Concept Map Template

Primary Diagnosis: Parkinson's disease

1. Describe the pathophysiology of the primary diagnosis in your own words. What are the
patient’s risk factors for this diagnosis?
Pathophysiology of Primary Diagnosis
Parkinson's disorder is a neurological condition characterized by the rapid loss of degeneration
of dopamine-producing neurons in a particular region of the brain referred to as the substantia
nigra. Dopamine is a chemical neurotransmitter that has a critical function in movement
regulation and control (Bloem et al., 2021). When these synapses become dead or impaired, it
results in a deficit of dopamine, compromising the brain's capacity to regulate motor
movements efficiently. This results in the typical symptoms of Parkinson's including tremors,
muscle flaccidity, slowness of motion, and balance and motor skills issues.
Causes Risk Factors (genetic/ethnic/physical)
The specific causes of Parkinson's are not Risk elements for Parkinson's include genetic
fully known, but it is considered to be predisposition, impact of environmental
associated with a mixture of genetic and chemicals such as herbicides and pesticides,
environmental causes. Some genetic variants and age. Although most occur on a sporadic
are related to an increase in the development basis, some genetic alterations, for example,
of Parkinson's degree, although these in the LRRK2 or SNCA mutation, can lead to
instances are rather infrequent (Váradi, 2020). an improved likelihood of disease occurrence.
Environmental conditions, such as being Furthermore, old age is a considerable
exposed to certain toxins or hazardous contributing factor, as most Parkinson's cases
chemicals, brain injuries, and viral diseases, are made among individuals over the age of
are also potential triggers for Parkinson's. 60 (Bloem et al., 2021). Other conditions,
such as head trauma, residence in a rural
environment, and chemical abuse, may also
increase the chance of getting the disease.

2. What are the patient’s signs and symptoms for this diagnosis? How does the diagnosis impact
other body systems and what are the possible complications?
Signs and Symptoms – Common presentation How does the diagnosis impact each body
system? Complications?
Parkinson's disease (PD) is a A diagnosis of Parkinson's disease has an
neurodegenerative condition marked by motor impact on different body structures.
and non-motor behaviors resulting from loss Neurologically, it results in disturbances in
of dopamine-producing cells in the brain. motor function, which impacts mobility and
Common symptoms include tremors, stability. This can result in difficulties with
bradykinesia (slowing of motion), daily living activities and an increase in the
inflexibility, and postural imbalance (Tolosa potential for falls (Weintraub et al, 2022).
et al., 2021). Non-motor effects may include Cognitive impacts can include dementia and
cognitive disturbances, mood changes, sleep problems with remembering, focusing, and
 problems, and autonomic deficits. executing. In addition, the vegetative system
may be affected, which leads to signs such as
orthostatic pressure, urinary incontinence, and
constipation. Parkinson's may also affect the
nervous psychiatric system, leading to
anxiety, depression, and mental illness
(Weintraub et al, 2022). Parkinson's disease
can have various complexities. Motor
complications can be caused by long-term
treatment, such as dyskinesia (involuntary
movement) and motor fluctuations.
Psychiatric difficulties, including mental
health issues such as depression and increased
anxiety, can aggravate the overall illness.

3. What are other potential diagnosis that present in a similar way to this diagnosis
(differentials)?
Several medical conditions can manifest symptoms similar to Parkinson's disease (PD), and
clinicians need to keep a variety of potential diagnostic differentials at the forefront of their
minds. Essential tremor, which is commonly misunderstood as the tremor associated with PD,
is a neurological disorder marked by involuntary shaking that commonly affects the fingers
(Vázquez-Vélez & Zoghbi, 2021). Typically, however, essential tremor is not usually followed
by other PD signs, such as stiffness or rigidity.
Also, multiple systemic atrophy (MSA) is a rare neurodegenerative condition that shares some
clinical characteristics with PD, particularly bradykinesia, rigidity, and position instability. In
contrast, MSA tends to develop more readily and is related to additional vegetative symptoms,
in particular orthostatic arterial hypotension and urinary urgency. Progressive supranuclear
palsy (PSP) is another rare degenerative neurodegenerative condition that shares some
characteristics with PD, such as some bradykinesia and a postural pattern (Vázquez-Vélez &
Zoghbi, 2021). However, PSP often present with early drops, upright gaze syndrome, and
speech disorders, which tend to be less frequent in PD.

4. What diagnostic tests or labs would you order to rule out the differentials for this patient or
confirm the primary diagnosis?
To eliminate possible alternative signs of Parkinson's disease (PD) or to validate the initial
diagnosis, several diagnostic tests and investigations may be performed. These diagnostic tests
help to estimate neurological function, eliminate other possible symptom causes, and support
the presence of typical PD features. First, a neurological assessment. This complex
neurological exam by a professional experienced in dealing with movement disorders is
essential. This should include an examination of motor performance, locomotion, tremor,
stiffness, and a postural stable, and an assessment of cognitive ability and autonomic
complaints. Secondly, neuroimaging studies such as magnetic resonance imaging (MRI) or
comprehensive tomography (CT) may be carried out to eliminate structural alterations in the
 brain, such as neoplasms or brain strokes, that may be producing symptoms. There is also
dopamine transporter (DAT) imaging: A single photon emission computerized tomography
(SPECT) or positron echo tomography (PET) scan with DAT labels can help estimate the
density of the transporter in the brain, aiding in the diagnostic distinction between Parkinson's
alone and other Parkinson's diagnoses.

5. What treatment options would you consider? Include possible referrals and medications.
Treatment choices for Parkinson's disease (PD) involve medications such as levodopa, a
dopamine receptor agonist, MAO-B inhibitors, and COMT receptor inhibitors to address
motor symptoms. Referral to a psychiatrist or specialist in movement disorders is essential to
confirming the treatment and diagnosis (Jankovic & Tan, 2020). Deep brain stimulation (DBS)
surgery may also be considered for patients with more advanced cases that are not responsive
to medication. Physical therapy and activity program can help keep you mobile. Speech
therapy can resolve speech and swallowing difficulties (Jankovic & Tan, 2020). Dietary
counseling can provide help with adjusting the diet, especially to cope with persistent
constipation. Regular monitoring by medical practitioners, including therapists and physicians,
ensure that treatment is working and can be adjusted if needed.
 References

Bloem, B. R., Okun, M. S., & Klein, C. (2021). Parkinson's disease. The Lancet, 397, 2284-2303.

https://doi.org/10.1016/S0140-6736(21)00218-X

Jankovic, J., & Tan, E. K. (2020). Parkinson’s disease: Etiopathogenesis and treatment. Journal

of Neurology, Neurosurgery & Psychiatry, 91(8), 795-808. https://doi.org/10.1136/jnnp-

2019-322338

Tolosa, E., Garrido, A., Scholz, S. W., & Poewe, W. (2021). Challenges in the diagnosis of

Parkinson's disease. The Lancet Neurology, 20(5), 385-397.

https://doi.org/10.1016/S1474-4422(21)00030-2

Váradi, C. (2020). Clinical features of Parkinson’s disease: The evolution of critical symptoms.

Biology, 9(5), 103-112. https://doi.org/10.3390/biology9050103

Vázquez-Vélez, G. E., & Zoghbi, H. Y. (2021). Parkinson's disease genetics and

pathophysiology. Annual Review of Neuroscience, 44, 87-108.

https://doi.org/10.1146/annurev-neuro-100720-034518

Weintraub, D., Aarsland, D., Chaudhuri, K. R., Dobkin, R. D., Leentjens, A. F., Rodriguez-

Violante, M., & Schrag, A. (2022). The neuropsychiatry of Parkinson's disease:

Advances and challenges. The Lancet Neurology, 21(1), 89-102.

https://doi.org/10.1016/S1474-4422(21)00330-6