Hospice & Palliative Care

End Stage Neurological Disorders – Parkinson’s Disease 帕金森病 (Learning about Hospice)

Parkinson’s disease is a fairly common disease of the central nervous system. It is a chronic, progressive neurodegenerative disease defined by the classic trial of tremor, rigor 僵直, and akinesis 运动消失 (There is a slow progression of motor skill complications, including resting tremors, excessive slowness in activity, and rigidity). Classic signs include pill-rolling movements in the hands, loss of facial expression, difficulty initiating movements, and gait changes. Because of its slow progression, patients may initially present with generalized weakness, aching, fatigue, and malaise. A slight tremor of an extremity may also be noted. Symptoms result from an imbalance between dopamine-activated and acetylcholine-actived neural pathways in the basal ganglia and are generally found in people older than 65 years. Parkinson-like symptoms can also be caused by medication toxicity, head trauma, or other degenerative conditions.

Typical non-motor symptoms and signs of Parkinson’s disease:

  1. Cognitive dysfunction: dementia, confusion
  2. Mood disorders: depression, anxiety, apathy, or abulia 意志缺乏
    • Approximately 40% of Parkinson’s Disease patients experience depression. Depressive symptoms are linked to increased motor disability and decreased quality of life.
  3. Autonomic dysfunction: urinary urgency or frequency, constipation, orthostasis, erectile dysfunction
  4. Pain and sensory disturbances: secondary to dystopia, dyskinesia
  5. Psychosis: hallucinations, delirium
    • Hallucinations occur especially in the advanced stages of the disease and affect up to 40% of patients.
    • Symptoms are often drug induced, the first step should include the critical reassessment of potentially offending antiparkinsonian drugs. Antiparkinsonian drugs should be reduced or stopped in reverse order of their potency and effectiveness if hallucinations are causing significant disability.
  6. Sleep disturbances: sleep interruption, periodic limb movement disorder (PLMS), sleep behavior disorder (RBD)
  7. Fatigue
  8. Dermatological findings: seborrhea 头皮痒

 

Reference:

Yennurajalingam, S., & Bruera, E. (2016). Oxford American Handbook of Hospice and Palliative Medicine and Supportive Care (2nd. Ed.)

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