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degenerative disorder of the central nervous system that often impairs the sufferer¶s motor skills,

speech and other functions.

Parkinson¶s disease belongs to a group of conditions called movement disorders. It is

characterized by muscle rigidity, tremor, postural abnormalities, a slowing of physical movement

(bradykinesia) in extreme cases. The primary symptoms are the results of decreased stimulation

of the motor cortex by basal ganglia, normally caused by the insufficient information and action

of dopamine produced in dopaminergic neurons of the midbrain (specifically the substantia

nigra). Secondary symptoms may include high level cognitive dysfunction and subtle language

problems. PD is both chronic and progressive.

PD is the most common cause of chronic progressive parkinsonism, a term which refers to the

syndrome of tremor, rigidity, bradykinesia, and postural instability. PD is called ³primary

parkinsonism´ or ³idiopathic PD´. While many forms of parkinsonism are idiopathic,

³secondary´ cases may result from toxicity most notably of drugs, head trauma, or other medical

disorders. The disease is named after English apothecary James Parkinson, who made a detailed

description of the disease in his essay: ³An Essay on the Shaking Palsy´(1817).

Parkinson¶s disease is a disorder that affects nerve cells, or neurons, in a part of a brain that

controls muscle movement. In parkinson¶s , neurons that make a chemical called dopamine die

or do not work properly. Dopamine normally sends signals that help coordinate your movements.

As symptoms get worse, people with disease may have trouble walking, talking or doing simple

tasks. They may also have problems such as depression, sleep problems or trouble chewing,

swallowing or speaking.
Parkinson¶s usually begins around age 60, but it can start earlier. It is more common in men then

in women. There is no cure for parkinson¶s disease. A variety of medicines help symptoms

dramatically.

The term Parkinsonism is used for a motor syndrome whose main symptoms are tremor at rest,

stiffness, slowing of movement and postural instability.

Parkinsonisms can be divided into four subtypes according to their origin: primary or idiopathic,

secondary or acquired, hereditary parkinsonism, and parkinson plus syndrome or multiple system

degenereation.

³Parkinson¶s disease´ is the common form of parkinsonism, and refers to the normal presentation

of idiopathic parkinsonisms. Genetic forms are usually included althougn the terms familial

Parkinson¶s disease are also used for entries with an autosomal dominant or recessive pattern of

inheritance. Parkinson-plus disease are primary parkinsonisms which present additional features.

They include multiple system atrophy (MSA), progressive supranuclear palsy (PSP), corticobasal

degeneration (CBD)

And dementia with Lewy bodies (DLB). While idiopathic Parkinson¶s disease patient also have

Lewy bodies in their brain tissue, the distribution is denser and more widespread. In (DLB).

Even so, the relationship between Parkinson¶s disease, Parkinson disease, Parkinson disease witn

dementia (PDD), and dementia with Lewy bodies (DLB) might be most accurately

conceptualized as a spectrum, with a discrete area of overlap between each of three disorders.

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Four motor symptoms are considered cardinal in P: tremor, rigidity, bradykinesia and postural

instability. Tremor is the most apparent and well known symptom. It is most commonly a rest

tremor: maximal when the limb is at rest and disappearing with voluntary movement and sleep. It

affects to a greater extent the most distal part of the extremity and is typically unilateral at onset

becoming bilateral later. Though around 30% of PD sufferers do not have tremor at disease onset

most of them would develop it along the course of the disease. Rigidity is due to joint stiffness

and increase muscle tone, which combined with a resting tremor produce a ratchet ³cogwheel

rigidity´ when the limb is passively moved. Rigidity may be associated with joint pain, such pain

being a frequent initial manifestation of the disease. Bradykinesia, is the most characteristic

feature of PD and it produces difficulties not only with the execution of a movement but also

with its planning and initiation. The performance of sequential and simultaneous movements is

also hindered. Bradykinesia is the most disabling symptom in the beginning of the disease. In the

late stages of the disease postural instability is typical, which leads to impaired balance and falls.

Nevertheless instability many times is absent in the initial stages, especially in younger patients.

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Parkinson's disease causes neuropsychiatric disturbances, which include mainly cognition, mood

and behavior problems and can be as disabling as motor symptoms.

Cognitive disturbances occur even in the initial stages of the disease in some cases. A very high

proportion of sufferers will have mild cognitive impairment as the disease advances. Most

common cognitive deficits in non-demented patients are executive dysfunction, which translates

into impaired set shifting, poor problem solving, and fluctuations in attention among other

difficulties; slowed cognitive speed, memory problems; specifically in recalling learned

information, with an important improvement with cues; and visuospatial skills difficulties, which

are seen when the person with PD is for example asked to perform tests of facial recognition and

perception of line orientation.

Deficits tend to aggravate with time, developing in many cases into dementia. A person with PD

has a sixfold increased risk of suffering dementia, and the overall rate in people with the disease

is around 30%. Moreover, prevalence of dementia increases in relation to disease duration, going

up to 80%. Dementia has been associated with a reduced quality of life in disease sufferers and

caregivers, increased mortality and a higher probability of attending a nursing home.

Cognitive problems and dementia are usually accompanied by behavior and mood alterations,

although these kind of changes are also more common in those patients without cognitive

impairment than in the general population. Most frequent mood difficulties include depression,

apathy and anxiety.[1] Obsessive±compulsive behaviors such as craving, binge eating, hyper

sexuality, pathological gambling, or other, can also appear in PD, and have been related to a

dopamine dysregulation syndrome associated with the medications for the disease. Psychotic

symptoms are common in later PD. Symptoms of psychosis are either hallucinations, or

delusions.

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I.V nilateral involvement only, usually with minimal or no functional impairment.

II.V Bilateral or midline involvement, without impairment of balance.

III.V First sign of impaired righting, evidenced as unsteadiness as the client turns or

demonstrated when the client is pushed from standing equilibrium with the feet
 together and eyes closed. Functionally, the client is somewhat restricted in activities

but may have some employment potential, depending on the type of employment.

Clients are physically capable of leading independent lives, and their disability is

mild to moderate.

IV.V Fully developed, severely disabling disease; the client is still able to walk and stand

unassisted but is markedly incapacitated.

V.V Client is confined to bed or wheelchair unless aided.

Objectives

iV To know late facts and keep ourselves updated with the information about

Parkinson¶s disease.

iV To be able to make appropriate nursing management that will help the patient

holistically.

iV To be able to identify what are the causes of Parkinson¶s disease.