Parkinson's Disease

Parkinson’s is a complex syndrome associated with decreased concentrations
of a chemical called dopamine. When a deficiency of Dopamine occurs, tremors,
rigidity, slowness and limited voluntary movement becomes apparent.

Parkinson’ affects 1 in 200 people in the United Kingdom. Men and women are
equally affected. There is no evidence of familial connection, nor is the disease
more prevalent in any particular part of the world.

MANIFESTATIONS

Parkinson’ is a progressive disease, and has four stages according to disability:

First stage:

• Tremor and muscle rigidity, usually unilateral at the onset
• Tremors worse when tired or stressed
• Tremor initially develops in the fingers or thumb creating the pill rolling movement
• The normal arm swing when walking is absent
• Movements are slowed
• The voice becomes monotone
• If in the dominant side, handwriting becomes small and cramped due to the
  tremor and rigidity of the hand

Second stage:

• The effects are bilateral
• Tremor is more pronounced
• Increased slowness
• Trunk and head become flexed forward
• The gait becomes a shuffle
• The muscles of the face become rigid giving a mask-like appearance (Parkinson’ mask)

Third stage:

• Gait and mobility are notably disturbed
• Becomes more stooped
• Acceleration of the shuffling walk leading to the problem of falls
• Difficulty in tasks involving finger movements
• Dribbling occurs due to the decrease in the automatic swallowing of saliva
• Excessive or absence of perspiration
• Erratic temperature regulation
• Excessive lacrimation
• Gastric activity is slowed causing constipation
• Pain and fatigue due to increased traction of the muscles
• Speech becomes weak and slurred

Fourth stage

• Disabled due to loss of voluntary movement
• Speech becomes incoherent
• Difficulty is chewing and swallowing
• Respiratory volumes are reduced
• Ability to cough diminished
• Dementia becomes evident

CARE REQUIRED

• Clear explanation of the disorder to the patient and the family
• Physiotherapy programme
• Help with regular changing of position
• Encourage interest in appearance, and self-care as far as possible. Provide aids as
  necessary to assist independence
• Provide a safe environment to minimise the risk of falls (raised toilet seats,
  hand rails, well fitting shoes) and burns (if the patient is to handle hot drinks)
• Encourage to discuss altered body image and self esteem, and encourage good grooming
• Attend oral hygiene due to excessive dribbling
• Monitor food and fluid intake especially when chewing and swallowing become difficult
• Feed little and often as fatigue and depression regularly occurs
• Offer soft or liquidized if necessary
• Ensure privacy is provided at mealtimes as patient may be very self conscious
• Monitor bowel movements to prevent constipation
• Regular toileting to prevent incontinence of urine
• Daily bathing if excessive sweating is present
• Patience with verbal communication to prevent frustration
• Deep breathing exercises to prevent chest infections when respiratory volume decreases
• Apply suction to remove excess secretions
• Elevate the head of the bed to assist breathing
• Frequent care of pressure areas, especially once confined to bed
• Frequent eye care, and installation of false tear drops due to the drying of the eyes
  because of lack of blinking

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