Define Parkinson's disease?
Parkinson Disease is a long-term degenerative dysfunction of the central nervous system. It mostly affects the motor system. The symptoms associated with the disease usually appear over time slowly. They include; slowness in movement, the rigidity of muscles, shaking, and difficulty in walking. The secondary effects involve thinking, and behavioral problems and dementia become a common symptom at the advanced stage of the disease. Other people show indications of depression and anxiety. The main motor symptoms collectively referred to as Parkinsonian Syndrome (AB Singleton, M Farrer, J Johnson, 2003).
The cardinal motor and non-motor symptoms of PD
There are four motor symptoms considered cardinal in Parkinson's disease; they are, slowness of movement, postural instability, tremor, of the hand at rest but disappears during voluntary movement of the hand, and rigidity of limb movement as a result of muscle tone. The non-motor symptom is neuropsychiatric disturbance which includes disorder of behavior and thought mood and cognition.
Symptoms of PD present in the patient
The patient complains of stiffness on her right side which is caused by muscle stiffness resulting to the slowness of movement caused by a disturbance in motor planning of movement initiation and linked to difficulties in motion along the whole process of action. That is, from plan to start, to the execution of a movement. She complains of taking too long to think, and she complains of taking longer to remember things. The symptom belonged to the Neuropsychiatric disturbance and manifested in executive dysfunction. Her symptoms lay cognitive flexibility, working memory and abstract thinking. Her slowed thinking process can also be as a result of delayed cognitive processing speed and impaired recall. Her reduced libido level can be perceived to be as a result of impulsive control disorder with her in particular to be compulsive sexual behavior which may be as a result of medication specifically orally active dopamine agonists.
Goals of Pharmacotherapy in this case
Using medication to manage PD will help in; provide significant improvements and allow improved movements, enhance the performance of daily activities, to manage implementation and monitoring so that to maintain a balance between clinical efficacy and adverse events. To increase the level of dopamine in the body. To counter the imbalance that is as a result of the dopaminergic loss.
Classification of dopamine
They are five types of dopamine namely; D1, D2, D3, D4, and D5. The receptors are divided into two significant subclasses of type D1like group which consists of D1 and D5 because they have similar structure and drug sensitivity. The other receptors (, D2, D3, D4) are grouped as D2like because they are identical in structure (SE Daniel, L Kilford, 1992).
Significant pathways for the dopaminergic system in the brain
The dopamine receptors pathways are; Nigrostriatal. Mesocortical, Mesolimbic, and Tuberoinfundibular. Nigrostriatal located at Substancia nigra, hippocampus, hypothalamus, kidney, blood vessels. Its function is to allow movement and sensory stimuli. Mesocortical mostly concentrated in mesolimbic, olfactory bulb, kidney, and hypothalamus. Its functions include cognition, emotional behavior, memory, learning, and attention. Mesolimbic found in low level in the hypothalamus, kidney, heart, cortex adrenal glands. Its functions include pleasure and reward-seeking behavior, emotion, addiction, and perception. Tuberoinfundibular only found in the CNS, and its functions are controlling the hypothalamic-pituitary endocrine system and inhibiting prolactin secretion (U Ungerstedt, 1971).
Synthesis of dopamine
The synthesis of dopamine is done from the amino acid tyrosine. The amino acid is taken up to the brain through the process of active transport. The liver manufactures tyrosine from phenylalanine through the action of phenylalanine hydroxylase. Tyrosine is taken to dopamine-containing neurons where a series of chain reactions take place to form to convert it to dopamine.
The role of dopamine in the patient with Parkinson Disease
Dopamine receptors are extensively localized in the brain; dopaminergic dysfunction is implicated in the pathophysiology of Parkinson's disease. Dopamine helps to control the moods of patients; decreased dopamine functioning is associated with depression, while increased dopamine activity contributes to mania. Mesolimbic dopamine pathway can be dysfunctional in depression while the dopamine D1 receptors can be related to hypoactive in depression. Dopamine is one of the neurotransmitters that are involved in the pathogenesis of ADHD. The impulses and behavior problems that are associated with ADHD are most likely caused by low levels of dopamine in the brain.
Assessment of the potential problems observed in the physical examination and laboratory findings
The trouble with dressing- putting on nylon socks and small bottom indicates slowed movement of the arms which can be as a result of the stiffness of the muscles especially around the arm or shaking of the hand which is causing the rapid movement. Her walking (freezing and walking) has not been affected; this means her postural stability has not been affected yet.
Monitoring parameters to be used to evaluate the patient response to medications and to detect adverse effects
Using self-rated scale such as BDI to track treatment adherence and side effects to adjust treatment and help patients achieve the best outcome. Measurement-based care clinicians to help make informed decisions during critical times.
Education to be provided to the patient
She should be told that some the drugs she is taking are likely to bring about new behavioral changes and that she should try to minimize any that affects her and people around her.
Side effects from the therapy
The impulsive control disorder in her mainly to be compulsive shopping behavior may be as a result of medication specifically orally active dopamine agonists. So she should try to reduce her shopping behaviour (RC Pierce, V Kumaresan, 2006).
Adjustment in drug therapy to be recommended
The after-effects may be as a result of overuse of the medication and thus, she should control her usage of the drugs.
Advice to reduce the effects of the therapy
If the side effects outweigh the benefits, she should reduce the intake of the medicines and seek further assistance from Parkinson's specialist.
Problems of the patients
Tremor, rigidity, stiffness, and gait problem, slowed and increased clumsiness, mild depression, sleep problems and forgetfulness. Reduced ability to make decisions, and anxiety
Adjustments in drug therapy at this time
She should increase her intake of Benztropine to restore the balance between dopamine and acetylcholine to ease the tremors and muscle stiffness. She should increase her water intake to at least ten glasses a day and take warm baths and do physical exercises to help her body digest and absorb the medications.
Singleton, A. B., Farrer, M., Johnson, J., Singleton, A., Hague, S., Kachergus, J., ... & Lincoln, S. (2003). a-Synuclein locus triplication causes Parkinson's disease. Science, 302(5646), 841-841.
Hughes, A. J., Daniel, S. E., Kilford, L., & Lees, A. J. (1992). The accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinicopathological study of 100 cases. Journal of Neurology, Neurosurgery & Psychiatry, 55(3), 181-184.
Ungerstedt, U. (1971). Stereotaxic mapping of the monoamine pathways in the rat brain. Acta Physiologica, 82(S367), 1-48.
Pierce, R. C., & Kumaresan, V. (2006). The mesolimbic dopamine system: the final common pathway for the reinforcing effect of drugs of abuse?. Neuroscience & biobehavioral reviews, 30(2), 215-238.
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