, which are discussed
in detail in the Guidebook, include:
o Pallidotomy
o Thalamotomy
o Deep brain stimulation
 Novel approaches for the treatment of Parkinson's disease that are currently under investigation
and which include:
 o Neuroprotective therapy
o Fetal cell transplantation
o Gene therapy
 A detailed overview of the American Academy of Neurology practice parameters for the
treatment of Parkinson's disease, including:
o Medical management
o Surgical management
o Management of non-motor symptoms such as depression, psychosis, dementia, and sleep
disorders
 The role of complementary and alternative therapies in the management of Parkinson's
disease.
 The prognosis (outlook) for people with Parkinson's disease and the important factors which can
significantly influence the prognosis.
 The impact of Parkinson's disease on the quality of life of both patients and their caregivers.
 Important questions to ask your doctor about Parkinson's disease.
A "One-of-a-Kind" Reference Guidebook on Parkinson's Disease that Goes Way Beyond the
Fundamentals
Since 1996, when Medifocus was founded, we've learned that many people with Parkinson's Disease are
seeking more specific information that goes beyond the fundamentals, such as the causes, diagnosis,
standard treatments, and treatment options. That's why we developed a "one-of-a-kind" reference
Guidebook that goes way beyond the basics and also includes the following sections:

 A Guide to Recent Medical Literature on Parkinson's Disease - This section of the Guidebook
contains an extensive bibliography of over 100 references to recently published articles about
Parkinson's Disease in authoritative, peer-reviewed medical journals with links to the absracts
(summaries) of the articles. These articles represent the latest advances in the field and focus on
cutting-edge research, new developments, and the lessons learned from recently published clinical
trials involving patients with Parkinson's Disease. This is the same level of that is used by doctors who
treat people with Parkinson's Disease to keep abreast of the latest developments and breakthroughs in
this specialized field of medicine.
 Centers of Research for Parkinson's Disease - We've compiled a unique directory of doctors,
hospitals, medical centers, and research institutions with special interest and, in many cases, clinical
expertise in managing people with Parkinson's Disease. The "Centers of Research" directory is a
valuable resource for quickly identifying and locating leading medical authorities and medical
institutions both within the United States and other countries who are considered to be at the forefront
in clinical research and treatment of Parkinson's Disease. You'd have to spend days - or even weeks -
attempting to compile your own list of doctors and medical centers but, with the "Centers of Research"
directory, the information is already right at your fingertips. All you have to do is act on the
information by selecting and contacting the experts or medical institutions listed in the directory by
state and country.
 Organizations and Support Groups for Parkinson's Disease - The Guidebook also includes a
directory of organizations and support groups whose goal is to help people with Parkinson's Disease
by providing access to information, resources, and services. Many of these organizations can answer
your specific questions, enable you to "network" with other patients, and provide guidance in areas
such as financial, social, or medical-legal issues. This valuable directory of organizations and support
groups includes complete contact information, including phone numbers and E-mail addresses.
The Guidebook is a Value-Added Proposition that Comes with a Risk-Free Satisfaction Guarantee
so that...You have Nothing to Lose and Everything to Gain
Still not sure if you'll benefit from the Medifocus Guidebook on Parkinson's Disease? Still not convinced
that the information included in the Guidebook is worth the minimal cost? If that's the case, then please
consider the following value-added proposition that comes standard with your purchase of the
Guidebook:
 Free Updates for One Year - With your initial purchase of the Guidebook, you also receive
access to free updates for one-full year. The Guidebook is updated with new information every 4 to 6
months, so that you will be able to access the updated information several times during the course of a
year for up to one full year after the date of your initial purchase.
 Free Digest E-Mail Alerts - When you purchase the Guidebook, you will also automatically
receive a free subscription to our monthly newsletter - the Medifocus Digest Alert for Parkinson's
Disease. This is an expertly selected listing of the latest articles published in the medical literature
about Parkinson's Disease with convenient links to the abstracts of the articles that focus on cutting-
edge research, clinical trials, and the latest treatment advances. The Medifocus Digest Alert for
Parkinson's Disease is automatically delivered straight to your "inbox" monthly and is a valuable
resource for keeping up with the latest developments in Parkinson's Disease almost as soon as the new
information is published in the medical literature.
 10% Discount - For a limited time, you can purchase the Medifocus Guidebook on Parkinson's
Disease at a special 10% discount off the regular list price. Your 10% discount will automatically be
applied when you go to "Checkout".
 Risk-Free Satisfaction Guarantee - Your purchase comes with our RISK-FREE satisfaction
guarantee. If, for whatever reason, you are not totally satisfied with the content of your Guidebook,
simply contact us within 30-days of your purchase for a prompt, full refund. We are so confident that
you will be satisfied with your Guidebook that we offer this RISK-FREE satisfaction guarantee
unconditionally - no questions and no hassles.
Parkinson disease (PD) is a common disorder that affects the brain's ability to control
movement. More than 1 million people in North America have been diagnosed with PD, most of
whom are greater than 60 years old. Parkinson disease progressively worsens over time,
although the rate of worsening varies greatly from one person to another; the majority of people
with PD who are treated are able to live many years without serious disability. A number of
treatments are available that can help to manage symptoms and improve a person's quality of
life.
This topic review discusses the causes, symptoms, and diagnosis of Parkinson disease.
Separate topic reviews are available that discuss treatment. (See "Patient information:
Parkinson disease treatment options — medications" and "Patient information:
Parkinson disease treatment options — education, support, and therapy".)
 PARKINSON DISEASE OVERVIEW

 PARKINSON DISEASE CAUSE

 PARKINSON DISEASE SYMPTOMS

 Motor symptoms

 Tremor

 Bradykinesia

 Rigidity

 Poor balance (postural instability)

 Other motor features

 Nonmotor symptoms

 Cognitive problems and dementia

 Psychosis and hallucinations

 Mood disorders

 Sleep disorders

 Daytime sleepiness

 Autonomic dysfunction

 Loss of sense of smell

 Pain

 PARKINSON DISEASE DIAGNOSIS

 Medical history and physical examination

 Response to medication

 Imaging tests

 PARKINSON DISEASE PROGNOSIS

 PARKINSON DISEASE TREATMENT

 WHERE TO GET MORE INFORMATION

 GRAPHICS


 Motor features PD

 Nonmotor symptoms PD

 Disorders that can mimic PD

Read
more: http://www.righthealth.com/topic/Parkinsons_Disease_Symptoms/overview/uptodate?
fdid=uptodate_a5c5d8ab37590c63f1ec7b36a011a796#ixzz117QzH8fQ

Convenient water exercise and therapy at home are perfect for battling the
symptoms of Parkinson's disease.  With regular water exercise in an Endless Pool
you'll build muscle strength, endurance and enhance flexibility.  Empower yourself
and fight the digenerative symptoms of Parkisons and improve your personal
outlook and mood.  With daily water exercise you'll experience:

 increased range of motion

 improved muscle tone while reducing stiffness and pain
 enhanced posture and motor control
 reduced fear of falling, leading to more confidence
 improved bowel function
 improved sense of well-being

While exercise will not reverse the symptoms of Parkinsons, it can enhance your
quality of life helping you maintain independence longer.  If medication and surgical
intervention have been your only treatment options, supplementing with regular
aquatic exercise can help.  With 6 types of swimming pools to choose from you are
sure to find one that suits your taste and budget.

Parkinsonism is a clinical condition that is characterized by the following: gradual slowing of

voluntary movement (bradykinesia); muscular rigidity; stooped posture; distinctive gait
with short, accelerating steps; diminished facial expression; and resting tremor. Parkinson’s
disease occurs with progressive parkinsonism in the absence of a toxic or known etiology
and is a progressively degenerative disease of the substantia nigra and basal ganglia.
Parkinson’s disease is also called paralysis agitans. Degeneration of the substantia nigra in
the basal ganglia of the midbrain leads to depletion of the neurotransmitter dopamine,
which is normally produced and stored in this location. Dopamine promotes smooth,
purposeful movements and modulation of motor function. Depletion of dopamine leads to
impairment of the extrapyramidal tracts and consequent loss of movement coordination.
Complications include injuries from falls, skin breakdown from immobility, and urinary tract
infections. Death is usually caused by aspiration pneumonia or other infection.

The majority of all cases of classic Parkinson’s disease are primary, or idiopathic,
Parkinson’s disease (IPD). The cause is unknown; a few cases suggest a hereditary pattern.
Secondary, or iatrogenic, Parkinson’s disease is drug- or chemical-related. Dopamine-
depleting drugs such as reserpine, phenothiazine, metoclopramide, tetrabenazine, and the
butyrophenones (droperidol and haloperidol) can lead to secondary Parkinson’s disease.

Nursing care plan assessment and physical examination

Obtain a family, medication, and occupational history. Parkinson’s disease progresses
through the following stages: (1) mild unilateral dysfunction; (2) mild bilateral dysfunction,
as evidenced by expressionless face and gait changes; (3) increasing dysfunction, with
difficulties in walking, initiating movements, and maintaining equilibrium; (4) severe
disability, including difficulties in walking and maintaining balance and steady propulsion,
rigidity, and slowed movement; and (5) invalidism, which requires total care. Note the
timing of progression of all symptoms.

The three cardinal signs of Parkinson’s disease are involuntary tremors, akinesia, and
progressive muscle rigidity. The first symptom of Parkinson’s disease is a coarse, rest
tremor of the fingers and thumb (pill-rolling movement) of one hand. It occurs during rest
and intensifies with stress, fatigue, cold, or excitation. This tremor disappears during sleep
or purposeful movement. The tremor can occur in the tongue, lip, jaw, chin, and closed
eyelids. Eventually, the tremor can spread to the foot on the same side and then to the
limbs on the other side of the body.

The diagnosis of Parkinson’s disease is made on the basis of two out of the four important
symptoms: resting tremor, bradykinesia (slowing down or loss of voluntary muscle
movement), cogwheel rigidity (rigidity of a muscle that gives way in a series of little jerks
when passive stretching occurs), and postural instability; one of the two symptoms must be
resting tremor or bradykinesia.

Assess the patient for signs of bradykinesia. Perform a passive range-of-motion

examination, assessing for rigidity. Rigidity of the antagonistic muscles, which causes
resistance to both extension and flexion, is a cardinal sign of Parkinson’s disease. Flexion
contractures develop in the neck, trunk, elbows, knees, and hips. Note alterations in the
respiratory status because rigidity of the intercostal muscles may decrease breath sounds or
cause labored respirations. Observe the patient’s posture, noting if he or she is stooped,
and assess gait dysfunction. Note involuntary movements, slowed movements, decreased
movements, loss of muscle movement, repetitive muscle spasms, an inability to sit down,
and difficulty in swallowing.

Observe the patient’s face, noting an expressionless, masklike appearance, drooling, and
decreased tearing ability; note eyeballs fixed in an upward direction or eyelids completely
closed, which are rare complications of Parkinson’s disease. Assess for defective speech, a
highpitched monotone voice, and parroting the speech of others. Autonomic disorders that
are manifested in Parkinson’s disease include hypothalamic dysfunction, so assess for
decreased or Parkinson’s perspiration, heat intolerance, seborrhea, and excess oil
production. Observe the patient for orthostatic hypotension, which manifests in fainting or
dizziness. Note constipation or bladder dysfunction (urgency, frequency, retention).

Parkinson’s disease does not usually affect intellectual ability, but 20% of patients with
Parkinson’s disease develop dementia similar to that of Alzheimer’s disease. The Parkinson’s
disease patient commonly develops depression later in the disease process, and this is
characterized by withdrawal, sadness, loss of appetite, and sleep disturbance. Patients may
also demonstrate problems with social isolation, ineffective coping, potential for injury, and
sleep pattern disturbance.

Nursing care plan primary nursing diagnosis: Self-care deficit related to rigidity and
tremors.

Nursing care plan intervention and physical examination

To control tremor and rigidity, pharmacologic management is the treatment of choice.
Longterm levodopa therapy can result in drug tolerance or drug toxicity. Symptoms of drug
toxicity are confusion, hallucinations, and decreased drug effectiveness. Treatment for drug
tolerance and toxicity is either a change in drug dosage or a drug holiday. Autologous
transplantation of small portions of the adrenal gland into the brain’s caudate nucleus of
Parkinson’s disease patients is offered on an experimental basis in some medical centers as
a palliative treatment. In addition, if medications are ineffective, a thalamotomy or
stereotaxic neurosurgery may be done to treat intractable tremor.

Physical and occupational therapy consultation is helpful to plan a program to reduce flexion
contractures and to maximize functions for the activities of daily living. To prevent impaired
physical mobility, perform passive and active range-of-motion exercises and muscle-
stretching exercises. In addition, include exercises for muscles of the face and tongue to
facilitate speech and swallowing. Use of a cane or walker promotes ambulation and prevents
falls.

Promote independence in the patient. Encourage maximum participation in self-care

activities. Allow sufficient time to perform activities, and schedule outings in late morning or
in the afternoon to avoid rushing the patient. Reinforce occupational and physical therapy
recommendations. Use adaptive devices as needed. If painful muscle cramps threaten to
limit the patient’s mobility, consider warm baths or muscle massage.

To facilitate communication, encourage the Parkinson’s disease patient to speak slowly and
to pause for a breath at appropriate intervals in each sentence. Teach deep-breathing
exercises to promote chest expansion and adequate air exchange. Be alert to nonverbal
clues, and supplement interactions with a communication board, mechanical voice
synthesizer, computer, or electric typewriter.

To maintain nutritional status, monitor the patient’s ability to chew and swallow. Monitor
weight, intake, and output. Position the patient in the upright position for eating to facilitate
swallowing. Offer small, frequent meals; soft foods; and thick, cold fluids. Supplemental
puddings or nutritional shakes may be given throughout the day to maintain weight.

Help the patient maintain a positive self-image by emphasizing her or his abilities and by
reinforcing success. Encourage the patient to verbalize feelings and to write in a journal.
Help the patient maintain a clean, attractive appearance. Caregivers may need a great deal
of emotional support. Explore strategies for long-term care with the patient and significant
others.

Nursing care plan discharge and home health care guidelines

Be sure the patient or caregiver understands all medications, including the dosage, route,
action, and adverse reactions. Avoid the use of alcohol, reserpine, pyridoxine, and
phenothiazine while taking levodopa. In general, recommend massage and relaxation
techniques, and reinforce exercises recommended by the physical therapist. Several
techniques facilitate mobility and enhance safety in Parkinson’s disease patients. Instruct
the patient to try the following strategies: (1) To assist in maintaining balance, concentrate
on taking larger steps with feet apart, keeping back straight and swinging the arms; (2) to
overcome akinesia, tape the “frozen” leg to initiate movement; (3) to reduce tremors, hold
objects (coins, keys, or purse) in the hand; (4) to obtain partial control of tremors when
seated, grasp chair arms; (5) to reduce rigidity before exercise, take a warm bath; (6) to
initiate movement, rock back and forth; (7) to prevent spine flexion, periodically lie prone
and avoid using a neck pillow; and (8) teach the patient to eliminate loose carpeting, install
grab bars, and elevate the toilet seat. Use of chair lifts can also be beneficial.