 Degenerative neurologic disorders leads to nerve damage

 Progressive disorders
 These diseases affects mainly
• Balance

• Coordination

• Movement

• Speech

• Respiration

• Heart functions
 More than 200 degenerative disorders
 The exact cause is not known
 Mostly genetic transmission
 It can’t be completely cured
 Treatment focuses on symptoms and to maintain
the functional level
 Patients have problems related to safety, self
care, mobility and coping
 Degenerative neurological diseases
include
• Alzheimer's disease
• Amyotrophic lateral sclerosis
• Friedreich's ataxia
• Huntington's disease
• Lewy body disease
• Parkinson's disease
• Spinal muscular atrophy
 Basically affects movement and balance.
 It is a form of parkinsonism
 PD is more common in men [3:2]
 Incidence of PD in India is
• 1% of adult above 65years

• 5% of adults above 85 years

• More than 1 million cases per year

• 7 million people living in India with PD.

 Parkinson’s disease [PD] is a chronic,
progressive, neuro-degenerative disorder
characterized by slowness in the initiation
and execution of movement [bradykinesia],
increased muscle tone [rigidity], tremor at
rest, and gait disturbance.
 Idiopathic

 Genetic [10-15% of reported PD have

family history]
 Environmental triggers [exposure to toxins]
 Male gender
 Age above 65 years
 Lewy bodies
• These are clumps of protein found in the brain of

patients with PD.

• Results in abnormal functioning of brain

• Why it is formed is not known so far.

 It has a gradual onset and slow progress
 The classical symptoms are [TRAP]
• Tremors

• Rigidity

• Akinesia or Bradykinesia

• Postural instability
 Uncontrolled sweating
 Orthostatic hypotension
 Depression, anxiety, dementia
 Delirium, hallucination
 Insomnia
 Micrographia [small handwriting]
 Dysphonia [altered voice production]
 Side effects of medication
 History collection
 Physical examination
 Neurological examination
 Movement and coordination test
 Genetic testing
 MRI
 PET and SPECT scan
 Positive response to levodopa
 Medical management
• It is the mainstay treatment

• Goals of treatment
 No complete cure
 Symptom control
 Maintain functional independence
 Treatment plan is individualized
• Anti parkinson’s medication action
 Increase striatal dopaminergic activity
 Reduce the effect of acetylcholine
 Acting on the neurotransmitter pathway

• Anti parkinson’s drug

 Levodopa [convert as dopamine in basal ganglia]
 Levodopa + Carbidopa [prevent metabolism of
levodopa before reaching brain].
 Examples are ropinirole, pramipexole, rotigotine.
 Can be monotherapy in early disease; need l-dopa in
mid to late disease
 Can add to l-dopa to reduce OFF time
 Frequent side effects! Nausea, sleep attacks,
hypotension, compulsive behaviors, LE edema
 More prone than l-dopa to causing hallucinations and
confusion. Caution in older or demented patients!
 Amantadine and apomorphine
 It blocks reuptake of dopamine into
presynaptic neurons
 Blocks cholinergic receptors
 Helps in balancing cholinergic and
dopaminergic activity.
 Eg: trihexyphenidyl
 It
has anticholinergic effect
 Eg: diphenhydramine
 It
blocks the breakdown of dopamine
 Eg: selegiline
 To relieve symptoms of PD.
 Patients with unresponsiveness to
medical management.
 Surgeries includes
• Deep brain stimulation [DBS]
• Ablation [destruction]
• Transplantation
 DBS
• Most common surgery for PD
• Placing an electrode in in the thalamus, globus
pallidus or sub thalamic nucleus.
• Electrode connected to a generator placed in
the upper chest.
• It delivers specific amount of current to the area
of electrode.
• It can be adjusted with patients symptoms
• It is reversible
 Diet is an important concern for PD patients.
 Malnutrition and constipation is major concern.
 Easily chewable food
 Include roughage and fruits
 Six small meals per day
 Provide ample time for eating
 Decrease protein intake [impair levodopa
absorption]
 Supplement Vitamin B6 and multivitamin
 Nursing assessment
• Subjective data
 Past health history
 Family history
 Medications
 Objective data
 Physical examination
 Neurological examination
 Musculoskeletal examination
 Impaired physical mobility related to
rigidity,