1. Introduction to Parkinson’s
Gemma Burgin

2. Agenda What is Parkinson’s? What does it look like?
The effects of Parkinson’s
Supporting people with Parkinson’s and their carers
Trouble shooting
Medication
Summary

3. What is Parkinson’s?
A neurological syndrome or disease caused by a lack of dopamine within the brain.
It is incurable, degenerative and eventually impacts on all aspects of daily life.
Dopamine is a neuro transmitter which ensures smooth movement of muscles.
Symptoms of Parkinson’s begin to surface once 80% of the dopamine producing cells have died.
There is a trend now to drop the disease element of the title of this illness. I describe it as a syndrome as it is a group of symptoms, but actually people are affected in different ways.
PDUK classification

4. What is Parkinson’s? Neurological = involves the nervous system
Neurotransmitter = chemical messenger which relays from the brain to the smooth muscles to give smooth, coordinated movement.

5. What does Parkinson’s look like?
SLOWNESS* (bradykinesia)
STIFFNESS* (rigidity)
TREMOR*
POSTURAL INSTABILITY*
STOOPED POSTURE
SHUFFLE
LACK OF ARM SWING WHEN WALKING.
LACK OF FACIAL EXPRESSION
DEPRESSED OR LOW IN MOOD
The four cardinal symptoms
A person has to have at least 2 of these four to support a diagnosis of PD.
Alternative diagnosis..Parkinsonism, PSP, MSA, LBD

6. The early stages of Parkinson’s
Diagnosis/ Early Raise awareness and self management Education and consider therapy input Reduce symptoms and distress Acceptance of diagnosis
Maintenance Promotion of normal activities. Maintenance of function and self care. Consider therapy referral Assess carer needs Symptom reduction, treatment compliance

7. The later stages of Parkinson’s
Complex
Adaptations to promote self-care
Optimise symptom control/compliance with meds
Assess for complications of medication and fluctuations
MDT input/Annual review/Carer support
Minimisation of disability
Palliative
Relief of symptoms
Absence of distress/Carer support
Maintenance of dignity
Good nursing care.
Analgesia, appropriate sedation, pressure care, continence, mouth care, communication.
“It should be noted that patients may move between stages either way, according to drug therapy and general condition.”
OK to stay initiative
Power of attorney for health and finances
DNAR
Preferred place of death.

8. The effects of Parkinsons.
Described in two ways….
MOTOR SYMPTOMS (physical capability)
NON-MOTOR SYMPTOMS affect anything within the body which is governed by muscles.
Symptoms will fluctuate from day to day and throughout the course of the day and night
Think of all the muscles in your body and the things they are needed for…..speech, swallow, bladder and bowel control, walking, talking….
They are not being awkward it is a part of the disease, what they were able to do an hour ago maay now be impossible, and vice versa, you may have struggled to wash and dress someone only to watch them wandering around an hour later. ON/OFF end of dose wearing off.
Give meds a chance to kick in to make your life easier!

9. Talking, communicating in a group, social isolation and embarrassment.
Walking
Talking, communicating in a group, social isolation and embarrassment.
Non-verbal communication, lack of vocal tone. Facial expression
Swallowing/saliva control . Eating in public.
Bladder and bowel control
Writing
Buttons, zips
Concentration, motivation, low mood
Sleep problems
Dementia, hallucinations
Keeping up in conversation, reacting to jokes, quips in a timely manner. The bradykinesia affects mind and body and by the time a Pwp has had time to digest what has been said, and formulate a response, often the topic of conversation has moved on.
Social withdrawal, Botox, kwells, atropine drops.
Becoming needy, vulnerable, a burden to those you love.
Dopamine is the pleasure/reward neurotransmitter…if there is not enough of it you can lack the ability to experience pleasure even of things yuo have previously enjoyed.

10. Parkinson’s Nurse Service
I am the specialist nurse for people who see Dr Liddle, Dr Samaniego and Dr Kappur.
I can be contacted on Please leave a message and I will get back to you as soon as I can within a few days.
These are elderly care physicians with specialist interest in Parkinson’s. We tend to look after people with multiple co-morbidities.
There is a team of nurses at RHH who work with the neurology consultants who deal with a range of movement disorders.
Their number is
Hand out service directory

11. Supporting people with Parkinson’s and their carers.
Listen to and support those closest to the person with Parkinson’s… they are often the experts.
Educate home care workers
Be patient. Give time…..Easier said than done I know!
Refer to specialists if you identify any difficulties with speech, swallow, dietary intake and obviously physio.
For freezing, use techniques of queuing….marching, counting, something which creates a rhythm.
Mobile phones, self administration of meds where possible.

12. Troubleshooting THINGS TO CHECK…. Do they have a UTI?
Are they constipated?
Have they been getting their medication?
Any changes to their medication lately?