Introduction

Parkinson's Disease Handout

Name of Disorder: Parkinson's Disease

Formal Name: Parkinson's Disease (PD)

Demographic Information:

• Incidence: Approximately 1 in 100 people over the age of 60
• Prevalence: About 1% of the population over 60 years old
• Gender: More common in men than women
• Onset Age: Typically between 55 and 65 years old, though early-onset Parkinson's can occur before the age of 50

Coding:

• ICD-11: 8A00
• OMIM: 168600
• UMLS: C0030567
• MeSH: D010300
• GARD: 7251

Medical Features and Pathophysiology:

• Etiology:

• Pathology:

• Symptoms:

- Tremor at rest (often described as "pill-rolling" tremor) - Bradykinesia (slowness of movement) - Rigidity (muscle stiffness) - Postural instability (impaired balance and coordination) - Non-Motor Symptoms: - Cognitive impairment and dementia - Psychiatric symptoms (depression, anxiety, hallucinations, and psychosis) - Autonomic dysfunction (constipation, orthostatic hypotension, urinary incontinence) - Sleep disturbances (REM sleep behavior disorder, insomnia)

• Diagnosis:

Assistive Suggestions and Requirements:

• Requirement Percentage for Assistive Technology:

• Assistive Technology Suggestions:

- Canes or Walkers: To assist with balance and prevent falls. - Wheelchairs: For individuals with severe mobility impairments. - Communication Aids: - Voice Amplifiers: To assist with hypophonia (soft speech). - Speech Generating Devices (SGDs): For individuals with severe speech difficulties. - Home Modifications: - Grab Bars and Handrails: To enhance safety and prevent falls. - Adjustable Beds: To improve comfort and ease of movement. - Feeding Aids: - Adaptive Utensils: For individuals with tremor or reduced hand dexterity.

• Access Modalities:

- Voice-Controlled Systems: Beneficial for those who retain good vocal strength. - Touchscreen Devices: Useful for those with adequate hand dexterity.

Care Management and Therapeutic Techniques:

• Aims:

- To provide supportive care and address complications through a multidisciplinary approach. - To offer education and support to patients and caregivers.

• SLP Suggestions:

- Regular speech and swallowing assessments to monitor changes and adjust therapy plans accordingly. - Techniques to improve speech clarity and address hypophonia (soft speech). - Swallowing techniques to ensure safe swallowing and reduce the risk of aspiration. - Augmentative and Alternative Communication (AAC): - Introduction of AAC devices early in the disease progression to ensure familiarity and ease of use as the disease progresses.

• Special Educator Suggestions:

- Activities designed to enhance executive function, memory, and attention. - Use of memory aids, such as notebooks or electronic organizers. - Behavioral Strategies: - Structured routines to manage apathy and maintain engagement in activities. - Positive reinforcement to encourage participation and effort in tasks.

• Occupational Therapist Suggestions:

- Training in the use of adaptive equipment for self-care activities (e.g., dressing, grooming). - Techniques to conserve energy and manage fatigue. - Home and Environmental Modifications: - Assessing and modifying the home environment to ensure safety and accessibility. - Recommendations for ergonomic furniture and tools to support independence.

Recommendations on AAC and Other Details:

• Text-Based AAC:

- Predictive text features to speed up communication.

• Symbol-Based AAC:

- Dynamic display devices that can grow with the user’s needs.

References:

• Jankovic, J. (2008). Parkinson’s disease: clinical features and diagnosis. Journal of Neurology, Neurosurgery & Psychiatry, 79(4), 368-376.
• Kalia, L. V., & Lang, A. E. (2015). Parkinson's disease. The Lancet, 386(9996), 896-912.
• Schapira, A. H. V. (2009). Neurobiology and treatment of Parkinson's disease. Neurology, 72(21 Supplement 4), S1-S136.

Additional Information:

Parkinson's Disease (PD) is a chronic and progressive movement disorder that affects millions of people worldwide. The exact cause of PD is unknown, but it is believed to involve a combination of genetic and environmental factors. The disease is characterized by the gradual loss of dopamine-producing neurons in the substantia nigra, a region of the brain that controls movement. The loss of dopamine leads to the hallmark motor symptoms of PD, including tremor, bradykinesia, rigidity, and postural instability.

In addition to motor symptoms, individuals with PD may experience a range of non-motor symptoms, such as cognitive impairment, psychiatric disturbances, autonomic dysfunction, and sleep disturbances. These non-motor symptoms can significantly impact quality of life and may even precede the onset of motor symptoms.

Diagnosis of PD is primarily clinical, based on the presence of characteristic motor symptoms and response to dopaminergic therapy. Imaging studies, such as dopamine transporter (DAT) scans, can support the diagnosis by demonstrating reduced dopamine activity in the basal ganglia. Genetic testing may be considered in cases with a family history of PD or early-onset disease.

Management of PD requires a multidisciplinary approach to address the diverse needs of affected individuals. Pharmacological treatments, such as levodopa and dopamine agonists, are commonly used to manage motor symptoms. Deep brain stimulation (DBS) may be considered for individuals with advanced PD who do not respond adequately to medication. Non-pharmacological interventions, including physical therapy, occupational therapy, and speech-language therapy, are essential for maintaining function and improving quality of life.

Support groups and advocacy organizations provide valuable resources and support for individuals with PD and their families. Engaging in advocacy efforts can help improve access to services, funding for research, and public awareness. Ongoing research into the underlying mechanisms of PD and the development of new treatments offers hope for future advancements in PD care.

In conclusion, Parkinson's Disease is a complex and multifaceted disorder that requires comprehensive management and support. Early diagnosis and intervention, along with ongoing care from a multidisciplinary team, can significantly improve the quality of life for individuals with PD.

Epidemiology and Demographics

Etiology and Pathophysiology

Clinical Features and Stages

Diagnosis

Clinical Recommendations

Care Management

Transition Planning