Northern Adelaide Local Health Network

Specialised Nursing Care For

People With Parkinson's
Disease.

Ruth Withey
Parkinson’s Nurse Consultant
Chronic Disease Management Unit, Lyell
McEwin Hospital
Tel: 8133 2107
 Introduction

> Parkinson’s disease is the second

most common occurring
neurological condition in Australia,
after dementia.

> It is a chronic, progressive and

fluctuating disorder
Introduction

The symptoms of Parkinson’s

Disease (PD) usually begin slowly,
develop gradually and in no
particular order

No two people with PD are exactly

the same in terms of nature and
severity of symptoms, rate at which
the condition progresses or
response to treatment
Introduction
> 70,000 people are living with
Parkinson’s in Australia and around
7,000 in South Australia.
> The average age of diagnosis is
around 62 years.
> 1 in 5 people are of working age.
> When a person is diagnosed before
the age of 50 , the disorder is called
“Young-onset Parkinson’s disease”
What goes wrong in
Parkinson’s disease

 In Parkinson’s disease (PD) a small area

of the brain called the substantia nigra
loses many of its nerve cells

 These nerve cells produce the

neurotransmitter ‘dopamine’

 dopamine is responsible for transmitting

signals between the substantia nigra and
other parts of the brain and spinal cord,
that control coordination of movement.
Brain regions affected by
Parkinson’s disease
 Causes of Parkinson’s Disease
The causes are as yet unknown but research has led to
some theories:

> Multiple cases of Young-onset PD in one family - a link to

LRRK -2 and parkin9 gene mutations.

> The majority of PD cases are non-familial. Genetic profile

may make some people more susceptible to triggers in the
environment.

> Trauma – head injury with loss of consciousness

> Vitamin D – low levels

> Drug induced – e.g. Stemetil

> New evidence suggests Parkinson’s may start in the gut and
spread to the brain via the vagus nerve.
Motor Symptoms of Parkinson's
Disease

> Slowness of movement

(bradykinesia)

> Muscular rigidity

> Tremor

> Postural changes leading to

walking and balance difficulties.
 Non – motor Symptoms

Non - motor symptoms are common in PD

and often more troublesome and disabling
than motor symptoms.
They include:
Mood disorders such as depression,
anxiety and irritability
Cognitive changes such as slowing of
thought, attention and planning. Language
and memory difficulties, personality
changes, dementia.
Hallucinations and delusions
Non – motor Symptoms

> Sleep disorders such as insomnia, excessive

daytime sleepiness, REM sleep (rapid eye
movement behaviour disorder), vivid dreams,
restless leg syndrome, cramp, difficulty turning in
bed.
> Orthostatic hypotension
> Constipation
> Urinary urgency, frequency and incontinence
> Vision changes double vision, dry eyes,
blepharospasm
 Non – motor Symptoms
> Speech difficulties - soft voice

> Swallowing problems, drooling or excessive

saliva

> Sexual difficulties can include erectile

dysfunction.

> Skin changes

> Impulse control disorders – such as binge

eating, excessive shopping or gambling, usually
a side effect of medications.
 Medication management

> As there is no cure for Parkinson’s at

present, drugs are the main treatment
to help control the symptoms.

> The main aim of drug therapy is to

restore the chemical imbalance
caused by the loss of the neuro-
transmitter dopamine
 Motor Fluctuations

> After 4 -5 years of drug therapy,

people may find that the smooth
control of their symptoms that
their drugs once gave them is
no longer dependable

> This is more related to the

progression of the disease than
effects of the medication
 Motor Fluctuations

The person may experience:

> Early wearing “off”
> On-off’ phenomenon
> Freezing of gait
> Dyskinesia - involuntary
movements
> Dystonia- prolonged muscular
contraction
 Medications
> PWPD can often progress to complicated drug
regimes to help treat motor fluctuations,
requiring specialist nurse support and guidance.

> They need to take their medications “On time,

every time” to avoid the return of distressing
symptoms. This can be difficult when admitted to
hospital.

> They may need to progress to device assisted

therapies such as Apomorphine subcutaneous
infusion, Duodopa Intestinal Gel, or Deep Brain
Stimulation.
 Parkinson’s Nurse Consultant
The PNC provides nurse led clinic assessment and
support at GP Plus Centres at Modbury and Elizabeth:
> Allowing for screening of non-motor symptoms,
identification of carer burden, risk of falls, malnutrition,
dementia, etc.
> The patient is referred on to relevant members of the
multidisciplinary team for early intervention.
> The patient is referred on to community supports as
required.
> Exercise is extremely important - patients are referred
on to exercise groups, physiotherapy in the home and
falls avoidance programs.
Multidisciplinary Team
G.P O.T
Dietician

Neurologist
Speech
Therapist

Client
&
P.D.N.S Family/carer
Physio

Psychologist &
P.D.S Councillors

Social
worker Nurse Pharmacist
Changes as a result of Parkinson's
Nurse role
> Phone and clinic support has led to early
intervention and troubleshooting of issues.
> Improved adherence to medication regimes
and the taking of medications on time.
> Reduced emergency department
presentations and hospital admissions due to:
Dizziness and falls.
Constipation
Anxiety and panic attacks
Infections UTI’s & CI’s - confusion, delirium,
hallucinations and paranoia
Changes as a result of Parkinson's
Nurse role
> Early identification and treatment of depression has led to
improved Parkinson’s control and quality of life.

> Improved access to exercise maintaining balance, posture

and strength for longer.

> Extra support for people with young onset PD has enabled
them to communicate with their employers and remain in
employment for longer, access disability support, improve
relationships with their partners and family, avoid
complications of Impulse control disorders.

> Consultive service for inpatients - has improved delivery of

medications on time, avoidance of complications from
the prescribing of contra indicated medications - reduction
of inpatient days.
Changes as a result of Parkinson's
Nurse role
> The introduction of Apomorphine therapy at the LMH has
been possible since the role was introduced.

> Home visits have led to a better understanding of risks to

safety and better access to equipment.

> Attending neurology outpatient clinic has enabled greater

support to newly diagnosed PWPD and early interventions.

> Educational talks on PD have led to better understanding

among health professionals and improved care of PWPD.
Parkinson’s Nurse Consultant

> Referrals are accepted from other health

care professionals, GP’s, Neurologists,
Geriatricians, residential care facilities,
hospital wards and emergency
departments.
 Parkinson’s SA Inc

23A King William Road

UNLEY SA 5061

Phone: (08) 8357 8909

Country callers: 1800 644 189
Email: info@parkinsonssa.org.au

www.parkinsonssa.org.au
References

> Non - motor symptoms of Parkinson’s

disease: diagnosis and management.
Saluwa FK, et al. Niger J Med. 2010 Apr
– Jun.
> National Parkinson Foundation
(Parkinson.org) Non motor symptoms.
> The Economic and Quality of Life Burden
Associated With Parkinson’s Disease: A
Focus on Symptoms. Deborah F. Boland,
DO, MSPT, and Mark Stacy, MD.
September 22, 2012.