1. PARKINSON’S DISEASE CHAMINDA UNANTENNE RN,MS,MSN

2. PARKINSON’S ◦ PROBLEMS WITH MOVEMENT. ◦ SLOW ( BRADYKINESIA). ◦ DECREASED DOPAMINOGIC NEURONS ◦ PROGRESSIVE ◦ NEUROGENERATIVE PATHOPHYSIOLOGY ◦ DECREASED DOPAMINOGIC NEURONS ◦ SUBSTANTIA NIGRA ◦ INCREASED LEWY BODIES: POST MORTEM SHOWS INCREASED LEWY BODIES. ◦ HYPOTHALAMUS ◦ MOTOR NEURONS

3. SIGNS & SYMPTOMS ◦ SHAKINESS - TREMORS ◦ STIFFNESS – WHEN BENDING ◦ SLOWED DOWN MOVEMENTS ABOVE THREE SIGNS ARE REFERRED AS PARKINSONISM OR PARKINSON’S SYNDROME. ◦ PROBLEMS WITH BALANCE OTHER SIGNS AND SYMPTOMS ◦ DEPRESSION ◦ MEMORY LOSS ◦ TROUBLE CONCENTRATING ◦ INSOMNIA ◦ DECREASED SENSE OF SMELL

4. CAUSES OF PARKINSON’S DISEASE ◦ IDIOPATHIC – UNKNOWN – MAJORITY OF THE TIME ◦ 15% FAMILY HOSTORY A.CAUSES 100% OF THE TIME B.INCREASED CHANCES OF PARKINSON’S DISEASE. RISK FACTORS ◦ CERTAIN PESTICIDES ◦ AGE ◦ CONCUSSIONS ◦ GENDER/MALES HIGHER ◦ HEAVY METALS COMMON MISCONCEPTIONS ◦ ONLY OLDER PEOPLE GET PARKINSON’S – 5-10% DIAGNOSED <50 YEARS.

6. HOEHN-YAHR STAGING SYSTEM

7. Stages of Parkinson’s Stage 1 ◦ Symptoms are present on one side of the body only- no significant disability. Gate near normal. Stage II ◦ Symptoms become present on both sides of body. Posture and gait affected but no impairment of balance. Gait still ok. Stage III ◦ Balance impaired. Mild to moderate disability. WITH TREATMENT INDUVIDUALS OFTEN FUNCTION WELL FOR YEARS. MOST COMMON SOURCE OF DISSABILITY Dementia, autonomic dysfunction, postural instability, ADVANCED STAGES: NON MOTOR SYMPTOMS. Stage IV ◦ Severe disability ◦ Still able to stand/walk without assistance. Stage V ◦ Confined to wheel chair or bed.

8. Medical Management ◦ NO MEDS TO STOP OR REVERSE THE DISEASE ◦ EVERYONE IS DIFFERENT ◦ SIDE EFFECTS TO CONSIDER

9. LEVODOPA

11. MEDICAL TREATMENT ◦ LEVODOPA/CARBIDOPA ( SINEMET) CARBIDOPA IS REQUIRED FOR LEVODOPA TO BE EFFECTIVE. NOT EFFECTIVE BY ITSELF CARBIDOPA INHIBITS AN ENZYME CALLED DDC & DECREASES THE PERIPHERAL PRODU CTION OF DOPAMINE. THIS PREVENTS SOME OF THE SIDE EFFECTS.

12. COMT INHIBITORS

13. MAO – B INHIBITORS

14. DOPAMINE AGONIST

15. OTHER MEDICATIONS