- Is a progressive neurologic disease affecting the brain centers responsible for control and regulation of movement.
- A deficiency of dopamine due to degenerative changes in the substantia nigra produces tremor, bradykinesia, rigidity, and autonomic dysfunction.
- The cause is not known.
- Complications of Parkinson’s disease include dementia, aspiration, and injury from falls.
- The incidence of Parkinson’s disease increases with age; approximately 1% of the population older than age 60 has this disorder.
- Characteristic resting tremor of the extremities (may be worse on one side), and possibly affecting the head and neck.
- Bradykinesia (slowness of movement).
- Muscle rigidity in performing all movements, as well as rest.
- Verbal fluency may be impaired.
- Signs of autonomic dysfunction (sleeplessness, salivation, sweating, orthostatic hypotension).
- Depression, dementia.
- Masklike facies.
- Poor balance, gait disturbances, speech problems.
- Diagnosis is based on observation of clinical symptoms and consideration of patient’s age and history, confirmed by favorable response to levodopa therapy.
- CT scanning and MRI may be performed to rule out other disorder.
- Various drugs can be used, often in combination to prolong effectiveness because tolerance develops.
- Anticholinergics to reduce activation of cholinergic pathways, which are thought to be overactive in dopamine deficiency.
- Amantadine, which may improve dopamine release in the brain.
- Levodopa, a dopamine precursor, combined with carbidopa, a decarboxylase inhibitor, to inhibit destruction of L-dopa in the bloodstream, making more available to the brain.
- Bromocriptine, a dopaminergic agonist that activates dopamine receptors in the brain.
- Monoamine oxidase inhibitors as adjunct to levodopa therapy.
- Catecholamine-O-methyltransferase (COMT) inhibitors, as adjunct therapy in combination with levodopa therapy; COMT is an enzyme that eliminates dopamine from the brain.
- Medical pallidotomy to improve dyskinesia, rigidity, and tremor.
- Chronic deep brain stimulation through electrodes implanted into the thalamus or globus pallidus to decrease tremor.
- Brain tissue transplants through the use of stem cells and genetically engineered animal cells are a promising area of research.
- Monitor drug treatment to note adverse reactions and allow for dosage adjustments. Monitor for liver function changes and anemia during drug therapy.
- Monitor the patient’s nutritional intake and check weight regularly.
- Monitor the patient’s ability to perform activities of daily living.
- To improve mobility, encourage the patient to participate in daily exercise, such as walking, riding stationary bike, swimming, or gardening.
- Advise the patient to perform stretching and postural exercises as outlined by a physical therapist.
- Teach the patient walking techniques to offset parkinsonian shuffling gait and tendency to lean forward.
- Encourage the patient to take warm baths and massage muscles to help relax muscles.
- Instruct the patient to rest often to avoid fatigue and frustration.
- To improve the patient’s nutritional status, teach the patient to think through the sequence of swallowing.
- Urge the patient to make a conscious effort to control accumulation of saliva (drooling) by holding head upright and swallowing periodically. Be alert for aspiration hazard.
- Have the patient use secure, stabilized dishes and eating utensils.
- Suggest the patient eat smaller meals and additional snacks.
- To prevent constipation, encourage patient to consume foods containing moderate fiber content (whole grains, fruits, and vegetables), and to increase his or her water intake.
- Obtained a raised toilet seat to help the patient sit and stand.
- Teach the patient facial exercises and breathing methods to obtain appropriate pronunciation, volume, and intonation.
- Teach the patient about the medication regimen and adverse reaction.