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Symptoms and Pharmacological Treatment of Parkinson’S Disease

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Symptoms and Pharmacological Treatment of Parkinson’S Disease SYMPTOMS AND PHARMACOLOGICAL TREATMENT OF PARKINSON’S DISEASE Jassin Jouria, MD Dr. Jassin M. Jouria is a practicing Emergency Medicine physician, professor of academic medicine, and medical author. He graduated from Ross University School of Medicine and has completed his clinical clerkship training in various teaching hospitals throughout New York, including King’s County Hospital Center and Brookdale Medical Center, among others. Dr. Jouria has passed all USMLE medical board exams, and has served as a test prep tutor and instructor for Kaplan. He has developed several medical courses and curricula for a variety of educational institutions. Dr. Jouria has also served on multiple levels in the academic field including faculty member and Department Chair. Dr. Jouria continues to serve as a Subject Matter Expert for several continuing education organizations covering multiple basic medical sciences. He has also developed several continuing medical education courses covering various topics in clinical medicine. Recently, Dr. Jouria has been contracted by the University of Miami/Jackson Memorial Hospital’s Department of Surgery to develop an e-module training series for trauma patient management. Dr. Jouria is currently authoring an academic textbook on Human Anatomy & Physiology. ABSTRACT There has been rapid development in the research on movement disorders and, specifically, new drugs and techniques to treat Parkinson’s Disease in recent years. Many newly diagnosed patients are candidates for pharmacological disease management, and the wide array of medications available help to improve both the length and quality of life for those with Parkinson’s Disease. The many treatment options have helped to delay the need for surgical intervention for years, if not decades, in many patients. Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education 1 nursece4less.com nursece4less.com nursece4less.com nursece4less.com requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. It is the policy of NurseCe4Less.com to ensure objectivity, transparency, and best practice in clinical education for all continuing nursing education (CNE) activities. Continuing Education Credit Designation This educational activity is credited for 3 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Pharmacology hours include 1 hour. Statement of Learning Need While the cause, risks and characteristics of Parkinson’s disease are well defined in recent movement disorder diagnostic guidelines, there is no definitive test that can confirm a diagnosis of Parkinson’s disease during a person's life. The diagnosis of Parkinson’s disease remains a clinical one, confirmed only after autopsy. Clinicians treat based on clinical observation and close follow up of symptoms, and must be well informed of the changing medical options to help prolong and improve quality of life for those diagnosed with the disease. Successful pharmacotherapy of Parkinson’s disease depends on the ability of clinicians to accurately recognize characteristic signs of the disease, and to successfully function within an interdisciplinary team that includes primary care and neurology medicine to arrive at the right diagnosis. Course Purpose To provide health clinicians with knowledge about Parkinson’s disease, its cause, risk factors and characteristics, and with an overview of the research 2 nursece4less.com nursece4less.com nursece4less.com nursece4less.com and guidelines to diagnose and treat Parkinson’s disease. Target Audience Advanced Practice Registered Nurses and Registered Nurses (Interdisciplinary Health Team Members, including Vocational Nurses and Medical Assistants may obtain a Certificate of Completion) Course Author & Planning Team Conflict of Interest Disclosures Jassin M. Jouria, MD, William S. Cook, PhD, Douglas Lawrence, MA Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures Acknowledgement of Commercial Support There is no commercial support for this course. Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article. Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course. 3 nursece4less.com nursece4less.com nursece4less.com nursece4less.com 1. The Movement Disorder Society (MDS) has identified three motor manifestations of Parkinson’s disease, which are a. dementia, micrographia, and bradykinesia. b. dyskinesia, dementia, and micrographia. c. bradykinesia, resting tremor, and rigidity. d. resting tremor, dementia, and dyskinesia. 2. When non-motor features predominate, the diagnosis classification is a. parkinsonian syndrome. b. moderate Parkinson’s disease. c. mitochondrial complex. d. prodromal Parkinson’s disease. 3. In the later stages of Parkinson’s disease, diagnosis is based on a. postural instability. b. dementia. c. resting tremor. d. non-motor symptoms. 4. True or False: All four signs of Parkinson’s disease (bradykinesia, resting tremor, rigidity and postural instability) must be present for a clinical diagnosis of Parkinson's disease to be made by a clinician. a. True b. False 5. ____________ tremor may be observed by having the patient hold their arms out in front of themselves. a. Resting b. Postural c. Rigid d. Non-motor 4 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Introduction Parkinson’s disease is a progressive, neurodegenerative disorder that is diagnosed based on physical characteristics involving bradykinesia, rest tremor, and rigidity. In the later stages of the disease, diagnosis is based on postural instability. Diagnosis is not based on testing but is based on the clinician's ability to recognize signs and symptoms of Parkinson’s disease and to diagnose it, hopefully in the early stages of the disease. Successful pharmacotherapy of Parkinson’s disease depends on the ability of clinicians to accurately recognize characteristic signs of the disease. A diagnosis of Parkinson’s disease is difficult to make without the appropriate training and skills. Often, an interdisciplinary team effort between primary care medicine and neurology is needed to arrive at the right diagnosis. Recommended treatment are discussed. Diagnosis Of Parkinson’s Disease: A Review The Movement Disorder Society has identified three motor manifestations of Parkinson’s disease, which are bradykinesia, in combination with either resting tremor, rigidity, or both.1,59,68-70 The centrality of motor symptoms for clinical diagnosis of PD are generally well-defined; however, non-motor symptoms can often predominate a clinical presentation and are acknowledged. When non-motor features predominate, the diagnosis classification is prodromal Parkinson’s disease. There are four cardinal signs of Parkinson’s disease that must be identified and are defined as resting tremor, rigidity, bradykinesia, and postural instability. Postural instability is not required for a diagnosis of PD, and commonly arises later in the disease process. 5 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Resting Tremor Resting tremor is assessed by having patients seated with their arms relaxed on their laps. The resting tremor may be observed without further instructions, or it may be triggered by asking the patient to count backwards from ten. Kinetic or postural tremor may be present but is not required as part of the diagnostic criteria. Kinetic tremor may be observed in the finger- to-nose test while postural tremor may be observed by having patients hold their arms out in front of themselves. Rigidity Rigidity is the “slow passive movement of major joints with the patient in a relaxed position and the examiner manipulating the limbs and neck.”68 This form of rigidity is the “lead-pipe” form exemplified as velocity-independent resistance to passive movement. The cogwheel phenomenon is often present (so-named because of its cogwheel-like jerks to passive movement), but lead-pipe rigidity must be present as well to fulfill the minimum requirements of rigidity. Bradykinesia The bradykinesia of PD requires a slowness of movement and a decrease in amplitude or speed of movement. Limb bradykinesia must be present to establish PD. Evaluation of bradykinesia may be accomplished by finger- tapping, protonation-supination, hand movements, toe or foot tapping, and postural instability. Postural instability, identified later in the disease process, can be tested using the retropulsion test. This test involves the patient being asked to stand with arms at their sides and eyes open. The patient is also told that this is a balance test and they will be caught if they begin to fall or unable to 6 nursece4less.com nursece4less.com nursece4less.com nursece4less.com regain their balance. The examiner stands behind the patient and pulls back on the shoulders. One or two steps to regain balance are considered normal. The Movement Disorder Society (MDS) proposed to redefine Parkinson’s disease in 2014. A number of critical issues were identified and discussed.1,59,68-70 • New findings challenge the central role of the classical pathologic criteria as the arbiter of diagnosis, notably genetic cases without synuclein deposition, the high prevalence of incidental Lewy body (LB) deposition, and the nonmotor prodrome of PD. It remains unclear, however, whether these challenges merit
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