Case Study Discussion: Parkinsons Disease

Case Study Discussion: Parkinsons Disease

This week’s case study is about a 67-year-old man who was diagnosed with Parkinson’s disease. The patient presented with tremors, stiffness, masklike immobile face, uneven gait, jerky cogwheeling movements, and episodes of nonactivity-related extreme sweating. The purpose of this case study is to describe the pathophysiology, the ethnic variables that impact the physiological functioning of PD patients, and their effects on the patients.

Pathophysiology

The predisposing factors of PD include age, environmental conditions like smoking, MPTP exposure, pesticide and herbicide exposure, and being male. There are two main pathophysiologic processes in the neurological and musculoskeletal presentation of PD. These include the loss of the pigmented cells from the substantia nigra pars compacta that produce dopamine and the presence of eosinophilic inclusions in the cytoplasm of neurons, Lewy bodies and Lewy neurites (Mccance & Huether, 2019). There has to be a substantial loss (60%-80%) of the pigmented cells from the substantia nigra pars compacta for symptoms of gross neurologic dysfunctions to occur.

In early disease, there is decreased affinity to the dopaminergic receptors leading to an increase in the number of receptors for compensation. Further disruption in the regulatory mechanisms in the musculoskeletal and nervous systems leads to the increased synthesis of dopamine from the remaining cells. The endogenous toxin hypothesis proposes a direct injury to the neural cells by the reactive oxygen species and highly reactive radicals formed in the degradation of dopamine. (Mccance & Huether, 2019).

Other mechanisms include programmed cell death of the dopaminergic neurons. Protein aggregation occurs as the α-Synuclein bind the Aβ-38 to form amyloid that resembles Lewy bodies. Lewy bodies express ubiquitin and proteosomes, which are proteins implicated in the cellular degradation of protein aggregates. Neuron loss is not confined to the dopaminergic neurons but extends to the sympathoadrenal, serotonergic, cholinergic, and catecholaminergic cells (Walsh, 2019). This wide range of loss of cells brings out the multisystemic nature of PD.

In normal movement, the basal ganglia modulate the output from the cerebral cortex. Dopamine from the SNpc activates the direct pathway and inhibits the indirect pathway in the basal ganglia. Decreased dopamine levels in the nigrostriatal pathway inhibit the direct and indirect pathways in the basal ganglia. Increased inhibition suppresses movement. Degeneration of the substantia nigra due to damage to the dopaminergic neurons confers an alteration in the neuronal output from the globus pallidus (Zafar & Yaddanapudi., 2022).

As a result, there are functional changes in the motor pathways that link the motor cortex to the basal ganglia (Kouli et al., 2018). This causes difficulty in performing sequential movements hence the stiffness, shuffling, and reduced facial expressions. Autonomic dysfunctions like constipation, sexual dysfunction, urinary incontinence, increased sweating, reduced sweating, and abnormal temperature control result from abnormal signaling of the autonomic nervous system.

Racial and ethnic variables

PD is more prevalent among whites, 54 per 100,000 among whites, 23 per 100,000 among African Americans, and 40 per 100,000 among Latinos (Kouli et al., 2018). There are also disparities in treatment and care where more whites received PD treatment compared to African Americans (Stoker & Greenland, 2018). African Americans have a higher disability and disease severity compared to Caucasians.

How These Processes Interact to Affect the Patient

The discussion brings out a broader perspective of PD, a multisystemic disorder that culminates in increased morbidity and mortality (Simon & Brundin, 2020). A disturbance in the autonomic relation causes increased sweating leading to dehydration, constipation, poor regulation of temperature, and urinary incontinence. Neuropsychiatric manifestations of PD range from dementia to anxiety, hallucinations, and depression.

The musculoskeletal aspects interfere with the patient’s movement and ability to perform tasks and fend for themselves. All these factors decrease patients’ self-esteem, reduce health seeking, and are causes of morbidity and mortality among these patients.

Conclusion

Parkinson’s Disease is a chronic progressive neurodegenerative disorder. The prevalence of PD increases with age and has a male predominance. PD is a multisystemic disease. The diagnosis mainly depends on the history and physical examination. The diagnosis requires the presence of two out of resting tremors, bradykinesia and rigidity.

References

Kouli, A., John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, UK, Torsney, K. M., Kuan, W.-L., Department of Medicine for the Elderly, Cambridge University Hospitals NHS Foundation Trust, UK, Clinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, UK, & John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, UK. (2018). Parkinson’s Disease: Etiology, Neuropathology, and Pathogenesis. In Parkinson’s Disease: Pathogenesis and Clinical Aspects (pp. 3–26). Codon Publications. https://doi.org/10.15586/codonpublications.parkinsonsdisease.2018.ch1

McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (9th ed.). Mosby.

Simon, D. K., Tanner, C. M., & Brundin, P. (2020). Parkinson’s disease epidemiology, pathology, genetics, and pathophysiology. Clinics in Geriatric Medicine36(1), 1–12. https://doi.org/10.1016/j.cger.2019.08.002

Stoker, T. B., & Greenland, J. C. (2018). Parkinson’s Disease: Pathogenesis and Clinical Aspects (T. B. Stoker, John Van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, UK, J. C. Greenland, & John Van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, UK, Eds.). Codon Publications. https://doi.org/10.15586/codonpublications.parkinsonsdisease.2018

Walsh, A. (Ed.). (2019). Parkinson’s disease: Symptoms, pathophysiology, and treatment. Foster Academics.

Zafar, S., & Yaddanapudi., S. S. (2022). Parkinson Disease. In StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; https://www.ncbi.nlm.nih.gov/books/NBK470193/

Case Study Discussion Instructions: Parkinsons Disease

Please be mindful of plagiarism and APA format, I have included the rubric. Please use my course resources as one of my references as instructed. Please include McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier in the references.

Learning Resources
Note: The below resources were first presented in Week 7. If you have previously reviewed them, you are encouraged to read or view them again here. 

Required Readings (click to expand/reduce)

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Chapter 15: Structure and Function of the Cardiovascular and Lymphatic Systems (stop at Aging and the nervous system)
Chapter 16: Pain, Temperature Regulation, Sleep, and Sensory Function (stop at Sleep); Summary Review
o   Chapter 17: Alterations in Cognitive Systems, Cerebral Hemodynamics, and Motor Function; pp. 504–511, pp. 516–530 (start at Acute confusional states and delirium) (stop at Alterations in neuromotor functions); (Parkinson’s Disease); Summary Review
Chapter 18: Disorders of the Central and Peripheral Nervous Systems and the Neuromuscular Junction (stop at Degenerative disorders of the spine); (start at Cerebrovascular disorders) (stop at Tumors of the central nervous system); Summary Review
Chapter 44: Structure and Function of the Musculoskeletal System (stop at Components of muscle function); Summary Review
Chapter 45: Alterations of Musculoskeletal Function (stop at Bone tumors); (start at Disorders of joints); Summary Review 
Chin, L. S. (2018). Spinal cord injuries. Retrieved from https://emedicine.medscape.com/article/793582-overview#a4

Required Media (click to expand/reduce)

Khan Academy. (2019b). Ischemic stroke. Retrieved from ttps://www.khanacademy.org/science/health-and-medicine/circulatory-system-diseases/stroke/v/ischemic-stroke

Note: The approximate length of the media program is 8 minutes.

Osmosis.org. (2019, June 12). Osteoporosis – causes, symptoms, diagnosis, treatment, pathology [Video file]. Retrieved from https://www.youtube.com/watch?v=jUQ_tt_zJDo

Note: The approximate length of the media program is 9 minutes.

Online Media from Pathophysiology: The Biologic Basis for Disease in Adults and Children
In addition to this week\'s media, it is highly recommended that you access and view the resources included with the course text, Pathophysiology: The Biologic Basis for Disease in Adults and Children. Focus on the videos and animations in Chapters 15, 16, 18, and the sections of Chapters 44 and 45 that relate to the neurological and musculoskeletal systems. Refer to the Learning Resources in Week 1 for registration instructions. If you have already registered, you may access the resources at https://evolve.elsevier.com/


Module 5 Assignment: Case Study Analysis
An understanding of the neurological and musculoskeletal systems is a critically important component of disease and disorder diagnosis and treatment. This importance is magnified by the impact that that these two systems can have on each other. A variety of factors and circumstances affecting the emergence and severity of issues in one system can also have a role in the performance of the other.

Effective analysis often requires an understanding that goes beyond these systems and their mutual impact. For example, patient characteristics such as, racial and ethnic variables can play a role.


Photo Credit: jijomathai - stock.adobe.com

An understanding of the symptoms of alterations in neurological and musculoskeletal systems is a critical step in diagnosis and treatment. For APRNs this understanding can also help educate patients and guide them through their treatment plans.

In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.

To prepare:

By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

Assignment (1- to 2-page case study analysis)
In your Case Study Analysis related to the scenario provided, explain the following:

1. Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
2.  Any racial/ethnic variables that may impact physiological functioning.
3. How these processes interact to affect the patient.

CASE:
Scenario 4: A 67-year-old man presents to the HCP with chief complaint of tremors in his arms. He also has noticed some tremors in his leg as well. The patient is accompanied by his son, who says that his father has become “stiff” and it takes him much longer to perform simple tasks. The son also relates that his father needs help rising from his chair. Physical exam demonstrates tremors in the hands at rest and fingers exhibit “pill rolling” movement. The patient’s face is not mobile and exhibits a mask-like appearance. His gait is uneven, and he shuffles when he walks and his head/neck, hips, and knees are flexed forward. He exhibits jerky or cogwheeling movement. The patient states that he has episodes of extreme sweating and flushing not associated with activity. Laboratory data unremarkable and the HCP has diagnosed the patient with Parkinson’s Disease. 

NOTE:
PLEASE INCLUDE AN INTRODUCTION WITH PURPOSE STATEMENT, A TITLE PAGE, AND A SUMMARY.