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.

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Parkinson Disease 帕金森病 (Reading & Sharing)

Parkinson’s Disease (PD) is a chronic degenerative disease of the nigrostriatal pathway that affects the dopamine producing neurons in the brain which cause an imbalance and impairment motor function that led to its name as a Shaking Palsy Disease when it was discovered in the 1800’s by Dr. Parkinson (Braun et al, 2017). The pathophysiology of PD shows a reduction of dopamine in the corpus striatum of the brain which upsets the normal balance between the inhibitory dopamine and excitatory acetylcholine neurotransmitters. This prevents the affected brain cells from performing their normal inhibitory function within the CNS and causes most of the parkinsonian symptoms which appears as characterized by tremor, bradykinesia, rigidity, and postural instability (Ekman et al ,2013):

  • Resting tremor, may be worse on one side of the body affecting the limbs and sometimes involves the head, neck, face, and jaw
  • Bradykinesia is slowness of movement, loss of spontaneous movement, and delay in initiating movement; and akinesia which is absence or poverty of normal movement
  • Rigidity in performance of all movements, and increased during movement.
  • Mask like facies secondary to rigidity and drooling.
  • Postural abnormalities: head bent forward, stooped posture, loss of postural reflexes
  • And other manifestations such as poor balance, autonomic disorders, depression, gait difficulties, verbal fluency impaired, and etc.

The above clinical manifestations could lead to complications such as injury from 1) Falls, 2) Food Aspiration due to impaired swallowing, 3) Urinary Tract Infections, and 4) Skin breakdown due to increased immobility. It is therefore of prime importance to measure the patient’s quality of life since PD is a debilitating disease and patient’s emotional and social well being are affected by its physical symptoms.

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