WRITTEN REPORT

PARKINSON’S DISEASE

SUBMITTED BY: AVIGAEL TAGLE

SUBMITTED TO: MR. JULUIS JURADO AMORANTO, RN.
Parkinson’s disease

• is a brain disorder that causes unintended or uncontrollable movements, such as

shaking, stiffness, and difficulty with balance and coordination.
• is a progressive disorder that affects the nervous system and the parts of the body
controlled by the nerves.
• Named after James Parkinson who published 'An Essay on the Shaking Palsy' in 1817,
which established Parkinson’s as a recognized medical condition.
• He studied at the London Hospital Medical College, qualifying as a surgeon in 1784
when he was 29.

• Parkinson’s disease is a chronic, progressive neurological disease that currently affects

about 1 million Americans. Parkinson’s disease involves a small, dark-tinged portion of
the brain called the substantia nigra. This is where you produce most of the dopamine
your brain uses. Dopamine is the chemical messenger that transmits messages between
nerves that control muscle movements as well as those involved in the brain’s pleasure
and reward centers. As we age, it’s normal for cells in the substantia nigra to die. This
process happens in most people at a very slow rate. But for some people, the loss
happens rapidly, which is the start of Parkinson’s disease. When 50 to 60 percent of the
cells are gone, you begin to see the symptoms of Parkinson’s.
 Types of Parkinson’s disease
• Idiopathic Parkinson's Disease
Idiopathic Parkinson's disease is the most common type of PD. It affects older
individuals, with an average age of onset around 60.
• Early-Onset Parkinson’s
also known as youth-onset PD, is a rare type of PD that affects individuals between the
age of 21 and 40 or 50 years.
• Familial Parkinson’s
When Parkinson’s disease runs in a family, it is referred to as familial Parkinson’s disease
and occurs when certain genetic mutations are inherited.

Stages of Parkinson’s disease

• In 1967, Hoehn & Yahr defined five stages of PD based on the level of clinical disability.
Clinicians use it to describe how motor symptoms progress in PD. On this scale, stages 1
and 2 represent early-stage, 2 and 3 mid-stage, and 4 and 5 advanced-stage PD.
• The Hoehn and Yahr scale is a commonly used system for describing how the symptoms
of Parkinson's disease progress. It was originally published in 1967 in the
journal Neurology by Margaret Hoehn and Melvin Yahr and included stages 1 to 5
• STAGE 1 - During this initial stage, the person has mild symptoms that generally do not
interfere with daily activities. Tremor and other movement symptoms occur on one side of the
body only. Changes in posture, walking and facial expressions occur.

• Stage 2 - Symptoms start getting worse. Tremor, rigidity and other movement symptoms affect
both sides of the body or the midline (such as the neck and the trunk). Walking problems and
poor posture may be apparent. The person is able to live alone, but daily tasks are more difficult
and lengthier.

• Stage 3 - Considered mid-stage, loss of balance (such as unsteadiness as the person turns or
when he/she is pushed from standing) is the hallmark. Falls are more common. Motor
symptoms continue to worsen. Functionally the person is somewhat restricted in his/her daily
activities now, but is still physically capable of leading an independent life. Disability is mild to
moderate at this stage.

• Stage 4 - At this point, symptoms are fully developed and severely disabling. The person is still
able to walk and stand without assistance, but may need to ambulate with a cane/walker for
safety. The person needs significant help with activities of daily living and is unable to live alone.

• Stage 5 - This is the most advanced and debilitating stage. Stiffness in the legs may make it
impossible to stand or walk. The person is bedridden or confined to a wheelchair unless aided.
Around-the-clock care is required for all activities.
 PREVALENCE RATE

• The prevalence of PD has doubled in the past 25 years. Global estimates in 2019 showed
over 8.5 million individuals with PD. Current estimates suggest that, in 2019, PD resulted
in 5.8 million disability adjusted life years (DALYs), an increase of 81% since 2000, and
caused 329 000 deaths, an increase of over 100% since 2000.
 Signs and symptoms
Parkinson's disease symptoms can be different for everyone. Early symptoms may be mild and
go unnoticed. Symptoms often begin on one side of the body and usually remain worse on that
side, even after symptoms begin to affect the limbs on both sides.
Tremor
Rhythmic shaking, called tremor, usually begins in a limb, often your hand or fingers. You may
rub your thumb and forefinger back and forth. This is known as a pill-rolling tremor. Your hand
may tremble when it's at rest. The shaking may decrease when you are performing tasks.

Slowed movement, known as bradykinesia

Over time, Parkinson's disease may slow your movement, making simple tasks difficult and
time-consuming. Your steps may become shorter when you walk. It may be difficult to get out
of a chair. You may drag or shuffle your feet as you try to walk.
Rigid muscles
Muscle stiffness may occur in any part of your body. The stiff muscles can be painful and limit
your range of motion.
Impaired posture and balance
Your posture may become stooped. Or you may fall or have balance problems as a result of
Parkinson's disease.
Loss of automatic movements
You may have a decreased ability to perform unconscious movements, including blinking,
smiling or swinging your arms when you walk.
Speech changes
You may speak softly or quickly, slur, or hesitate before talking. Your speech may be more of a
monotone rather than have the usual speech patterns.
Writing changes
It may become hard to write, and your writing may appear small.
ETIOLOGY
It's not known why the loss of nerve cells associated with Parkinson's disease occurs, although
research is ongoing to identify potential causes. Currently, it's believed a combination of
genetic changes and environmental factors may be responsible for the condition.

Risk factors
PREDISPOSING FACTOR
Age - The biggest risk factor for developing Parkinson’s is advancing age. The average age of
onset is 60.
Gender - Men are more likely to develop Parkinson’s disease than women.
Genetics - Individuals with a parent or sibling who is affected have approximately two times the
chance of developing Parkinson’s.
PRECIPITATING FACTOR
Environmental causes - Medical experts believe that environmental causes may help trigger
Parkinson’s disease. Exposure to farming chemicals, like pesticides and herbicides and working
with heavy metals, detergents and solvents have all been implicated and studied for a clearer
link. That said, it’s unlikely that most people who develop Parkinson’s disease do so because of
exposure to environmental hazards.
Head trauma (Repeated blows to the head) like Muhammad Ali — likely increases one’s risk of
developing Parkinson’s. “at this point, we don’t know with 100 percent certainty that it causes
the disease,” says Liana Rosenthal M.D. assistant professor of neurology at the Johns Hopkins
University School of Medicine. “Not everyone who gets head trauma is going to develop
Parkinson’s, and we can’t say for sure that there’s a type, severity or frequency of head trauma
that increases your risk.”

DIAGNOSIS
Parkinson’s disease (PD) is a clinical diagnosis. This means that an individual’s history,
symptoms, and physical exam are used to make the diagnosis. There is not a specific lab or
imaging test that can diagnose PD. However, certain tests such as magnetic resonance imaging
of the brain (MRI brain), a dopamine transporter scan (DaT scan), or blood work can be used to
support the diagnosis of PD or to rule out other medical conditions that can mimic PD.

MEDICAL TREATMENT
• Levodopa
Developed more than 30 years ago, levodopa is often regarded as the gold standard of
Parkinson's therapy. Levodopa works by crossing the blood-brain barrier, the elaborate
meshwork of fine blood vessels and cells that filter blood reaching the brain, where it is
converted into dopamine. Since blood enzymes break down most of the levodopa before it
reaches the brain, levodopa is now combined with an enzyme inhibitor called carbidopa. The
addition of carbidopa prevents levodopa from being metabolized in the gastro intestinal tract,
liver and other tissues, allowing more of it to reach the brain. Therefore, a smaller dose of
levodopa is needed to treat symptoms.

Side effects may include nausea, vomiting, dry mouth and dizziness. Dyskinesias (abnormal
movements) may occur as the dose is increased. In some patients, levodopa may cause
confusion, hallucinations or psychosis.
 • Dopamine Agonists
Bromocriptine, pergolide, pramipexole and ropinirole are medications that mimic the role of
chemical messengers in the brain, causing the neurons to react as they would to dopamine.
They can be prescribed alone or with levodopa and may be used in the early stages of the
disease or administered to lengthen the duration of effectiveness of levodopa. These
medications generally have more side effects than levodopa, so that is taken into consideration
before doctors prescribe dopamine agonists to patients

• Side effects may include drowsiness, nausea, vomiting, dry mouth, dizziness and feeling
faint upon standing. While these symptoms are common when starting a dopamine
agonist, they usually resolve over several days. In some patients, dopamine agonists
may cause confusion, hallucinations or psychosis.
• COMT Inhibitors
• Entacapone and tolcapone are medications that are used to treat fluctuations in response to
levodopa. COMT is an enzyme that metabolizes levodopa in the bloodstream. By blocking
COMT, more levodopa can penetrate the brain and, in doing so, increase the effectiveness of
treatment. Tolcapone is indicated only for patients whose symptoms are not adequately
controlled by other medications, because of potentially serious toxic effects on the liver.
Patients taking tolcapone must have their blood drawn periodically to monitor liver function.

• Side effects may include diarrhea and dyskinesias.

• Selegiline
• This medication slows down the activity of the enzyme monoamine oxidase B, the enzyme that
metabolizes dopamine in the brain, delaying the breakdown of naturally occurring dopamine
and dopamine formed from levodopa. When taken in conjunction with levodopa, selegiline may
enhance and prolong the effectiveness of levodopa.

• Side effects may include difficulty in concentrating, confusion, insomnia, nightmares,

agitation and hallucinations. Amantadine may cause leg swelling as well as mottled skin,
often on the legs.
 • Anticholinergic medications
• Trihexyphenidyl, benztropine mesylate, biperiden HCL and procyclidine work by blocking
acetylcholine, a chemical in the brain whose effects become more pronounced when dopamine
levels drop. These medications are most useful in the treatment of tremor and muscle rigidity,
as well as in reducing medication-induced parkinsonism. They are generally not recommended
for extended use in older patients because of complications and serious side effects.

• Side effects may include dry mouth, blurred vision, sedation, delirium, hallucinations,
constipation and urinary retention. Confusion and hallucinations may also occur.

SURGERY
Neurosurgeons relieve the involuntary movements of conditions like Parkinson's by operating on the
deep brain structures involved in motion control – the thalamus, globus pallidus and subthalamic
nucleus. To target these clusters, neurosurgeons use a technique called stereotactic surgery. This type of
surgery requires the neurosurgeon to fix a metal frame to the skull under local anesthesia. Using
diagnostic imaging, the surgeon precisely locates the desired area in the brain and drills a small hole,
about the size of a nickel. The surgeon may then create small lesions using high frequency radio
waves within these structures or may implant a deep brain stimulating electrode, thereby
helping to relieve the symptoms associated with Parkinson's.
 • Pallidotomy

This procedure may be recommended for patients with aggressive Parkinson's or for those who
do not respond to medication. Pallidotomy is performed by inserting a wire probe into the
globus pallidus – a very small region of the brain, measuring about a quarter inch, involved in
the control of movement. Most experts believe that this region becomes hyperactive in
Parkinson’s patients due to the loss of dopamine. Applying lesions to the global pallidus can
help restore the balance that normal movement requires. This procedure may help eliminate
medication-induced dyskinesias, tremor, muscle rigidity and gradual loss of spontaneous
movement.
 • Thalamotomy
Thalamotomy uses radiofrequency energy currents to destroy a small, but specific portion of the
thalamus. The relatively small number of patients who have disabling tremors in the hand or
arm may benefit from this procedure. Thalamotomy does not help the other symptoms of
Parkinson's and is used more often and with greater benefit in patients with essential tremor,
rather than Parkinson’s.

• Deep Brain Stimulation (DBS)

DBS offers a safer alternative to pallidotomy and thalamotomy. It utilizes small electrodes
which are implanted to provide an electrical impulse to either the subthalamic nucleus of the
thalamus or the globus pallidus, deep parts of the brain involved in motor function.
Implantation of the electrode is guided through magnetic resonance imaging (MRI) and
neurophysiological mapping, to pinpoint the correct location. The electrode is connected to
wires that lead to an impulse generator or IPG (similar to a pacemaker) that is placed under the
collarbone and beneath the skin. Patients have a controller, which allows them to turn the
device on or off. The electrodes are usually placed on one side of the brain. An electrode
implanted in the left side of the brain will control the symptoms on the right side of the body
and vice versa. Some patients may need to have stimulators implanted on both sides of the
brain.
COMPLICATIONS
• Thinking difficulties - You may experience cognitive problems, such as dementia, and thinking
difficulties. These usually occur in the later stages of Parkinson's disease. Such cognitive
problems aren't usually helped by medicines.

• Depression and emotional changes - You may experience depression, sometimes in the very
early stages. Receiving treatment for depression can make it easier to handle the other
challenges of Parkinson's disease.

You also may experience other emotional changes, such as fear, anxiety or loss of motivation. Your
health care team may give you medicine to treat these symptoms.

• Swallowing problems. You may develop difficulties with swallowing as your condition
progresses. Saliva may accumulate in your mouth due to slowed swallowing, leading to drooling.

• Chewing and eating problems. Late-stage Parkinson's disease affects the muscles in the mouth,
making chewing difficult. This can lead to choking and poor nutrition.

• Sleep problems and sleep disorders. People with Parkinson's disease often have sleep problems,
including waking up frequently throughout the night, waking up early or falling asleep during the
day.

People also may experience rapid eye movement sleep behavior disorder, which involves acting out
dreams. Medicines may improve your sleep.

• Bladder problems. Parkinson's disease may cause bladder problems, including being unable to
control urine or having difficulty in urinating.

• Constipation. Many people with Parkinson's disease develop constipation, mainly due to a
slower digestive tract.

• Blood pressure changes. You may feel dizzy or lightheaded when you stand due to a sudden
drop in blood pressure (orthostatic hypotension).

• Smell dysfunction. You may experience problems with your sense of smell. You may have
trouble identifying certain odors or the difference between odors.

• Fatigue. Many people with Parkinson's disease lose energy and experience fatigue, especially
later in the day. The cause isn't always known.

• Pain. Some people with Parkinson's disease experience pain, either in specific areas of their
bodies or throughout their bodies.

• Sexual dysfunction. Some people with Parkinson's disease notice a decrease in sexual desire or
performance.
Prevention

• Because the cause of Parkinson's is unknown, there are no proven ways to prevent the disease.

• Some research has shown that regular aerobic exercise might reduce the risk of Parkinson's
disease.

• Some other research has shown that people who consume caffeine — which is found in coffee,
tea and cola — get Parkinson's disease less often than those who don't drink it. Green tea also is
related to a reduced risk of developing Parkinson's disease. However, it is still not known
whether caffeine protects against getting Parkinson's or is related in some other way. Currently
there is not enough evidence to suggest that drinking caffeinated beverages protects against
Parkinson's.
REFERENCE:

https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/symptoms-
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