Term Paper Sample: Pathophysiology of Parkinson's Disease

Introduction

Mohamed Ali is remembered for his prowess in boxing, and he is among the best boxers in the world history. He won heavyweight boxing champions thrice and also won many other competitions including Olympics in the year 1964, 174, and 1981. Although many folks know him as a professional boxer, Mohamed was also a philanthropist and an activist. He retired from active boxing tournaments in 1981, and he was diagnosed with Parkinsons disease in 1984 (Sawer, 2017). As time progressed, the ailment started to manifest itself making him lose his motor skills and ability to speak coherently. As the disease progressed, his health conditions deteriorated and died in the year 2016. After being diagnosed with this disease, Mohamed Ali started to carry out numerous campaigns with an aim raising awareness of the deadly disease. Together with his wife they founded a Parkinsons disease center in 1997 referred as Muhammad Ali Parkinson Center that offers quality care for people living with the disease. Many people assume that Mohamed Ali contracted Parkinsons disease as a result of numerous punches that he had received during his boxing career. However, this is not the case because his doctors confirmed that his disorder was genetic (Sawer, 2017).

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Pathophysiology of Parkinsons disease (PD)

Parkinsons disease is a progressive disorder that mainly affects the nervous system (Goetz, 2011). It is considered to be idiopathic. James Parkinson was the first physician to describe the disease as a neurological syndrome in 1817 although descriptions of the disease can be traced much earlier. For example, ancient Chinese sources and traditional Indian documents provide descriptions that hint existence of PD back in 1100 BC (Goetz, 2011). American Parkinson Disease Association define PD as is a kind of movement disorder which can affect the ability to perform, daily tasks. PD is associated with numerous symptoms; there are main features that patient with the condition experience. The major ones are those affect movement or motor symptoms and non-motor symptoms. The primary common motor symptoms of the disease are a tremor, the rigidity of the muscles, and bradykinesia. A patient suffering from the disease may also have a problem with balance, posture, walking, and coordination. Some common non-motor symptoms of the disease are constipation, sleep problems, depression, anxiety, and fatigue. Although these are common symptoms of the disorder, they highly vary from an individual to another. Additionally, these symptoms differ from how they emerge and how they change with time from a person to another. The condition is common to people who are above an age of 50 years, but it can affect younger people as well. According to a report by American Parkinson Disease Association in 2016, about 1 million people are living with PD in the U.S and about 10 million folks globally.

The condition is considered to be caused by the interaction of genes of an individual with environmental factors. Research shows that PD is genetically linked and researchers are still studying to understand the major genetic factors that are associated with the disorder. Symptoms of the condition become evident over time because more cells of the patient become affected by the malady. Some individuals show fewer symptoms than others as their age progresses while other people show critical symptoms as they age. The disease is purported to be a multifaceted neurodegenerative disorder having a chain of progression. The disorder starts by affecting the dorsal motor nucleus and olfactory, and nucleus bulbs follow (Pahwa & Lyons, 2013). Afterward, the condition progresses affecting locus coeruleus and lastly the substantia nigra. With time, the PD can also affect the cortical regions of the brain.

Planning of Diagnosis

Physical therapy aims for PD can be divided into sections- short-term and long-term goals.

Short-term goals

• To maintain healthy range of motion in all joints of the patients
• To promote and improve motor mobility and function

Long-term goals

• Minimize or delay progression and impacts of symptoms
• Maintain the functional abilities of the patient

Nurses can achieve these aims if various factors are put together to work more efficiently. First, there must have a comprehensive plan which maximizes movement to maintain and improve functional independence. Second, the patients must fully cooperate and be motivated to achieve the goals. Lastly, there must be a proper coordination within the whole rehabilitation team which includes full family cooperation (Goetz, 2011).

PD Diagnosis

PD is usually diagnosed clinically, meaning physicians look for presence or absence of potential symptoms of the disorders by interviewing the client and carrying out a comprehensive neurologic examination. The disease is most identified by a general neurologist, who is proficient in diagnosing and treating neurologic disorders. The physician should consult with a movement disorder specialist to avoid misdiagnosis. A movement disorder specialist is a professional doctor, who has undergone further subspecialty training in diagnosing and treating movement disorders like PD after he/she has been trained in general neurology.

Expectations during the first physician visit

It is always advisable to know what one as a patient expects during the first visit to the physician for evaluation of PD symptoms. Care providers should perform the following tasks during the initial physician visit to a health center:

• They take complete and careful medical history of the client
• Take blood pressure of the patient while both seated and standing
• Assess the cognitive or thinking skills of the client
• Examine facial expression of the patient
• Look for tremor in the hands, face, legs or arms of the patient
• Examine presence of stiffness in the torso, legs, arms or shoulders of the client
• They should determine whether the patient can easily get up from a chair without using his arms
• Examine the walking pattern of the patient as well as his balance as he stands (Pahwa & Lyons, 2013)

A well-trained physician considers the diagnosis of PD if the client being examined exhibits a minimum of two vital motor symptoms of PD including tremor, bradykinesia, and rigidity. A physician is supposed to discuss with the patient the absence or present of PD, and the expected level of certainty when receiving a diagnosis. A care provider makes this determination based on the medical history and examination done to the person during this initial visit.

Tools to aid PD diagnosis

After the physicians have taken history and performed a comprehensive neurologic examination, they occasionally use brain imaging to assist in supporting a particular diagnosis. However, due to the limited technology used to diagnosis PD, brain imaging are usually used in selected patients. Brain imaging is rarely performed by movement disorder specialists or neurologists, especially when the symptoms of the patient highly suggest that idiopathic PD is the right diagnosis. Brain imaging is recommended when the diagnosis is uncertain or when caregivers are looking for any changes in the brain that reflect Parkinsonian syndromes or others conditions similar to those of PD. Magnetic resonance imaging (MRI), is usually used to assess PD and Parkinsonian syndromes and is used to examine the structure of the brain (Pahwa & Lyons, 2013). DaTscan is approved by Food and Drug Administration (FDA) to assist in detecting dopamine function in the brain. A DaTscan can help to differentiate idiopathic PD from other disorders that cause Parkinsonian syndromes or tremor. Many physicians offices have access to MRI, but DaTscan imaging is mostly found in larger medical centers or hospitals.

Focused Ultrasound Therapy

This is an early-stage, non-invasive, therapeutic technology that has a potential to advance the quality of life and reduce the cost of providing care for folks with Parkinsons disorder. This high technology focuses ultrasonic rays directly and accurately on deep parts of the brain without damaging adjacent normal tissues. On the spot where beams converge, ultrasound produces various therapeutic effects allowing treatment of the disease to take place without surgery. Currently, no cure for Parkinsons disease that has been discovered, but motor symptoms has important treatment options including drug therapy and invasive surgery. Some common Invasive surgeries include radiofrequency lesioning and deep brain stimulation (Goetz, 2011). Focused ultrasound can offer a non-invasive alternative to surgery with lower cost and less risk of complications. In the long run, focused ultrasound might treat the underlying disorder pathology and avert progression and restore function.

Relief of motor symptoms

According to scholars, focused ultrasound has a high potential of achieving symptomatic relief by ensuring that thermal lesions deep in the brain interrupt circuits that are involved in dyskinesia and tremor activities. Focused ultrasound assesses the following symptoms for treatment:

Parkinsonian dyskinesia by targeting in the subthalamic nucleus or globus pallidusParkinsonian tremor by targeting in the thalamotomy or thalamus

Parkinsonian akinesia or tremor by targeting in the pallidothalamic tract (Pahwa & Lyons, 2013)

Today, focused ultrasound is being evaluated to be used in treating one side of the brain. Hence it will affect dyskinesia or tremor unilaterally. If the technology is used to make the beams to target in the pallidothalamic tract, it might offer knowledge of treating patients bilaterally.

Treating Underlying Pathology

Pre-clinical studies show that focused ultrasound has great potential to restore function in Parkinsons models. It can temporarily open the blood-brain barrier to facilitate delivery of:

• Anti-alpa synuclein antibodies
• Growth factors, genes, stem cells and other neurorestorative or neuroprotective drugs
• Many clinical trials that assess the safety, feasibility and initial efficacy of this technology in treating various symptoms of Parkinsons disease have been conducted.

New Technologies

Mobile phone applications and new wearable sensor networks are being tested to understand how they can be used to monitor and manage individuals with Parkinsons disease. The purpose of the research is to come with affordable wearable sensors that will collect and process accelerometry indicators continuously to sense and quantify the signs of a client automatically. Just like in other diseases, the technology will help the physician to build a profile of the condition for every person and realize a personalized treatment. This will be a significant milestone in an attempt to provide quality healthcare to all patients.

Summary of the care plan

NURSING DIAGNOSIS EXPECTED OUTCOME

NURSING INTERVENTIONS

RATIONALE

EVALUATION

Tremors, slurred speech, and slow body movement than normal Promote and improve motor mobility and function

Minimize or delay progression and impacts of symptoms(Lees & Playfer, 2006)

Maintain the functional abilities of the patient

Maintain normal range of motion in all joints of the patients(Lees & Playfer, 2006)

Improve voice loudness and carry daily communication(Lees & Playfer, 2006)

Implementation of exercise programs early enough(Lees & Playfer, 2006)

Identifying deterioration and intervening on time

Involving the client and carers in decision-making

Employing a broad range of activities to be done by the patient(Lees & Playfer, 2006)

Ensuring client participates in respiratory and prosodic exercises(Lees & Playfer, 2006) To prevent deconditioning and other potential preventable complications(Lees & Playfer, 2006)

To prevent progression of the condition(Lees & Playfer, 200...