Parkinson’s disease (PD)

Parkinson’s disease (PD) is a progressive, chronic, and incurable neurodegenerative disorder affecting 1% of >65 years of age (Abyad, 2020). Two main neuropathological findings in PD include the loss of neurons in the substantia nigra pars compacta and basal ganglia resulting in decreased dopamine production and the development and accumulation of Lewy bodies. An earlier feature of PD is resting tremor also described as “pill-rolling”. Other primary motor symptoms of parkinsonism include bradykinesia which can be evaluated by hand movements including pronation-supination and toe/foot tapping, and rigidity or stiffness in the limbs and trunk which is also known as cogwheeling (Levin et al., 2016). A combination of rigidity and bradykinesia results in secondary motor symptoms, in which patients may present with dysarthria, dysphagia, gait freezing, hypersalivation, and mask-like expression. Additionally, nonmotor symptoms include orthostatic hypotension, urinary retention, constipation, erectile dysfunction, depression, anxiety, apathy, obsessive-compulsive disorder, and Lewy body dementia (Levin et al., 2016). Risk factors include family history and environmental risks such as well water, pesticides, industrial chemicals, and farming. Also, toxins and certain medications, such as antipsychotics, can lead to extrapyramidal side effects and motor manifestations resulting in secondary parkinsonism. Therefore, patients should decrease exposure to environmental risks and limit the use the drugs.

If a patient presents with tremor at rest, rigidity, and/or bradykinesia, Parkinson’s disease should be suspected and a neurologist should be consulted. Clinical diagnosis is based on neurological exam and assessment findings. The Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) can be utilized which evaluates various aspects of PD including non-motor and motor symptoms and complications. Thus, a thorough history and physical examination are essential for PD diagnosis as specific labs and imaging studies are typically unremarkable. An MRI can be useful in narrowing the differential and excluding other conditions, such as hydrocephalus or mass/lesions. However, to help confirm the diagnosis of PD is a therapeutic response to Levodopa treatment as it decreases side effects and improves CNS (Abyad, 2020).

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Symptoms typically occur between ages 60-80 years and most prevalent in geriatrics; therefore, symptoms and disease may be overlooked resulting in undiagnosed/misdiagnosed in adults. Adults may have symptoms of dystonia, dyskinesia, tremors, and rigidity whereas geriatrics will also experience problems with balance and coordination, confusion, and memory loss. In later stages of PD, patients are at risk for aspiration pneumonia, falls, and cognitive decline as 80% of patients will typically develop dementia increasing morality (Abyad, 2020). Therefore, depending on symptoms, PT/OT should be consulted to increase mobility, speech therapy to maximize communication and swallow therapy to prevent aspiration.

References

Abyad, A. (2020). Parkinson’s disease: An update on pathophysiology, epidemiology, diagnosis and management. Part 2: Etiology and pathophysiology. Middle East Journal of Family Medicine, 18(6), 71–80. https://doi.org/10.5742MEWFM.2020.93824

Levin, J., Kurz, A., Arzberger, T., Giese, A., & Höglinger, G. U. (2016). The differential diagnosis and treatment of atypical parkinsonism. Deutsches Ärzteblatt International, 113(5), 61–69. https://doi.org/10.3238/arztebl.2016.0061

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