Quiz - Alverno College Faculty
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Parkinson’s Disease Self-study Tutorial Created by: Holly A. Hepp, BSN, RN MSN Program Alverno College Milwaukee, WI May 2006 holly_hep@msn.com Parkinson’s Disease - Objectives Introduction Objectives Symptoms Pathophysiology Causes Treatments http://office.m icrosoft.com/e n-us/tou.aspx ♦ Identify Symptoms of Parkinson’s Disease (PD) ♦ Understand possible causes of PD ♦ List treatment options for PD Parkinson’s Disease - Introduction Introduction Parkinson's disease (PD): Symptoms ♦ Is a neurodegenerative disorder Pathophysiology Causes Treatments http://office.m icrosoft.com/e n-us/tou.aspx ♦ Develops around age 50 * incidence rises with age * affects 1-2% of population > age 65 ♦ Higher incidence in men (62%) compared to women (38%) Porth, 2005 , Wooten, 2004 Parkinson’s Disease - Introduction Introduction Symptoms Pathophysiology Causes Treatments http://office.microsoft.com /en-us/tou.aspx Increasing proportion of elderly individuals PLUS PD & related neurodegenerative disorders CREATES Growing burden on health care system Parkinson’s Disease - Symptoms Introduction Symptoms Pathophysiology Patients initially present with a triad of motor impairments: 1. tremor 2. rigidity 3. bradykinesia Causes Symptoms worsen as Treatments disease progresses. www.netterimages.com Porth, 2005 Parkinson’s Disease - Symptoms Introduction Tremors – Continued Symptoms ♦ usually unilateral ♦ becomes bilateral ♦ worsens with stress Pathophysiology Causes Treatments Porth, 2005 Pictures used with permission from www.netterimages.com Parkinson’s Disease - Symptoms Introduction Symptoms Pictures used with permission from www.netterimages.com Tremors Pathophysiology Causes Treatments Usually -♦ first symptom ♦ occurs in the hands or arms – can occur in head, face, jaw, & leg ♦ disappears with purposeful movement – such as picking up an object Porth, 2005 Parkinson’s Disease - Symptoms Introduction Symptoms Postural manifestations – ■ postural instability ■ rigidity Pathophysiology ■ stooped Causes Treatments www.netterimages.com Postural changes cause balance instability Porth, 2005 Parkinson’s Disease - Symptoms Introduction Symptoms Pathophysiology Causes Treatments Patients also suffer from nonmotor symptoms such as: ♦ cognitive impairments ♦ olfactory impairments ♦ dysphagia ♦ GI dysfunction ♦ sleep disturbances ♦ depression http://office.microsoft.com/en-us/tou.aspx Fleming, Fernaut, & Chesselet, 2005 Microsoft© Parkinson’s Disease – Stages of Symptoms Introduction Symptoms Pathophysiology Causes Treatments Stage Symptoms One Unilateral Two Bilateral No balance impairment Three Balance impairment Mild to moderate disease Physically independent Four Severe disability Still able to walk & stand unassisted Five Wheelchair-bound or bedriddened unless assisted http://www.ninds.nih.gov/disorders/parkinsons_disease Parkinson’s Disease – Symptoms & Stress Introduction Symptoms Question: Does daily stress worsen PD symptoms? Answer: Yes, but only temporarily Pathophysiology Causes Treatments ♦ Stress is not the cause of PD ♦ Any stress can briefly worsen PD symptoms ♦ Stress-related symptoms resolve after stress is relieved. Hakansson, et al., 2005 Parkinson’s Disease - Symptoms Introduction Quiz --PD Symptoms Question #1 Symptoms Pathophysiology Causes Treatments Are all the following symptoms of PD? • bradykinesia • tremor • rigidity • gastrointestinal dysfunction • postural instability • sleep disturbances • cognitive impairments. True False microsoft© Parkinson’s Disease - Symptoms Introduction Symptoms You are correct! Pathophysiology Causes Treatments http://office.microsoft.com/en-us/tou.aspx Parkinson’s Disease - Symptoms Introduction Symptoms Pathophysiology Causes Treatments Wrong! The correct answer is true. All the following are symptoms of PD bradykinesia tremor rigidity gastrointestinal dysfunction postural instability sleep disturbances cognitive impairments. Parkinson’s Disease - Symptoms Introduction Quiz --PD Symptoms Question #2 Symptoms Pathophysiology Causes Treatments Postural instability, rigidity, and stooped posture places the PD patient at greatest risk for: a. b. c. d. Sleeping Sneezing Falling Dying microsoft© Parkinson’s Disease - Symptoms Introduction Symptoms You are correct! Pathophysiology Causes Treatments http://office.microsoft.com/en-us/tou.aspx Parkinson’s Disease - Symptoms Introduction Symptoms Pathophysiology Causes Treatments Wrong! Postural instability, rigidity, and stooped posture places the PD patient at greatest risk for falling. Parkinson’s Disease - Pathophysiology Introduction Symptoms Pathophysiology Causes Question: What causes the movement problems of PD? Answer: Deficiency of the brain chemical dopamine occurs in the basal ganglia. The Basal Ganglia is an area deep inside the cortex of the brain that coordinates normal muscle activity. Porth, 2005 Cross section of striatum Treatments Substantia nigra ww.netterimages.com Parkinson’s Disease - Pathophysiology Introduction Symptoms Pathophysiology Causes Question: What causes the dopamine deficiency? Answer: Degenerative changes in the substantia nigra and striatum portions of the basal ganglia reduce dopamine production. Porth, 2005 Cross section of striatum Treatments Substantia nigra ww.netterimages.com Parkinson’s Disease - Pathophysiology Introduction Symptoms The Basal Ganglia Pathophysiology Striatum Cortex Globus Pallidus Thalamus Subthalamic Causes Substantia Nigra nucleus Treatments In PD, cellular degeneration starts in the substantia nigra of the basal gangla, where dopamineproducing nerve cells, called nigral cells, are formed. Porth, 2005 Parkinson’s Disease - Pathophysiology Introduction Symptoms The Basal Ganglia Pathophysiology Striatum Cortex Globus Pallidus Thalamus Subthalamic Causes Treatments nucleus Nigral cells Substantia Nigra Dopamine Muscle control •In PD the striatum portion of the basal ganglia receives an inadequate amount of nigral cells, which impairs a person’s ability to control movement. •The basal ganglion’s connection to the cortex and the thalamus also affects movement. Porth, 2005 Parkinson’s Disease - Pathophysiology Introduction Healthy Sn Symptoms PD Sn Pathophysiology Causes www.netterimages.com Cells degenerate in substantia nigra (Sn) Substantia nigra destroyed Dopamine decreases Treatments Muscle cell activation decreases Movement control decreases Porth, 2005 Parkinson’s Disease - Pathophysiology Introduction Question: What causes PD? Symptoms Pathophysiology Answer: Process not understood completely Microsoft© Causes Treatments - May be combination of factors involving genetics, environmental agents,& abnormalities in cellular process. Microsoft© Parkinson’s Disease - Pathophysiology Introduction Symptoms Quiz --PD Pathophysiology What causes the movement problems of PD? Pathophysiology Causes Treatments A. B. C. D. Excess amount of epinephrine Inadequate amount of epinephrine Excess amount of dopamine Inadequate amount of dopamine Parkinson’s Disease - Pathophysiology Introduction You are correct! Symptoms Pathophysiology Causes http://office.microsoft.com/en-us/tou.aspx Treatments Deficiency of the brain chemical dopamine cause movement disorders. Parkinson’s Disease - Pathophysiology Introduction Symptoms Pathophysiology Causes Treatments Wrong! Please try again! Parkinson’s Disease – Causes Introduction Symptoms Question: Is Genetics a Factor in PD? Answer: Pathophysiology ♦ Recent discoveries support a genetic component to some familial forms of PD in both early-age and late-age onset Causes ♦ 15-25% of PD patients have relative with PD Treatments ♦ Majority of PD cases occur without apparent genetic factor Berg, 2005, Duovisin, 2004, Foroud, 2005, Gasser, 2005, Paisàn-Ruiz, 2005. Parkinson’s Disease - Causes Introduction Symptoms Pathophysiology Causes Recent studies discovered several genes that can cause PD ♦ Some genes effect dopamine cell functions ♦ Some genes affects are unknown ♦ PD genetics research is on-going Treatments Foroud, 2005 http://office.microsoft.com/en-us/tou.aspx Parkinson’s Disease - Causes Introduction Question: How will Identification of genetic mutation affect PD? Symptoms Answer: Pathophysiology 1. might help scientists better understand how PD damages the brain & causes symptoms of the disease. 2. might lead to better therapies for Parkinson's disease and, hopefully, a cure! Causes Treatments Foroud, 2005 Parkinson’s Disease – Causes Introduction Symptoms Question: Is PD an immune/inflammatory response? Answer: Not certain. Pathophysiology Causes ♦ Pathogenesis of PD as an immune response being studied ♦ Link between PD and a proinflammatory cytokine shown in three recent studies Treatments ♦ Indications are present but inconclusive Hakansson, et al., 2005 Parkinson’s Disease – Causes Introduction Symptoms Question: Do environmental agents cause PD? Answer: Not certain. Pathophysiology Causes Treatments Microsoft© ♦ Environmental link may be present ♦ - genetic factor may place person at increase risk when exposed to pesticides ♦ Indications present but inconclusive Jiang,, Ellis, & Greenlee, 2004 Parkinson’s Disease – Causes Introduction Quiz-- PD Causes Symptoms All of the following are true except: Pathophysiology Causes Treatments A. Majority of PD cases are due to an inherited gene. B. PD is contagious C. A link between PD and a proinflammatory cytokine shown in three recent studies D. Pesticide exposure may be linked to PD. Berg, 2005, Duovisin, 2004, Foroud, 2005, Gasser, 2005, Paisàn-Ruiz, 2005. Parkinson’s Disease - Causes Introduction Symptoms Correct! Pathophysiology http://office.microsoft.com/en-us/tou.aspx Causes Treatments While the majority of PD cases do not have a known cause, it is not contagious. Parkinson’s Disease - Genes & Things Introduction Symptoms Pathophysiology Causes Treatments Wrong! Please try again! Parkinson’s Disease - Treatment Introduction Symptoms Pathophysiology Causes Treatments Question: What are some treatment approaches for PD? Answer: a. Medical therapy b. Surgical therapy. c. General lifestyle modifications * rest and exercise * physical therapy * speech therapy Parkinson’s Disease - Treatment Introduction Symptoms Pathophysiology Causes Treatments Question: Do the treatments cure Parkinson's Disease or stop it from progressing? Answer: No. • Treatments do not cure the disease • Goal is to alleviate symptoms and maintain independent function Parkinson’s Disease - Treatment Introduction Symptoms Pathophysiology Causes Treatments Question: Is there a “best” treatment for PD? Answer: No standard exists Surgical treatment for PD is considered for patients who respond to medications but have intolerable side effects. Parkinson’s Disease - Treatment Introduction Symptoms Pathophysiology Causes Medical Approaches Question: Are PD patients given dopamine? Answer: No. • Dopamine, itself, does not pass the blood-brain barrier • Levodopa (L-dopa) is given to pass into the brain and the nerve cells then use it to make dopamine Treatments http://office.microsoft.com/en-us/tou.aspx Parkinson’s Disease - Treatment Introduction Other Medical Approaches Symptoms Pathophysiology Causes Treatments Dopamine-agonists: acts on dopamine receptors, mimics natural dopamine, not as effective as L-dopa Meds: Bromocriptine, Pergolide, Pramipexole, Ropinirole Anticholenergic: helps relieves tremor in mild to moderate disease Meds: Benztropine, Biperidan, Orphenadrine, Trihexyphenidyl Hickey, 2000 http://office.microsoft.com/en-us/tou.aspx Parkinson’s Disease - Treatment Introduction Symptoms Surgical Approaches a. Ablation b. Deep Brain Stimulator Pathophysiology Causes Treatments http://office.microsoft.com/en-us/tou.aspx Parkinson’s Disease - Treatment Introduction Symptoms Pathophysiology Causes Treatments Surgical Approach--Ablation An area of the brain affected by PD is ablated (destroyed) Purpose: destroy tissue that produces abnormal chemical or electrical impulses that produce abnormal movements Parkinson’s Disease - Treatment Introduction Symptoms Pathophysiology Causes Treatments Surgical Approach – Deep Brain Stimulation (DBS) Surgically implanted, batteryoperated device delivers electrical stimulation to targeted areas in the brain Purpose: block abnormal nerve signals that that cause tremor and PD symptoms Parkinson’s Disease - Treatment Introduction Quiz-- PD Treatment Symptoms Pathophysiology Causes Treatments All of the following approaches are used to treat PD? a. L-dopa pills b. Dopamine pills c. Deep Brain Stimulation surgery True False Parkinson’s Disease - Symptoms Introduction Symptoms YES! Pathophysiology You are correct! Causes Treatments Dopamine does not cross the bloodbrain barrier when delivered in pill form. • Levodopa (L-dopa) is given to pass into the brain and the nerve cells then use it to http://office.microsoft.com/en-us/tou.aspx make dopamine Parkinson’s Disease - Symptoms Introduction Symptoms Pathophysiology Wrong! Dopamine pills would not cross the blood brain barrier. Causes Treatments • Levodopa (L-dopa) is given to pass into the brain and the nerve cells then use it to make dopamine Parkinson’s Disease – Nursing Implications Introduction Symptoms Pathophysiology Causes Treatments 1) PD has many different symptoms ask patients about intensity, frequency, & duration of symptoms. 2) PD is chronic, with no known cure Psychosocial & other nursing interventions could decrease stress & symptoms. Parkinson’s Disease – References (page 1 of 2) Introduction Symptoms Duvoisin, R.C., Golbe, L.I., Mark, M.H., Sage, J., Walters, AS. (2004). Parkinson’s disease handbook: A guide for patients and their families [Electronic version]. The American Parkinson Disease Association, Inc. Retrieved February 9, 2006 http://www.apdaparkinson.org/data/Booklets/Parkinson%20Handbook.pdf. Fleming, S.M., Fernagut, O., Chesselet, M. (2005). Genetic Mouse Models of Parkinsonism: Strengths and Limitations [Electronic version]. NeuroRx, 2(3), 495–503. Retrieved February 22, 2006 from http://www.pubmedcentral.gov/articlerender.fcgi?tool=pubmed&pubmedid=16389313 Foroud,, Y. (2005). LRRK2-Both a cause and a risk factor for parkinson’s disease [Electronic version]. Neurolog, 65(5), 664-665. Retrieved February 9, 2006 from http://gateway.ut.ovid.com/gw1/ovidweb.cgi Accession Number: 00006114-200509130-00004. Pathophysiology Causes Treatments Gasser, T. (2005). Genetics of Parkinson’s disease [Electronic version]. Current opinon in neurology, 18:363-369. Retrieved February 9, 2006 from http://gateway.ovid.com/ovidweb.cgi?T=JS& NEWS=N&PAGE=fulltext&AN=00019052-200508000-00003&LSLINK=80&D=ovft Hakansson, A., Westberg, L., Nilsson, S., Buervenich, S., Carmine, A., Holmberg, B., Sydow, O., Olson, L., Johnels, B., Eriksson, E., Nissbrandt, H. (2005). Investigation of genes coding for inflammatory components in parkinson’ s disease [Electronic version]. Movement disorders, 20(5), 569-573. Retrieved March 3, 2006 from Movement Disorders http://www3.interscience.wiley.com/cgi-bin/fulltext/109865259 Hickey, J.V. (2000). The Clinical Practice of Neurological and Neurosurgoical Nursing (5th ed.). Philidelphia: Lippincott, Williams & Wilkins Jiang, Y., Ellis, T., Greenlee, A.R. (2004). Genotyping parkinson’s disease-associated mitochondrial polymorphisms [Electronic version]. Clinical Medicine & Research, 2(2), 99-106. Retrieved February 22, 2006 from http://www.pubmedcentralgov/articlerender.fcgi?tool=pubmed&pubmedid=15931342 Parkinson’s Disease – References (page 2 of 2) Introduction Symptoms O’Brien, J.T., Colloby, S., Fenwick, J., Williams, E.D., Firbasnk, M., Burn, D., Aarsland, D., McKeith, I.G. (2004). Dopamine tramnsporter loss visualized with FP-CIT SPECT in the differential diagnosis of dementia with lewey bodies [Electronic version]. Archives of Neurology, 61(6), 619-625. Retrieved March 29, 2006 from http://archneur.ama-assn.org/icons/home/title.gif Paisàn-Ruiz, C., Sàenz, A., Lopez de Munain, A., Marti, I., Gil, A. M., Marti-Massp, J., Perez-Tur, J. (2005). Familial Parkinson;s disease: Clinical and genetic analysis of four basque families [Electronic version]. Annuals of Neurology, 57, 365-372. Retrieved February 9, 2006 from http://www3.interscience.wiley.com/cgi-bin/fulltext/109931600 Pathophysiology Causes Treatments Pankratz, N., Foroud, T. (2004). Genetics of Parkinson’s Disease [Electronic version]. NeuroRx, 1(2), 235- 242. Retrieved February 22, 2006 from http://www.pubmedcentral.gov/articlerender.fcgi?tool=pubmed&pubmedid=1571702 Porth, C (2005) Pathophysiology: Concepts of Altered Health States (7th ed.). Philidelphia: Lippincott, Williams & Wilkins. Wooten, G.F., L J Currie, L.J., V E Bovbjerg, V.E., Lee, J.K.,J Patrie, J. (2004). Are men at greater risk for parkinson’s disease than women? [Electronic version]. Journal of Neurology Neurosurgery and Psychiatry, 75, 637-639. Retrieved February 9, 2006 http://jnnp.bmjjournals.com/cgi/content/full/75/4/637 Youdim, M.B.H., Reider, P. (1997) Understanding Parkinson's disease. [Electronic version] Scientific American, 276(1), 52-59. Retrieved February 10, 2006 from http://search.epnet.com/login.aspx?direct=true&db=afh&an=9704275992 Parkinson’s Disease Introduction Symptoms Pathophysiology Causes Treatments Thank You for viewing this tutorial on Parkinson’s Disease holly_hep@msn.com
