Parkinson Disease and Parkinsonism
Lack of coordination is characteristic of Parkinson disease. Rhythmic tremors develop, insidiously at first. In some muscle groups, these tremors lead to rigidity, and in others, weakness. Affected patients may have trouble maintaining position or posture, and they may develop the condition known as bradykinesia, marked by difficulties in performing intentional movements and extreme slowness or sluggishness.
As Parkinson disease progresses, walking becomes a problem; a shuffling gait is a hallmark of the condition. In addition, patients may drool, and their speech may be slow and slurred. As the cranial nerves are affected, they may develop a mask-like expression. Parkinson disease does not affect the higher levels of the cerebral cortex, so a very alert and intelligent person may be trapped in a progressively degenerating body.
Parkinsonism is a term used to describe the Parkinson disease–like extrapyramidal symptoms that are adverse effects associated with particular drugs or brain injuries. Patients typically exhibit tremors and bradykinesia.
See the following table of Anticholinergic Agents
At this time, there is no treatment that arrests the neuron degeneration of Parkinson disease and the eventual decline in patient function. Surgical procedures involving the basal ganglia have been tried with varying success at prolonging the degeneration caused by this disease. Drug therapy remains the primary treatment.
Therapy is aimed at restoring the balance between the declining levels of dopamine, which has an inhibitory effect on the neurons in the basal ganglia, and the now-dominant cholinergic neurons, which are excitatory. This may help to reduce the signs and symptoms of parkinsonism and restore normal function for a time. Total management of patient care in individuals with Parkinson disease presents a challenge. Patients should be encouraged to be as active as possible, to perform exercises to prevent the development of skeletal deformities, and to attend to their care as long as they can. Both the patient and family need instruction about following drug protocols and monitoring adverse effects, as well as encouragement and support for coping with the progressive nature of the disease.
Because of the degenerative effects of this disease, patients may experience episodes of depression or emotional upset. Psychological support, as well as physical support, is a crucial aspect of care.