Parkinson's

Parkinson's[edit|编辑年代ource]

Parkinson's disease (PD) is aneurodegenerative disorder(specifically asynucleinopathy). PD mostly presents in later life with generalized slowing of movements (bradykinesia) and at least one other symptom of resting tremor or rigidity. Other associated features are a loss of smell,睡眠障碍, mood disorders, excess salivation, constipation, and excessive periodic limb movements insleep(REM behavior disorder)^[1].It is the seconds most common neuro-degenerative condition in the world afterAlzheimer's.

Parkinson disease is by far the most common cause of theparkinsoniansyndrome, accounting for approximately 80% of cases, the remainder being due to other neurodegenerative diseases eg Lewy body dementia.^［2］

This 3 minute video gives an overview of PD

^[3]

Parkinson's was described 3000 years ago in Indian and Chinese medicines with mainly plant-based remedies, however, James Parkinson was the first to describe it in the western medicine in his 1817 essay as the Shaking Palsy.

Etiology[edit|编辑年代ource]

Over the past century, our understanding of the etiology of PD has evolved immensely. PD is a disorder of thebasal ganglia, which is composed of many other nuclei. The dopaminergic tract is predominantly affected in PD and it is characterised by neuronal loss of dopaminergicneuronsin thesubstantia nigrapars compacta^[4].Dopamineis a natural substance found in the brain that plays a major role in our brains and bodies by messaging and therefore communicating across various systems.
The cause of PD has been linked to the

• Use of pesticides, herbicides, and proximity to industrial plants.
• After injection of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) (An accidental finding). This chemical accumulates in the mitochondria.
• Oxidation and generation of free radicals causing damage to the thalamic nuclei.
• 基因,兄弟姐妹PD的风险增加one member of the family has the disorder. These cases also tend to occur much earlier in life.
• The altered function of alpha-synuclein may play a role in the etiology of PD. Current research is focussed on preventing the propagation and aggregation of alpha-synuclein^[1]

Epidemiology[edit|编辑年代ource]

Parkinson disease is by far the most common cause of the parkinsonian syndrome, accounting for approximately 80% of cases (the remainder being due to other neurodegenerative diseases, such asLewy body dementia) and is one of the most common nervous system disorders of the aging population.

PD usually occurs after the age of 50 affecting 1 to 2 people per 1000 at any time. An estimated seven to 10 million people worldwide are living with Parkinson's.^[5]The prevalence increases with age to affect 1% of the population above 60 years. Genetics play a part in 5% to 10% of patients. It is more common in men than women, with incidence and prevalence rising with age^[1].

Interprofessional管理[edit|编辑年代ource]

PD is one of the most common motor disorders worldwide. The disorder has no cure and is progressive. The condition can present with motor abnormalities and a variety of psychiatric and autonomic problems. Almost every organ is affected by this disorder, and as the disease progresses, management can be difficult. An interprofessional team approach is the best way to manage the disorder^[1].

Some non-motor aspects (sleep problems, low mood, constipation, and loss of sense of smell) occur several years prior to observable motor symptoms develop. Physiotherapists are most often involved in the mid-stages of the condition, once balance and mobility become affected, but it can be helpful if they can assess and advise people soon after diagnosis in order to maintain activity and prevent problems.
Besides physicians, nurses, pharmacists, social workers, and physical therapists play a vital role in the daily management of these patients. Parkinson’s creates complexities for health and social staff helping individuals and those affected by it (carers, family members, friends). Managing these complex issues is a challenge due to the varied combinations of a motor (movement) and non-motor symptoms presented throughout the course of the condition.

Common Motor Symptoms that Require Management[edit|编辑年代ource]

• Tremor is a prominent and early symptom of PD (not always present and is not a necessary feature for diagnosis).
• Slowness, or bradykinesia, a core feature of PD.
• Rigidity is the third prominent feature on examination.
• A combination of bradykinesia and rigidity leads to some other characteristic features of PD, such as micrographia.
• The fourth prominent feature of PD isgaitdisturbance, although this is typically a late manifestation. Flexedposture,ataxia, reduced arm swing, festination, march-a-petits-pas, camptocormia, retropulsion, and turning en bloc are popular terms to describe the gait in PD. Gait disorder is not an early feature of PD but is frequently described as it is easy to recognize and cinches the diagnosis in later stages^[1].

Complications to Address[edit|编辑年代ource]

• Depression
• Dementia
• Laryngeal dysfunction
• Autonomic dysfunction
• Kyphosisleading to cardiopulmonary impairment^[1]

Prognosis[edit|编辑年代ource]

The rate of progression of the disease may be predicted based on the following:^[1]

• Males who have postural instability of difficulty with gait.
• Patients with older age at onset, dementia, and failure to respond to traditional dopaminergic medications tend to have early admission to nursing homes and diminished survival.
• Individuals with just tremors at the initial presentation tend to have a protracted benign course.
• Individuals diagnosed with the disease at older age combined with hypokinesia/rigidity tend to have a much more rapid progression of the disease.

The disorder: leads to disability of most patients within ten years; has a mortality rate three times the normal population.

Parkinson’s cannot yet be cured (treatment can improve symptoms but the quality of life is often poor)^[1]. A lot of financial and other resources are being expended on research to find a cure.

Differential Diagnosis[edit|编辑年代ource]

• Essential tremor
• Huntington chorea
• Dementiawith Lewy bodies
• Progressive supranuclear palsy
• Neuroacanthocytosis
• Normal pressure hydrocephalus

Resources[edit|编辑年代ource]

Information about Parkinson’s can be found on the following websites:

USA

UK

Europe

European Parkinson’s Disease Association[edit|编辑年代ource]

TheEuropean Parkinson’s Disease Association(EPDA) is a European Parkinson's umbrella organisation. They represent45 member organisationsand advocate for the rights and needs of more than 1.2 million people with Parkinson’s and their families.

The EPDA vision is to enable all people with Parkinson's in Europe to live a full life while supporting the search for a cure.

The group launched theEuropean Parkinson’s Disease Standards of care Consensus Statementin the European Parliament in November 2011. The document defines what the optimal management of Parkinson’s should be and what good-quality care should consist of. The document is not only developed by experts in the field of Parkinson’s but includes the voice of people with Parkinson’s. In addition to this, they have produced some amazing resources to introduce people to the condition.

[6]

Parkinson's UK[edit|编辑年代ource]

TheParkinson’s UK websitehosts a lot of information about Parkinson's and management of the condition. Local support groups are also available through Parkinson's UK and are an excellent resource available to persons with Parkinson's and Parkinsonism. Often exercise groups are also provided through these groups.

Move4Parkinson's[edit|编辑年代ource]

Move4Parkinson’swas set up by Margaret Mullarney who was diagnosed with Parkinson’s in 2004. The site is dedicated to educating, empowering and inspiring People with Parkinson’s and their families or carers (Parkinson’s communities) to gain the knowledge and skills they need to improve their Quality of Life. Margaret recommends the Five Elements Framework based on her personal experience:

National Institute of Neurological Disorders and Stroke[edit|编辑年代ource]

TheNational Institute of Neurological Disorders and Stroke(NINDS) provides a list of American based organizations:

Viartis[edit|编辑年代ource]

Viartisis an independent, non-commercial, and self-funded medical researcher specializing in Parkinson's. Viartis is not part of any other company, university or organization, and have no religious or political allegiances. They choose articles solely on the basis of their medical significance or potential interest, and you can register to receive information free of charge. The site provides links to a range ofinternationalorganizations.

Parkinson's Conference, 2009[edit|编辑年代ource]

In September 2009,SPRING(the research interest group of the Parkinson’s Disease Society) hosted aconferenceon the effect of exercise on Parkinson’s.Bhanu Ramaswamywas part of the organizing committee with her AGILE / ACPIN Parkinson’s Project Officer hat on, alongside Vicki Goodwin, who was also invited to speak on her research. The conference explored known aspects plus issues yet to be discovered about the benefits of exercise for people with Parkinson's. Contributions were from invited participants from across the world in the hope of enabling proposals for new research collaboration to promote exercise as an essential component of therapy for Parkinson's.

General conference information can be accessed through the website

Below are videos of the two keynote presentations from the conference:

[7]

[8]

Related pages in Physiopedia[edit|编辑年代ource]

• Anatomy, Pathology, Prognosis, and Diagnosis
• Clinical Presentation
• Drugs for the Treatment of Parkinson's
• Physiotherapy - Referral and Assessment
• Physiotherapy - Management and Interventions
• Key Evidence and resources

References[edit|编辑年代ource]