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.

The initial presentation of Parkinson’s may be subtle, usually begining with mild unilateral symptoms such as pill rolling (circular movement of the tips of the thumb and the index finger when brought together) or a fine tremor at rest. As the disease progresses, bilateral and more severe symptoms are noticed. The patient expreiences a decrease in all functional abilities, causing autonomic dysfunction, musculoskeletal deformities sensory issues psychiatric symptoms, sleep disturbances, and dermatological problems as the disease progresses.

Understanding Parkinson’s Disease Anatomical Chart

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

1. Cognitive dysfunction: dementia, confusion
   • Approximately 15-20% of patient with parkinson’s develope a dementia similar to Alzheimer’s disease.
2. Mood disorders: depression, anxiety, apathy, or abulia 意志缺乏
   • Approximately 40% (as many as 50%) 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

Common complications include falls, aspiration pneumonia respiratory and urinary tract infection, malnutrition contractures orthostatic hypotension, dyskinesia (impaired ability to perform voluntary movement) akinesia (loss of muscle movement), and dementia.

Reference:

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