Parkinson's Disease

Parkinson’s disease is a progressive neurological condition, marked by both motor and non-motor symptoms.

Parkinson’s disease is the result of deterioration occurring in the nerve cells in the middle area of the brain (parietal lobe), the area in which dopamine is produced (Better Health Channel 2017).

Dopamine relays messages between areas of the brain that are responsible for body movement (Brain Foundation n.d.), it is vital for the smooth control of muscles and mobility more broadly (Health Direct 2018). Low levels of dopamine make it difficult to manage muscle tension and muscle movement both at rest and during activity (Brain Foundation n.d.).

Parkinson’s is often understood as ‘movement disorder’ due to its association with tremors, stiffness and balance problems, however, there are many non-movement issues that occur as a result of this disease. Non-movement symptoms include depression, constipation and memory loss (The Michael J. Fox Foundation n.d.a).

As Parkinson’s disease is a progressive condition, its symptoms worsen over time (Parkinson’s News Today n.d.).

Parkinson’s Disease Facts

The disease is named after British physician James Parkinson, who first described it in ‘An Essay on the Shaking Palsy’ in 1817 (Parkinson’s News Today n.d.).

It is estimated that there are close to 80,000 Australians living with Parkinson’s disease (Parkinson’s NSW 2019).

Parkinson’s disease is a global phenomenon, recognised across cultures. It is estimated to impact 6.3 million people worldwide and is slightly more common in men than in women, with a ratio of 5:4 (Parkinson’s News Today n.d.; Parkinson’s Australia 2013).

Primarily, Parkinson’s disease occurs in people over the age of 65, but onset can take place earlier (Health Direct 2018).

An American study found that 10 to 20% of people with Parkinson's will experience symptoms before the age of 50, this is called ‘young onset’. Treatments are the same but the experience of the disease tends to differ (The Michael J. Fox Foundation n.d.a).

Causes of Parkinson’s Disease

There is no known cause of Parkinson’s disease, hence the name ‘idiopathic Parkinson’s disease’, and it is not yet clear why some people develop Parkinson’s disease while others do not (Parkinson’s Australia 2017b).

Factors that may contribute to the cause of Parkinson’s disease include the following (or a combination of these):

• Age;
• Genetics;
• Environment;
• Head trauma;
• Chemical exposure; and
• Infectious proteins.

(Parkinson’s Australia 2017a; Better Health Channel 2017)

It is thought that only a small percentage of cases (around 30%) are passed on through genetics (Parkinson’s Australia 2017b; The Michael J. Fox Foundation n.d.a).

Symptoms of Parkinson’s Disease

The symptoms of Parkinson’s disease will vary according to type, severity and progression. Some of the main symptoms include:

• Motor skills:
• • Involuntary tremors or shaking, often beginning in one hand or arm;
  • Muscle stiffness and rigidity;
  • Slowed movement (bradykinesia);
  • Stooped posture;
  • Freezing (sudden inability to move);
  • Difficulty with balance.
• Non-motor skills:
• • Depression;
  • Pain;
  • Apathy;
  • Low blood pressure;
  • Sleeping difficulties;
  • Problems with memory;
  • Problems with urination;
  • Sexual dysfunction;
  • Sensory changes;
  • Changes in the gastrointestinal system.

(Health Direct 2018; Parkinson’s News Today n.d.; Better Health Channel 2017; The Michael J. Fox Foundation n.d.b)

While tremors are often associated with Parkinson’s, they only occur in 70% of cases (Parkinson’s Disease 2017a).

Diagnosis of Parkinson’s Disease

At present, to make a clinical diagnosis of Parkinson’s, the four cardinal symptoms of Parkison’s are utilised, in combination with a positive response to Levodopa (Parkinson’s Australia 2019).

The cardinal symptoms are:

• Bradykinesia;
• Muscle rigidity;
• Tremor(s); and
• Postural instability.

(Parkinson’s Australia 2019)

A referral to a neurologist or geriatrician is recommended for diagnosis (Parkinson’s Australia 2019).

Diagnostic investigations can include:

• Magnetic resonance imaging (MRI);
• Computerised tomography (CT);
• Functional neuroimaging (SPECT & PET); and
• A metaiodobenzylguanidine (MIBG) scan may be considered to differentiate Parkison’s and Atypical Parkinsonism.

(Parkinson’s Australia 2019)

Reactions ranging from anger to disbelief are to be expected from patients when they receive a diagnosis of Parkinson’s Disease. Support and education are integral to overcoming the shock of a Parkinson’s diagnosis. For some, the emotional impact of the diagnosis may outweigh the physical limitations in the early stages (Parkinson’s Australia 2019).

Managing Parkinson’s Disease

There is not yet a cure for Parkinson’s disease. However, symptoms can be managed effectively by observing the following:

• Medications to increase/substitute for dopamine (Levodopa);
• A healthy and balanced diet;
• Regular exercise;
• Multidisciplinary treatment such as a combination of therapies, including physiotherapy; occupational therapy; speech pathology; and psychology;
• Surgical treatments, such as brain stimulation.

(Health Direct 2018; Parkinson’s Australia 2017a)

Surgical Intervention

There have been multiple exciting developments in surgical responses to Parkinson’s in recent years.

Deep Brain Stimulation

Deep brain stimulation (DBS) is the process of using mild electric impulses to stimulate a chosen area of the basal ganglia in the mid-area of the brain (Parkinson’s Australia 2018).

Deep brain stimulation (DBS) is the primary surgery used for Parkinson’s treatment. Note this is not a cure, but a method of managing symptoms – particularly movement symptoms such as slowness, stiffness and tremors (Parkinson’s Victoria n.d.).

As a result of DBS, a patient may be able to reduce their medication. To be a candidate for DBS, a person will need to meet certain criteria. As with all surgery, there are significant risks involved (Parkinson’s Australia 2018).

Lesioning Techniques

Lesioning is the process of making selective damage (a lesion) to certain cells in a target area of a person’s brain (Parkison’s Victoria n.d.).

Lesioning surgery can be an effective treatment for Parkinson’s, but it isn’t a recommended choice for most people because lesioning may cause irreversible side effects (Parkinson’s Victoria n.d.).

Rehabilitation of Patients with Parkinson’s Disease

Rehabilitation programs from an interprofessional team including doctors, physiotherapists, occupational therapists, speech therapists, palliative care services and specialist nursing care can be very beneficial for people with Parkinson’s.

Physiotherapy may help to decrease disability, and regular exercise has many benefits for the individual, including increased muscle strength and flexibility, reduced muscle cramping, improved posture, improved coordination and balance and improved control over gross body movements. A rehabilitation program can ensure a patient with Parkinson’s receives holistic care and treatment whilst in a supportive environment (Greenwood et al. 2013).

Nursing Care of Patients with Parkinson’s Disease

When a patient with Parkinson’s is in hospital, it is the nurse who has the most direct care with them. This means they are able to observe the patient's level of function throughout the day and assist with implementing strategies to improve it.

Nurses need to display patience and understanding when caring for patients with Parkinson’s, as patients may need a long time to complete activities of daily living, and their level of function may fluctuate from one day to the next.

As with any degenerative neurological disorder, the effects of Parkinson's are widespread. Care needs to not only address the physical effects Parkinson's has on the body, but also the patient's emotional, psychological and social needs. Therefore, support for these individuals and their carers is essential, and as nurses, we can help provide this support (Greenwood et al. 2013).

Conclusion

Parkinson’s is not considered fatal, however, the progression of the symptoms can considerably reduce a person’s overall quality of life (Parkinson’s News Today n.d.)

There are multiple effective treatments available to manage and offer considerable relief of the symptoms of Parkinson’s disease. In some cases, surgery is an appropriate treatment. Multidisciplinary treatment by physiotherapists, neurologists, dietitians and counsellors may be recommended (Parkinson’s NSW 2019; Health Direct 2018).

Additional Resources

• The Michael J. Fox Foundation
• Parkinson’s Australia

References

• Better Health Channel 2018, Parkinson's Disease, Better Health Channel, viewed 7 October 2019, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/parkinsons-disease
• Brain Foundation n.d., Parkinson’s Disease, Brain Foundation, viewed 7 October 2019, https://brainfoundation.org.au/disorders/parkinsons-disease/
• Greenwood, RJ, Barnes, MP, McMillan, TM & Ward, C (eds) 2013, Handbook of Neurological Rehabilitation, 2nd edn, Routledge, New York.
• Health Direct 2018, Parkinson's Disease, Health Direct, viewed 7 October 2019, https://www.healthdirect.gov.au/parkinsons-disease
• Michael J. Fox Foundation n.d.a, Parkinson’s 101, Michael J. Fox Foundation, viewed 9 October 2019, https://www.michaeljfox.org/parkinsons-101
• Michael J. Fox Foundation n.d.b, Symptoms, Michael J. Fox Foundation, viewed 9 October 2019, https://www.michaeljfox.org/symptoms
• Parkinson’s Australia 2013, Description, Incidence and Theories Of Causation, information sheet, Parkinson’s Australia, viewed 9 October 2019, https://docs.wixstatic.com/ugd/bfe057_34024982ceed4546803bace895e9d86e.pdf
• Parkinson’s Australia 2017a, About Parkinson's, Parkinson’s Australia, viewed 9 October 2019, https://www.parkinsons.org.au/aboutparkinsons
• Parkinson’s Australia 2017b, What Causes Parkinson's, information sheet, Parkinson’s Australia, viewed 7 October 2019, https://www.parkinsons.org.au/diagnosis-symptoms
• Parkinson’s Australia 2019, Diagnosis of Parkinson’s, information sheet, Parkinson’s Australia, viewed 9 October 2019, https://docs.wixstatic.com/ugd/bfe057_e76ea0d02a984be68e557dbb96432293.pdf
• Parkinson’s Australia 2018, Surgery for Parkinson’s, information sheet, Parkinson’s Australia, viewed 9 October 2019, https://docs.wixstatic.com/ugd/bfe057_14450a71185b4e56a261ce3869de6407.pdf
• Parkinson’s News Today n.d, What is Parkinson’s Disease?, Parkinson’s News Today, viewed 7 October 2019, https://parkinsonsnewstoday.com/what-is-parkinsons-disease/
• Parkinson’s NSW 2019, Parkinson’s Disease, Parkinson’s NSW, viewed 7 October 2019, https://www.parkinsonsnsw.org.au/about-parkinsons-disease/parkinsons-disease/
• Parkinson’s Victoria n.d., Surgery, Parkinson’s Victoria, viewed 9 October 2019, https://www.parkinsonsvic.org.au/parkinsons-and-you/surgery/