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What is Parkinson’s?

What is Parkinson’s?. Third Edition September 2008. This presentation has been produced by GlaxoSmithKline. The H istory of Parkinson’s 1. Parkinson's was first described by Dr James Parkinson in 1817 He noted ‘ Involuntary tremulous motion’ ‘A propensity to bend forwards’

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What is Parkinson’s?

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  1. What is Parkinson’s? Third Edition September 2008 This presentation has been produced by GlaxoSmithKline

  2. The History of Parkinson’s1 • Parkinson's was first described by Dr James Parkinson in 1817 • He noted • ‘Involuntary tremulous motion’ • ‘A propensity to bend forwards’ • ‘The senses and intellect are intact’ • In the 1860s Charcot named the condition Parkinson’s disease

  3. Parkinson’s defined2 Parkinson’s is a progressive neurodegenerative condition resulting from the death of the dopamine-containing cells of the substantia nigra

  4. Parkinson’s in the UK3

  5. Men are 1.5 times more likely than women to develop Parkinson’s4 1.5x Female Male

  6. 50 60 70 Ageing Genes Environment Possible protective effect: smoking and caffeine What causes Parkinson’s? Parkinson’s disease

  7. Basal ganglia structure9 Subthalamic nucleus acts like a car brake on the basal ganglia Substantia nigra acts like a car accelerator on the basal ganglia Adapted from www.stanford.edu/group/hopes/basics/braintut

  8. Normal motor control12 Normal movement Dopamine increases the inhibitory activity of the direct pathway Motor cortex GPi inhibitory activity is reduced Thalamus Striatum Dopamine Dopamine decreases the excitatory activity of the indirect pathway Excitatory (indirect) Substantia Nigra (SN) Inhibitory (direct) Adapted from Swinn, Parkinson’s disease, Theory and practice for nurses.

  9. Changes in the basal ganglia in Parkinson's12 The motor cortex receives diminished excitatory output from the thalamus so movement is inhibited Dopamine depletion results In decreased inhibitory activity of the direct pathway GPi inhibitory activity is increased Inhibition of the thalamus Striatum Dopamine depletion Dopamine depletion Increases the excitatory activity of the indirect pathway Excitatory (indirect) Substantia Nigra (SN) Inhibitory (direct) adapted from Swinn, Parkinson’s disease, Theory and practice for nurses.

  10. Pathophysiology of Parkinson's13 • Presence of Lewy bodies in the: • Basal ganglia • Brain stem • Cortex • Loss of pigmented (dopaminergic) neurons • Change in alpha-synuclein protein • Damage to the substantia nigra Number correlates with disease progression

  11. When do clinical signs of Parkinson's develop?14 Striatal dopamine levels Reduced by 80% Cell loss in the substantia nigra Reaches 50%

  12. The ‘Braak hypothesis’15 Stage 5 and 6:Changes spread to the cortex Stage 3 and 4:Pathology spreads to the midbrain and basal ganglia Stage 1 and 2:Pathology confined to certain structures in the brain stem, not yet the substantia nigra Image adapted from The Professionals Guide to Parkinson’s Disease, Parkinson'sS

  13. Neurotransmitters in the basal ganglia17 Neurotransmitter Action Site of action Excitatory to D1 receptors (direct pathway) Inhibitory to D2 receptors (indirect pathway) Striatum Dopamine Excitatory Acetycholine Striatum Links with direct and indirect pathways GABA Inhibitory Substance P Inhibitory Localised with GABA in the direct pathway Enkephalin Inhibitory Localised with GABA in the indirect pathway

  14. The message is transmitted Introduction to dopamine and its receptors18 Dopamine synthesis Neurone Dopamine vesicles Catechol-O-methyltransferase Pre-synaptic membrane Dopamine inactivation Synapticcleft Monoamine oxidase Dopamine release Post-synaptic membrane Dopamine receptorsD1, D2, D3, D4, D5 Image adapted from B R Thanvi, post grad. 80. p453

  15. Diagnosis of Parkinson's Cardinal motor signs Postural instability Bradykinesia Rigidity Tremor Levels of diagnostic confidence Possible Definite Probable

  16. Motor symptoms of Parkinson's Motor symptoms of Parkinson’s Postural instability Speech Hypomimia Micrographia Reduced arm swing Turning in bed Turning Posture Freezing Tremor Arising from a chair Gait festination Shuffling gait Bradykinesia Click the symptom to view a video Falls (no video) Rigidity

  17. Ten most reported everyday tasks patients have difficulty with25 Writing 80 Doing up buttons and zips 71 Turning over in bed 64 Getting in and out of a chair 63 Starting to walk 56 Task Getting in and out of bed 55 Opening bottles, jars or tins 53 Picking things up 47 Controlling saliva 47 Climbing stairs or steps 47 0 10 20 30 40 50 60 70 80 % of respondents

  18. Non-motor symptoms of Parkinson's Autonomic Neuropsychiatric Sleep disturbance Sensory symptoms Dementia Depression Apathy Anxiety Loss of libido REM sleep disorder RLS Vivid dreams Daytime somnolence Dystonia Constipation Urinary incontinence Erectile dysfunction Excessive sweating Postural hypotension Excessive salivation Pain Paraesthesia

  19. Sleep disturbance Impact of Parkinson's on patients’ quality of life Non-motor symptoms Motor symptoms Disruption to daily life Activities of daily living Handwriting Cutting food Walking Speech Pain Panic Dizziness Depression

  20. Author contact details If you have any further questions, please contact: Lynne Osborne Nurse Consultant Parkinson's Disease Camborne Redruth Community Hospital Barncoose terrace Redruth TR15 3ER Tel: 01209 88 1719

  21. References • Parkinson J (1817) An Essay on Shaking Palsy, Macmillan & PDS, London • National Institute for Health and Clinical Excellence.(2006) NICE Clinical guideline 35. Parkinson’s disease: diagnosis and management in primary and secondary care • Clarke C (2007 second edition) Parkinson’s Disease in Practice. Royal Society of Medicine Press. London. pg1 • Clough C, et al. (2007) Fast Facts: Parkinson’s Disease. Health Press Ltd. pg9 • Playfer J, et al (2001) Parkinson’s Disease in the Older Patient. Arnold, London. pp11&18 • Edwards M, et al. (2008), Parkinson’s Disease and other Movement Disorders. Oxford University Press. pg38 • Swinn L (2005) Parkinson’s disease, Theory and Practice for Nurses. Whurr Publishers Ltd. pg5 • Clarke C (2007 second edition) Parkinson’s Disease in Practice. Royal Society of Medicine Press, London. pp6&7 • http://www.stanford.edu/group/hopes/basics/braintut/ab6.html (link accessed 15/08/08) • Edwards M, et al (2008) Parkinson’s Disease and other Movement Disorders. Oxford University Press. pg10 • Clarke C (2007 second edition) Parkinson’s Disease in Practice. Royal Society of Medicine Press, London. pg15 • Swinn L (2008) Parkinson’s disease, Theory and Practice for Nurses. Whurr Publishers Ltd. pp1-3 • Edwards M, et al (2008) Parkinson’s Disease and other Movement Disorders. Oxford University Press. pg24 • Clarke C (2007 second edition) Parkinson’s Disease in Practice. Royal Society of Medicine Press, London. pg11 • PDS (2007) The Professionals Guide to Parkinson’s Disease. pg1 • Clough C, et al. (2007) Fast Facts: Parkinson’s Disease. Health Press Ltd. pg23

  22. References • Edwards M, et al (2008) Parkinson’s Disease and other Movement Disorders. Oxford University Press. pg16 • Thanvi BR, Lo T C N (2004) Long term motor complications of levodopa. Postgrad. Med.80. pp452-458 • Quinn N (1997) Parkinson’s Disease: Clinical Features. Balliere’s Clinical Neurology. pg81 • Clarke C (2007 second edition) Parkinson’s Disease in Practice. Royal Society of Medicine Press. London. pg29 • Douglas J (1999) Diagnostic Criteria for Parkinson’s disease. American Medical Association. pp33 – 39 • Swinn L (2008) Parkinson’s disease, Theory and Practice for Nurses. Whurr Publishers Ltd. pg10 • Swinn L (2008) Parkinson’s disease, Theory and Practice for Nurses. Whurr Publishers Ltd. p10118 -119 • Playfer J, et al (2001) Parkinson’s Disease in the Older Patient. Arnold, London pp47-196 • PDS (2008) Members survey report – Life with Parkinson’s today – room for improvement. pp4&25 • Edwards M, et al (2008) Parkinson’s Disease and other Movement Disorders. Oxford University Press. pg34 • Clarke C (2007 second edition) Parkinson’s Disease in Practice. Royal Society of Medicine Press, London. p69-74 • Edwards M, et al (2008) Parkinson’s Disease and other Movement Disorders. Oxford University Press. pg 60 • Happe S, et al (2002) The association between Disease severity and Sleep related problems in patients with Parkinson’s disease . Neuropsychobiology 46. pp0-96 • Swinn L (2008),Parkinson’s disease, Theory and Practice for Nurses. Whurr Publishers Ltd. pg48 • Playfer J, et al (2001) Parkinson’s Disease in the Older Patient. Arnold, London pg92 and 286

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