Parkinsons Disease a neurodegenerative disorder of the substantia nigra

1. Parkinson’s
Disease
PRESENTED BY: Okumu Jeremiah Valley

2.  Definition and causes
 Epidemiology and predisposing factors
 Pathophysiology
 Signs and symptoms
 Management
 Applied pharmacology

3. PARKINSON'S DISEASE (PD)
CLINICAL OVERVIEW.
Progressive Neurodegenerative disorder
of the dopaminergic neurones in the
substantia nigra.
Parkinsonism is a clinical syndrome
consisting of four cardinal features:
 Bradykinesia (slowness and poverty of
movement)
 Muscular rigidity
 Resting tremor (which usually abates
during voluntary movement)
 Impairment of postural balance leading to
disturbances of gait and falling .

4.  Most common neurologic disorder affecting
approximately 1% of the population of
individuals above 60years of age
 7.5 million people world wide

5.  The most common cause of parkinsonism is
idiopathic PD, first described by James
Parkinson in 1817 as paralysis agitans, or
the "shaking palsy." The pathological
hallmark of PD is a loss of the pigmented,
dopaminergic neurons of the substantia
nigra pars compacta, with the appearance of
intracellular inclusions known as Lewy
bodies.

6.  Progressive loss of dopamine-containing
neurons is a feature of normal aging;
however, most people do not lose the 70% to
80% of dopaminergic neurons required to
cause symptomatic PD.

7.  Genetic
factors(PARK2/7,PIN
K1)
 Environmental
factors - manganese
and pesticides
 Drugs -
antipsychotics
(clozapine)
 Cerebrovascular
disease (stroke)
 Smoking
 Coffee

8.  The primary deficit in PD is a loss of the
neurons in the substantia nigra pars
compacta that provide dopaminergic
innervation to the striatum (caudate and
putamen).since dopamine facilitates the
inhibiton on a wide range of motor activities,
release of this inhibiton causes in
appropriate activation of these motor
activities
 The presence of lewy bodies

10.  Stage 1 - Mild symptoms such as tremors
 Stage 2 - Symptoms are bilateral
 Stage 3 - Inability to walk straight or
stand
 Stage 4 - Rigidity and bradykinesia
 Stage 5 - Unable to take care of themselves
and requires a contant one on one nursing
care

11.  Cardinal Features
-Resting tremors
-Rigidity
-Bradykinesia
-Postural instability

12.  Other features
-Hypomimia
-Dysphagia
-Hypohonia
-Shuffling gait
-Festinations

14.  Medical
-Gene therapy
-Dietary consideration
-Deep brain stimulation
-Neural transplantation
-Speech therapy
-Exercise and physical therapy
-Pharmarcological therapy

15.  Nursing
-Assessment
1. •Do you have leg or arm stiffness?
2. •Have you experienced any irregular jerking of
your arms or legs
3. • Have you ever been “frozen” or rooted to the
spot and unable to move
4. • What specific activities do you have difficulty
doing?

16.  During this assessment, the nurse observes
the patient for quality of speech, loss of facial
expression, swallowing deficits,tremors
 slowness of movement, weakness, forward
posture, rigidity and evidence of mental
confusion

17.  Diagnosis
1. • Impaired physical mobility related to muscle
rigidity and motor weakness
2. • Self-care deficits (feeding, dressing, hygiene, and
toileting) related to tremor and motor disturbance
3. • Imbalanced nutrition, less than body
requirements, related to tremor, slowness in
eating, difficulty in chewing and swallowing
4. • Impaired verbal communication related to
decreased speech volume, slowness of speech,
inability to move facial muscles

18.  Planning and goals
 Improving functional mobility
 Maintaining independence in activities of
daily living
 Achieving adequate bowel elimination,
attaining and maintaining acceptable
nutritional status
 Achieving effective communication

19.  Interventions
Mobility - range-of-motion exercises
promote joint flexibility
- Warm baths and massage to relax
muscles
Self care - Teaching, supporting and
encouraging the patient during activities
of daily living promote self-care

20. Nutrition - Monitoring weight on a weekly basis
indicates whether caloric intake is adequate
- Nasogastric tube maybe necessary as
the disease progresses
Communication - A speech therapist may be
helpful in designing speech improvement
exercises and assisting the family and health care
personnel to develop and use a method of
communication to meet the patient’s needs

21.  Dopamine Agonists
- levodopa combined with a peripheral
decarboxlase inhibitor e.g cardidopa
 Anticholinergics
- benztropine mesylate for treatment of motor
symptoms
 MAO-Inhibitors
- selegiline block the breakdown of dopamine

22.  Acetylcholinesterase inhibitors (central)
-Donepazil treatment of dimentia
 COMT Inhibitors
-Tolcapone inhibit COMT the major catecholamine
degrader

23.  Medscape,wikipedia,katzung.

24.  O.J