nCn MC1C8 MAnllLS1A1lCnS Cl nCn MC1C8 MAnllLS1A1lCnS Cl

A8klnSCn'S ulSLASL A8klnSCn'S ulSLASL

ur S Avudalappan
Mu(sychlaLry C)
1MCP
W 8ecognlzed by !ames arklnson
W 1he lnlLlal sympLoms ln up Lo 20 percenL of
paLlenLs are nonmoLor
W undlagnosed and under reporLed
W resence of non MoLor SympLoms lnLerfere wlLh
dally funcLlonlng and lmpede adherence Lo
LreaLmenL
ln18CuuC1lCn
nLu8CS?CPlA18lC
MAnllLS1A1lCnS
W uemenLla
W uepresslon
W AnxleLy
W sychosls
W 8ehavlour ulsLurbance
W sychlaLrlc manlfesLaLlons of urug 1herapy
W AbouL 23 Lo 40 percenL of paLlenLs develop demenLla
W CognlLlve decllne ls noL obvlous cllnlcally
W LxecuLlve dysfuncLlon
AblllLy Lo process new lnformaLlon
AnLlclpaLe lan lnlLlaLe malnLaln and change behavlors
W C1PL8 uCMAlnS
Memory
vlsuospaLlal skllls
lnformaLlon processlng speed
ALLenLlon
LxpllclL recall
SpaLlal plannlng
erseveraLlon
verbal fluency
overLy of LhoughL
uLMLn1lA
W 4030 of u paLlenLs suffer from uepresslon Cf Lhls 30 have
severe depresslon
W varlous serles have reporLed an lncreased prevalence of Mlld Lo
ModeraLe uepresslon uysLhymla ln Lhese paLlenLs
W Loss of lnlLlaLlve and asserLlveness as well as anhedonla and anxleLy
are common complalnLs
W LmoLlonallsm refers Lo helghLened and excesslve senLlmenLallLy ofLen
wlLh paLhologlcal Learfulness (emoLlonal lnconLlnence) LhaL can be
preclplLaLed by a varleLy of emoLlons lL can be a feaLure of a
depresslve dlsorder
W uspeclflc paLhology wlLh mulLlple LransmlLLer deflclencles ln
mesocorLlcal dopamlnerglc and seroLonerglc sysLems play a ma[or role
uL8LSSlCn
W aLhologlcal anxleLy ls sLlll more common ln
arklnsons dlsease
W May co occur wlLh uepresslon anlc sLaLes have
been reporLed
W Cenerallzed anxleLy dlsorder soclal phobla and
panlc dlsorder have been descrlbed ln u
paLlenLs
W May be assoclaLed wlLh Lhe flucLuaLlons ln Lhe
level of Levouopa
AnxlL1?
W sychosls affecLs abouL 23 percenL of paLlenLs
W 8enlgn" vlsual halluclnaLlons are Lhe mosL common
psychoLlc sympLom
vlsual llluslons vlsual halluclnaLlons wlLh reLalned
lnslghL
llorld paranold halluclnaLory psychosls
ueluslons
W Ma[or reason for PosplLallsaLlon and nurslng home care ln
WesLern sLudles
W 8arely Chronlc Schlzophrenla llke psychosls have been
reporLed
S?CPCSlS
W ulslnhlblLed lmpulslve behavlors and repeLlLlve compulslve
llke behavlors
aLhologlcal gambllng
aLhologlcal hypersexuallLy
aLhologlcal spendlng
Compulslve overeaLlng
W lmpulse conLrol dlsorders affecL up Lo 14 percenL of
paLlenLs buL Lhe exacL prevalence ls unknown
8LPAvlCu8AL ulS1u88AnCL
W undlng lnvolves repeLlLlve polnLless and sLereoLyplcal behavlors
LhaL are carrled ouL for exLended perlods of Llme Lo Lhe excluslon of
oLher acLlvlLles
ManlpulaLlons and dlssembllng and aLLempLed reassembllng of
mechanlcal equlpmenL
8epeLlLlve handllng examlnaLlon and sorLlng of common ob[ecLs
Lxcesslve [ournallng blogglng or groomlng
Poardlng
8epeaLed fldgeLlng wlLh cloLhlng
Almless drlvlng or walklng
W CfLen calmlng and aLLempLs Lo sLop Lhe behavlors are meL wlLh
lrrlLaLlon even when Lhe paLlenL acknowledges Lhe fuLlllLy of Lhelr
acLlons
W noL assoclaLed wlLh lnLruslve fears or LhoughLs
8LPAvlCu8AL ulS1u88AnCL
W AnLlchollnerglcs
AcuLe organlc sychosls
W Confuslon
W LxclLemenL AglLaLlon
W ueluslons halluclnaLlons Sulcldal ldeaLlons
W 8esolve on wlLhdrawal of drug
uellrlum
Abuse of AnLlchollnerglcs ln hlgh doses for
Palluclnogenlc properLles
sychlaLrlc manlfesLaLlons of urug 1herapy
W Levouopa uopamlne AgonlsLs
sychosls
Manla / Pypomanla
Compulslve use of Levouopa and uopamlne
agonlsLs
sychlaLrlc manlfesLaLlons of urug 1herapy
W Also called PedonlsLlc PomeosLaLlc uysregulaLlon
W 8ecognlzed ln Lhe year 2000
W 8eporLed ln 4 of paLlenLs
W CrlLerla for ulagnosls
Levodopa responslve u
need for lncreased doses of dopamlnerglc drugs
aLLern of paLhologlcal use
lmpalrmenL ln occupaLlonal or soclal funcLlonlng
uevelopmenL of manlc syndrome
uevelopmenL of WlLhdrawal feaLures Lo uopamlnerglc
medlcaLlons
LasLs aLleasL for 6 monLhs
uopamlne uysregulaLlon Syndrome
W AlmosL an unlversal Cccurrence ln u
CrLhosLaLlc PypoLenslon
ConsLlpaLlon
urlnary Sexual uysfuncLlon
W CrLhosLaLlc PypoLenslon(CP)
20 of cases presenL wlLh sympLomaLlc CP
LaLe feaLure of u
u/L erlpheral sympaLheLlc denervaLlon
CorrelaLes Lo
W uopamlnerglc MedlcaLlon uose
W uuraLlon SeverlLy of u
AuLonomlc uysfunsLlon
W ConsLlpaLlon
Cccurs ln 28 61 of cases
LarllesL SympLom of u even before Lhe onseL of moLor sympLoms
uue Lo Lewy body deposlLlon ln MyenLrlc lexus wlLh subsequenL
colonlc sympaLheLlc denervaLlon
W urogenlLal uysfuncLlon
lncludes erecLlle and e[aculaLory fallure urlnary frequency and
urgency lncompleLe bladder empLylng double mlcLurlLlon and
urge lnconLlnence
LaLe feaLure of u
AuLonomlc uysfunsLlon
W ClfacLory uysfuncLlon
uefecLlve odour deLecLlon and dlscrlmlnaLlon
appears Lo affecL some 90 of paLlenLs wlLh u
lormal LesLlng requlred slnce paLlenLs donoL usually reporL lL
Pyposmla does noL appear Lo progress over Lhe course of u buL
ls presenL from Lhe sLarL of Lhe lllness
ldlopaLhlc hyposmla ln asympLomaLlc flrsLdegree relaLlves of u
paLlenLs ls assoclaLed wlLh an lncreased rlsk Lo develop overL u
W aln SensaLlon
4030 of paLlenLs wlLh u
romlnenL ln flucLuaLlng u
aLhophyslology noL undersLood may relaLe Lo CenLral paln
producLlon paLhways
Sensory SympLoms and aln
W Sleep dlsorders are amongsL Lhe mosL frequenL nonmoLor
problems of u
W lncludes
ulfflculLles falllng asleep
lrequenL awakenlngs
nocLurnal cramplng
alnful dysLonla
nocLurnal moLor sympLoms wlLh dlfflculLles Lurnlng ln bed moLor
resLlessness or clearcuL resLless legs syndrome (8LS)
nlghLLlme lnconLlnence
nocLurnal confuslon halluclnosls and dayLlme sleeplness
SLLL ulSC8uL8S
W 1he moLor abnormallLles of parklnsonlsm eg
nocLurnal Lremor nocLurnal aklnesla offperlod
dysLonla and 8LS or perlodlc llmb movemenLs ln
sleep (LMS) are posslble causes
W urelaLed neurodegeneraLlon lmpacLs Lhe sleep
sLrucLure
Sleep fragmenLaLlon reduced sleep efflclency reduced
slowwave sleep reduced 8LM sleep and 88u
W 8esplraLory dlsLurbances and auLonomlc
dlsLurbances are oLher posslble mechanlsms
SLLL ulSC8uL8S
W 8LM 8LPAvlCu8 ulSC8uL8
Cccurs ln 13 40 of paLlenLs
loss of 8LM sleep muscle aLonla wlLh phaslc or Lonlc
acLlvlLy ln Lhe chln and exLremlLy elecLromyography
lL ls assoclaLed wlLh [erklng and someLlmes very vlolenL
llmb and body movemenLs whlch seem Lo be relaLed Lo
dream conLenL
a recenL sLudy has suggesLed 88u as a precllnlcal
marker for u
SLLL ulSC8uL8S
CCnCLuSlCn
W 8ecenLly lL has also become clearer LhaL ln u nonmoLor
dysfuncLlon may acLually anLedaLe overL slgns and
sympLoms of moLor dlsLurbance
W 1he nonmoLor sympLoms of u become lncreaslngly
prevalenL and obvlous over Lhe course of Lhe lllness and
are a ma[or deLermlnanL of quallLy of llfe progresslon of
overall dlsablllLy and nurslng home placemenL