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Parkinson disease

definition
Parkinson's disease:
Chronic disease and progressive
neurological disorder that
characterized by shaking, stiffness,
reduced
speed of movement, and facial
expression blank
like mask dg excessive salivation.

epidemiology
1. incidence increases with increasing
age (figure
life expectancy)
2. onset occurs at about age 60 years old
3. Environmental factors are not so
influential
4. In Parkinson's disease that occurs
under 50 years old,there may be a
genetic factor

etiology
risk factors are unknown, but most patients
etiology can be identified is patients who received
dopamine antagonists
some of the things that can cause symptoms
Parkinson's, among others:
- Medications, such as: phenothiazines, benzamid,
methyldopa, and reserpine,
metoclopramide, SSRI, Amiodarone, Diltiazem,
acid
Valproate
- Heavy metal poisoning (Mn)
- Anoxia (CO poisoning)
- Post-trauma, etc..

pathophysiology
main pathological abnormalities: cell degeneration with
loss of the pigmented dopaminergic neurons in the pars
compacta substantia nigra in the brain and imbalance
extrapyramidal motor circuit (control movement in the
brain).
In normal person: reduced dopamine: 5% per decade
in 45% of Parkinson's patients during the first decade after
diagnosis
Usually new symptoms appear when dopamine in striatal
already reduced by 80%
nerve degeneration in the nigrostriatal dopamine causes
increased activity of striatal cholinergic tremor effect

Dopaminergic neurons

Dopamine in the corpus striatum regulate the activity of


cholinergic
Degeneration of dopamine in striatal
cholinergic
activity increased

Signs and symptoms


The main signs:
tremor at rest, the
severity is relatively stable
stiffness elbow and swivel motion
reduced wrist,
stiff facial expression
weakening movement
akinesia or
bradikinesia short step,
reduced wave
body imbalances often fall
Non-motor signs
incontinence
dementia
depression
dysphagia
sleep disorders
constipation
sweating,

diagnosis
- Need to see any info druginduced history
of drug use.
Parkinsonism
- The possibility of precise diagnosis if
patients show
bradikinesia, tremor, rigidity
- Symptoms usually begin unilaterally motor
- Once diagnosed, it can be evaluated
progress
disease by Hoehn and Yahr scale

Scale of Hoehn and Yahr

Stage 0 No signs of disease


Stage 1 signs of unilateral
Stage 1.5 Signs unilateral and axial
Stage 2 bilateral signs without balance disorders
Stage 2.5 mild bilateral disease
Stage 3 Bilateral disease mild - moderate, tjd
imbalance
body, still physically independent
Stage 4 disease is severe, unable to live alone
Stage 5 cant walk or stand without assistance

therapeutic strategies
Non-pharmacological :
- Exercises
- Education
- Nutrition
- Surgery
Pharmacology:
- Increasing levels of endogenous dopamine
- Enabling the dopamine receptor agonist
- Pressing cholinergic activity with drugs
anticholinergic

The drugs used and mechanism


Increasing levels of endogenous dopamine
- L-Dopa Dopa precursor
- Carbidopa, Benserazid inhibit peripheral metabolism by dopa
decarboxylase
- Entacapon, tolcapon
Dopa inhibits degradation by
Ometiltransferase
- Selegilin
Dopa inhibits degradation by MAO B
- Amantadine increase the synthesis and release of dopamine,
inhibit the re-uptake
Enabling dopamine receptors by agonists
- Bromocriptine, lisurid D2 agonist
- Pramipeksol, ropinirol D2 and D3 agonist
- Pergolid,
agonist apomorphine D1 and D2
Pressing cholinergic activity of drugs with anticholinergic
- Benztropin, triheksifenidil

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