PARKINSONISM’S DISEASE

Presented By :

• Ghalib hussain Khan• bs. PhysiotheraPy • institute of PhysiotheraPy

luMhs JaMshoro sindh

• eMail: dr.Khan127@GMail.coM

• facebooK: www.facebooK.coM/Ghalib.Khan09

Outlines:• Introduction• Etiology• Risk factors• Epidemiology

• Clinical Manifestations

• Diagnosis• Treatment

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Parkinson’s disease

Parkinson’s disease (PD) is a progressive neurodegenerative condition•The second most common progressive neurodegenerative disorder

diagnosis is primarily clinical, based on history and examination

History

• James Parkinson (1755-1824), • Remembered for the disease state named after him by Charcot

History of Parkinson’s Disease

• His small but famous publication, "Essay on the Shaking Palsy", appeared in 1817, 7 years before his death in 1824.

Pathophysiology

PD

IPDSecondary

PD

IPD (Idiopathic Parkinson disease )

• Idiopathic Parkinson Disease (also referred to as primary or classical Parkinson disease), is a progressive neurodegenerative disorder associated with decrease dopamine in parts of the brain (nigrostriatal neurons).

• Affecting about 0.4% people>40y• 1% people>65y• 10%people>80y

Age - the most important risk factor Positive family history Male gender Environmental exposure: Herbicide and pesticide

exposure, metals (manganese, iron), well water, farming, rural residence, wood pulp mills; and steel alloy industries

Race Life experiences (trauma, emotional stress, personality

traits such as shyness and depressiveness)? An inverse correlation between cigarette smoking and

caffeine intake in case-control studies.

Secondary PD:

• Normally Dopamine & Ach neurotransmitters work together to enable motor neurons to refine voluntary movement

• Parkinson's results from the degeneration of dopamine-producing nerve cells in the brain, specifically in the substantia nigra and locus coeruleus

• Clients have lost 80% or more of their dopamine-producing cells by the time symptoms appear

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Epidemiology

• 1-2% of population over age 65 years• 85% sporadic, 10-15% familial clustering and <5% monogenic inheritance• Advancing age is important risk factor• Twin studies report similar concordance of 10-20% for monozygotic and

dizogtic twins.• May be less prevalent in China and other Asian countries, and in African-

Americans.

• Prevalence rates in men are slightly higher than in women; reason unknown, though a role for estrogen has been debated.

incidence and prevalence

•PD is estimated to affect 100–180 in 100,000 people•annual incidence of 4–20 per 100,000•rising prevalence with age•higher prevalence and incidence of PD in males

•depression affects around 40% of PD patients

Clinical Manifestations

(shaking with the limb at rest)(shaking with the limb at rest)

Most common first symptom, usually asymmetric and most evident in one hand with the arm at rest.

stiffness, increased resistance to passive stiffness, increased resistance to passive movement of the limbs or trunk movement of the limbs or trunk

Muscle tone increased in both flexor and extensor muscles providing a constant resistance to passive movements of the joints; stooped posture, anteroflexed head, and flexed knees and elbows.

(may produce muscle pain, expressionless, mask-like face, difficulty chewing)(may produce muscle pain, expressionless, mask-like face, difficulty chewing)

Aknesia:

Difficulty in initial movement

( slowness of movement)slowness of movement)

Difficulty with daily activities such as writing, shaving, using a knife and fork, and opening buttons; decreased blinking, masked facies, slowed chewing and swallowing.

Postural instabil i ty : Due to loss of postural reflexes .

Stoop Psoture

Other motor symptoms• Gait• Dystonia• Hypophonia• Drooling Choking, coughing, • Dysphagia• Dysarthria• Fatigue • Akathesia• Micrographia :small, constricted handwriting• Diminished arm swing

• Hypomimia

Non-motor Symptoms

• depression.• Behavior—indirectly, e.g., a result of dementia, depression.• Thinking-slowed reaction time and executive dysfunction• Sensation—impaired sense of smell• Excessive daytime sleep, insomnia, and sleep disturbances• Vision problems• Impaired proprioception• Excessive salivation

• Excessive sweating • Loss of bowel and/or bladder control • Anxiety, depression, isolation • Slow response to questions • Cognitive impairment (mood swings...dementia)• Weight loss• Incontinence• Constipation

Investigation & Diagnosis

• History• Symptoms: Must have two or more of the primary symptoms, one of

which is a resting tremor or bradykinesia)• Progression of symptoms• CT-Scan• MRI• Autopsy

Features that support diagnosis

• Characteristic resting tremor• Narrow-based gait with flexed/ stooped posture• Reduced arm swing with tremor

• Sustained and significant levodopa effect

• Unilateral symptom onset

Goals of therapy:

• Minimize disability• Maintain quality of life.• Pt & family education & involvement in decisions.

• In patients with mild disease →drug not recommended if disabilities haven’t developed.

Management

• Education

• Exercise• Nutrition• Psychiatric counseling

EXERCISE AND PHYSICAL THERAPY :

• Exercise will not slow the progression of akinesia, rigidity, or gait disturbance, but it can prevent or alleviate some secondary orthopedic effects of rigidity and flexed posture such as

• shoulder, hip, and back pain• and it may also improve function in some motor tasks..

• Brisk walks,• swimming,• water aerobic exercises • are particularly useful.

Speech therapy :• Dysarthria• Hypophonia

Nutrition:

• Elderly patients with chronic illness are at risk for poor nutrition and weight loss.

• Prompt recognition and management of this problem is important to avoid loss of bone and muscle mass.

• No specific diet influences the course of Parkinson disease (PD),• A high fiber diet and adequate hydration help manage the

constipation of PD.• Large, high-fat meals should be avoided.

Psychological Counseling:

The emotional and psychological needs of the patient and family should be addressed.

. Support for the caregiver is particularly important. Referral of the patient and/or family to a psychologist or psychiatric social worker experienced in dealing with chronic illness may be appropriate in some cases.

Prognosis

• Parkinson's disease has no common prognosis with symptoms that vary for each patient

• It is a disease that remains for the patients life time• Symptoms can get worse over time

Celebrities with PD

Michael J Fox

Sir Joh Bjelke- Petersen

Pope John Paul II Muhammad Ali

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Funny Facts about PD

• People are much less likely to get Parkinson's Disease if they:• Smoke cigarettes• Drink alcohol • Have high cholesterol• Drink too much coffee.

?? Questions ??