Explainers

Parkinson’s Disease


Parkinson’s disease affects about 70,000 people in Australia. It’s a progressive neurological disease that can be quite insidious during its presentation and is often difficult to diagnose. It is the second most common neurodegenerative disorder, following Alzheimer’s disease.

It is slightly more common in men than woman and people tend to be diagnosed at the mean age of 55 years old, however younger people can also be diagnosed with Young Onset Parkinson’s. Diagnosis tends to be made by a neurologist who takes a detailed history of the patient and then examines them for signs and symptoms of the disease.

The disease process behind Parkinson’s is not well understood and there is no known cause. However, it is known that Parkinson’s disease is characterised by the accumulation of abnormal proteins, called Lewy bodies, within the neurons in our brains (Greenwood et al. 2013; Parkinson’s Australia 2015; Worth 2013).

What are the Symptoms of Parkinson’s Disease?

The symptoms commonly seen in people with Parkinson’s disease are as a result of an imbalance between two neurotransmitters: dopamine (an inhibitory neurotransmitter) and acetylcholine (an excitatory neurotransmitter). The Basal Ganglia in our brain helps co-ordinate movement and is also where dopamine is located. In Parkinson’s there is a decrease in the levels of dopamine. This decrease means that acetylcholine is not inhibited, resulting in muscle rigidity and tremors seen in people with Parkinson’s.

Symptoms such as sleep disturbance, depression, anxiety and hypo/anosmia (loss of sense of smell) are often found to precede the person’s diagnosis of Parkinson’s disease and become worse for the individual as the disease progresses.

People with Parkinson’s disease will generally present with tremors, bradykinesia, impaired postural reflexes and rigidity. This rigidity is what causes the person to have the shuffling gait that is characteristic of Parkinson’s and puts them at an increased risk of falls. They may also have a mask-like facial expression, which is also a result of the increased levels of acetylcholine causing muscle rigidity.

20161125-1body

Non-motor symptoms of Parkinson’s disease include fatigue, anxiety, depression, sleep disturbances, bladder dysfunction, constipation, cognitive impairment and dementia. However, these symptoms tend to be under reported by patients and overlooked by healthcare professionals.

All of these symptoms present can have many effects on the individual. For example, tremors and rigidity of the hands can cause reduced dexterity and the individual may have trouble using a knife and fork to eat. Or the mask-like facial expression of the individual can cause negative reactions in others resulting in not only negative social implications for the individual, but also feelings of isolation (Greenwood et al. 2013; Mauk 2012; Worth 2013).

How is Parkinson’s Treated?

Parkinson’s disease can also be broken down into four stages: diagnosis, maintenance, complex and palliative. In the early stages of Parkinson’s disease, medication treatment can be very effective. However as the disease progresses into the complex and palliative stages, the individual may become more restricted despite an ideal medication therapy regime.

There is no ideal medicinal treatment for Parkinson’s. Therapy will be tailored to the individual, their symptoms, disease progression, lifestyle and physical tolerance. However most medication prescribed to someone with Parkinson’s will fit into one of these categories:

  • Levodopa – dopamine replacement therapy
  • Dopamine agonists – mimic the action of dopamine
  • COMT inhibitors – these are used in conjunction with Levodopa and blocks the COMT enzyme to prevent levodopa breaking down in the intestine so more of it will reach the brain
  • Anticholinergic – block the effect of acetylcholine to rebalance its levels with dopamine
  • Amantadine – has anticholinergic properties and improves dopamine transmission
  • MAO type B inhibitors – prevent the metabolism of dopamine within the brain

As the disease progresses, medication management for the individual will need to change. However one important factor which must be taken into consideration regarding medications is time. These medications need to be taken on time: if they are taken late, they can severely impair the movements of the person with Parkinson’s.

Another important note to consider is that these medications will help to alleviate symptoms, however they will not stop the progression of symptoms or of the disease over time.

Surgery can also be another option to help treat Parkinson’s, however it is not suitable for everyone. These surgeries include:

  • Thalamotomy – helps alleviate some forms of tremor
  • Pallidotomy – helps alleviate dyskinesia
  • Deep brain stimulation – helps control specific symptoms by an electrical impulse creating a lesion that blocks abnormal nerve signals and consequently reduces the symptoms.

(Wade et al. 2003; Worth 2013)

Rehabilitation of the Patient with Parkinson’s Disease

Rehabilitation programs can be very beneficial for people with Parkinson’s. It allows them access to a multidisciplinary team that may include a doctor, physiotherapist, occupational therapist, speech therapist, palliative care services and specialist nursing care.

Physiotherapy can been seen to decrease disability, and regular exercise has many benefits for the individual, including increasing muscle strength and flexibility, reduced muscle cramping, improved posture, improved co-ordination and balance and improved control over gross body movements. A rehabilitation program can ensure the person with Parkinson’s receives holistic care and treatment whilst in a supportive environment (Greenwood et al. 2013).

Nursing Care of the Patient with Parkinson’s Disease

When the person with Parkinson’s is in hospital, it is the nurse who has the most direct care with the patient. This means they are able to observe the patient’s level of function throughout the day and assist with implementing strategies to improve the function of the patient.

Nurses also need to display patience and understanding with patients with Parkinson’s. They may need a long time to complete activities of daily living and also their level of function may change from one day to the next.

 As with any degenerative neurological disorder, the effects are widespread for the person and care needs to be provided not only for the physical effects to the body, but also to the person’s emotional, psychological and social aspects of their health. Therefore, support for these individuals and their carers is essential, and as nurses, we can help provide this support (Greenwood et al. 2013).

Show References

 References

  • Greenwood, RJ, Barnes, MP, McMillan, TM & Ward, C (eds) 2013, Handbook of Neurological Rehabilitation, 2nd edn, Routledge, New York.
  • Mauk, KL 2012, Rehabilitation Nursing: A Contemporary Approach to Practice, Jones & Bartlett Learning, Sudbury.
  • Parkinson’s Australia 2015, What is Parkinson’s?, viewed 23 November 2016, http://www.parkinsons.org.au/what-is-parkinsons
  • Wade, DT, Gage, H, Owen, C, Trend, P, Grossmith, C & Kaye, J 2003, ‘Multidisciplinary rehabilitation for people with Parkinson’s disease: A randomized controlled study’, Journal of Neurological and Neurosurgical Psychiatry, vol. 74, pp. 158-62, viewed 23 November 2016, http://jnnp.bmj.com/content/74/2/158.full
  • Worth, PF 2013, ‘How to treat Parkinson’s disease in 2013’, Clinical Medicine, vol. 13, no. 1, pp. 93-6, viewed 23 November 2016, http://www.clinmed.rcpjournal.org/content/13/1/93

Hide References

Document this CPD

Comments

Explainers
Preventing Unnecessary Use of Antipsychotics in Dementia Care
Explainers
Increased Intracranial Pressure: A Guide For Nurses
Explainers
Understanding the Relationship Between Oxygen Flow Rate and FiO2