The Parkinson's Disease - Essay Example

PARKINSON’S DISEASE CASE STUDY Parkinson’s disease: A Case Study Mr. John Adams is a Caucasian male who is 64 years old. He was diagnosed with Idiopathic Parkinson’s disease at the age of 58 with initial symptoms of resting tremors in his hands and muscle rigidity when attempting to undertake tasks that he had previously accomplished with ease. The disease was in its initial stages which explain the mild symptoms. Resting tremors, muscle rigidity and bradykinesia are the three main symptoms associated with Parkinson’s disease. Mr. Adams has used medication, Carbidopa/Levodopa 25/100 mg two to three times daily to manage the symptoms of the condition whilst continuing to live independently. During a routine hospital visit it was observed that Mr. Adams appeared unkempt and struggled to move around as freely as he had on a previously hospital visit. He was also noticed to have significant cognitive impairment showing reduced concentration and delayed response in his execution of simple motor tasks. Mr. Adams condition has continued to deteriorate despite his commitment to taking the prescribed medication. This deterioration has now necessitated the hiring of a nurse to assist Mr. Adams with his every day living tasks. Figure one shows the gradual increase of Parkinsons disease in male and females according to age. Figure 1: Incidence of Parkinson’s disease by age and gender, Kaiser Permanente, 1994–1995. While the initial symptoms were mild and only included difficulties in movement and tremors in the hand and some muscle rigidity Mr. Adams condition has continued to deteriorate. This is because the disease advances with age. He is now showing signs of depression including moderate to severe mood swings, dysfunction of the autonomic nervous system, for example bladder dysfunction, impaired gastrointestinal motility and impairment in cognition. These are symptoms that are associated with the deterioration of the condition and mostly occur in the later stages of the disease. Mr. Adams also experiences difficulties in sleeping and as such he has to take medication to aid him to sleep. There are currently no biochemical tests to confirm diagnoses but a combination of clinical signs and history confirm this and post mortem the presence of lewy bodies in the neurons of the substantia nigra to provide final confirmation. In patients with Parkinson’s, substantia nigra degenerates at a faster rate than ordinary people. Mr Adams presented with typical symptoms, due to the symptoms that he presented and the fact that his age made him a prime candidate for Parkinson disease (Waters, 2008, p. 161). There are several complications that Mr. Adams has had to deal with due to his condition. Chapuis et al. assert that the most common complication to patients of Parkinson’s disease is in the disruption of the motor skills. The difficulty in swallowing is also one of the complications that have made it necessary for the patient to change his lifestyle to meet his dietary needs. This is one of the symptoms or complications that face patients with this condition at later stages. The difficulty in swallowing occurs due to the loss of both the voluntary and involuntary muscle control (Le Witt and Oertel, 1991, p. 51). He has also been faced with the problem of dementia. This caused by the significant loss of functionality in the brain that is associated with the condition. For patients with the condition, the rate at which the substantia nigra in the brain dies is higher than that of normal people (Iyer 2000). Dementia presents itself in difficulty in concentrating and in following conversations (Ekman, et al 1995) Parkinson disease is one of the diseases that do not have a cure as yet, and patients often take medication to control the symptoms of the condition and slow down the rate of deterioration. The most effective treatment plan for patients with the condition is treatment with dopamine. This means that the medication that the patient is taking is to help him in the management of the symptoms and help him live a comfortable life. Mr. Adams is currently undergoing counseling therapy as part of his treatment plan. This therapy is part of the care and support that is given to patients with the condition. The therapy is however used together with medication (dopamine) to manage the symptoms and the complications arising from the condition. In the United States, the deep brain stimulation therapy has recently been approved by the Food and Drug Association. This therapy is done by electronic stimulation of parts of the brain, and should be considered for use in the UK as it has shown positive results upon use in the United States. This is according to clinical trials such as the one conducted by Weaver et al (2009). It is expected that the therapy will also help him in stopping the tremors and regaining control of the ability to move around freely (Weaver FM, Follett K, Stern M, et al., 2009, p. 65). In addition to the brain stimulation therapy, Mr. Adams has to take the medication that is usually prescribed for the Parkinson disease. These medications include Carbidopa and Levodopa. The Carbidopa is given together with Levopida to help delay its conversion to dopamine until such a point that the medication reaches the brain. Levodopa is converted into dopamine by the brain. Carbidopa works as a decarboxylase inhibitor that prevents the Levodopa from converting into dopamine before it gets to the brain (Katzenschlager and Lees, 2004). The treatment of the condition becomes more complex as the condition advances. At the advanced stage, the condition is managed through a combination of rehabilitative measures, speech therapy, nursing care and occupational therapy. (Varanese et al, 2010). This means that Adams is undergoing a combination of the medication and the therapy because of the deteriorating nature of his symptoms. The combination is important as it helps in the treatment of the physical signs as well as the emotional complications that are brought about by the condition. Adams is being observed to ensure that he continues to respond to the combination of the medication and the therapy. If his symptoms continue to deteriorate, then the option of surgery will be explored. The neurosurgical therapy is directed at either GPI or STN (Eskandar et al., 2010). This is because surgery can target the specific parts of the brain that have been affected by the condition. The limitations to the treatment options that are explored is that they have numerous side effects that make life uncomfortable for the patient. Such side effects include vomiting and nausea. Another complication to the medication is that it does not cure the condition. The medication only seeks to manage the symptoms. The symptoms that Mr. Adams has have however continued to get worse despite the medication (Kum et al., 2009, p. 1035). In addition to the medication, Mr. Adams has been advised and has gone ahead to make some lifestyle changes to help him manage his condition. These changes include making changes in his diet. This was made necessary by the fact that he sometimes had difficulties in swallowing hard solid foods as he cannot control his muscles (Factor and Veiner, 2007). As such, his diet now consists of softer foods that are easy to swallow yet are balanced to meet his dietary needs. He has also had to undergo physical therapy to help him regain coordination in his movements. There are several adjustments that have had to be made to his house to ease his life. These adjustments include the installation of railings and banisters to help him move around the house comfortably. The research on the condition is still ongoing. There is therefore hope that with research, patients such as Adams will have better ways of managing the symptoms and complications that arise as a result of the condition. In the meantime, Adams continues to be under medication and his case is evaluated on a constant basis. This makes it possible for new symptoms to be detected and treated early enough. The complications of the condition can also be managed appropriately. References Chapuis, S. et al 2005, Impact of the motor complications of Parkinsons disease on the quality of life. Movement Disorders, 20(2). Ekman ,R., ,et al. 1995, ECT in Parkinsons disease. Changes in motor symptoms, monoamine metabolites and neuropeptides. Journal of neural transmission, 10 (2-3). Eskandar, E, et al ‘Surgery for Parkinson’s Disease.’ Retrieved from http://neurosurgery.mgh.harvard.edu/functional/PDsurgery.htm. Factor, S., Veiner, W 2007, and Parkinson’s disease: diagnosis and clinical management, Demos Medical Publishing, New York. Katzenschlager, R., Lees, A., 2004, Treatment of Parkinson’s disease: levodopa as the first choice. Journal of Neurology, 249(2). Kum, et al., 2009., Risk factors in development of motor complications in Chinese patients with idiopathic Parkinson’s disease Journal of Clinical Neuroscience, (16) 8, 1034-1037. Le Witt, P., Oertel., W., 1999, Parkinsons disease: the treatment options, Taylor and Francis, New York. Varanese, S. et al 2010, treatment of Parkinson’s disease. Parkinson’s disease. 2010 (2010). Waters, C 2008, diagnosis and management of Parkinson’s disease, Professional Communications Inc., New York. Weaver FM, Follett K, Stern M, et al., 2009, Bilateral deep brain stimulation vs. best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. JAMA, 301(1):63-73. Read More