Parkinson’s Disease
What is it?
- Affects the substantia nigra of the midbrain, which leads to the depletion of the neurotransmitter dopamine.Â
- Affects older adults (> 60)
- Most common signs and symptoms are tremors
Signs
- Tremors at rest, which improvement with movement
- Tremors of: hands, fingers, arms, legs, lips, & tongue.
- “Pill-rolling” = tremors of hands and fingers
- Poor Coordination
- Changes in writing
- Shuffling Gate
- Freezing of Extremities
Symptoms
- Loss of smell
- Constipation
- Swallowing/Speech problems
- Slow movements (bradykinesia)
-  ↓ Facial Expression
- Handwriting gets small
- Depression is a major problem
Interventions
- Constipation: Increase fiber and fluids
- Chewing/swallowing: Soft foods such as scrambled eggs.
- Shuffling gait: low heels w/smooth soles. No rubber sole shoes.
- Wear easy to put on clothes: Velcro pants, Non-slip socks, and pull over sweatshirts. No buttons
Freezing
- Freezing of the extremities while walking.
- Try changing direction
- Walk with a partner
- Use can with laser point when walking
- Consciously lift legs as if marching
- Do not just push through the freeze ups. Does not work.
Remembering
- Levodopa is considered the most effective treatment for symptoms but can cause side effects such as dyskinesia, nausea, and hallucinations at high doses.
- Dopamine agonists can stimulate dopamine receptors and reduce symptoms, but may have side effects such as nausea, dizziness, and hallucinations. (Ropinirole)
- MAO-B inhibitors, which block the enzyme that breaks down dopamine, can help preserve dopamine levels in the brain but can cause insomnia, constipation, and lightheadedness. Must avoid foods with tyramine. (Rasagiline)
- COMT inhibitors, which help prolong the effects of levodopa, may cause diarrhea, nausea, and dyskinesia. (Entacapone, tolcapone).
- Anticholinergics can also be used to reduce tremors but have side effects such as dry mouth, blurred vision, and confusion (Benztropine)
Carbidopa/Levodopa
- Takes up to 3 weeks to work
- Body fluids may turn dark/stain clothes
- Vitamin B6 foods/supplement ↓ absorption
- Do not take Carbidopa/Levodopa with high protein food because it competes with protein in small intestine.
- Carbidopa prevents levodopa from breaking down before getting to the brain.
- Entacapone (Comtan), a COMT enzyme inhibitor may be given to make Carbodopa/levodopa last longer in the body.
Ropinirole
- Ropinirole or Requip
- Dopamine promoter
- Also used in restless leg syndrome
- Side effect: Drowsiness.Â
- Do not drive or operate machinery for safety
Rasagiline
- Brand name Azilect
- MAO B inhibitor that slows breakdown of dopamine in brain
- Like MAO inhibitors do not eat foods with tyramine to prevent hypertensive crisis
- NO aged cheese, smoked/cured meets, fermented food or beer.
Benztropine
- Brand name Congentin
- Anticholinergic that reduces muscle spasms and rigidity
- Contraindicated in Glaucoma
- Side effects: Drowsiness, dizziness, constipation, flushing, nausea, nervousness, blurred vision, or dry mouth
