184 PART II: PRIMARY CARE DISORDERS
Lifestyle Changes: Practical Tips for Your
Patients
Caregiversupportisessentialintreatingthepatient.
Support groups, social work support, a counseling
referral, and respite services should be provided to
family members. Home-based physical therapy can
also be provided to the patient for the convenience of
thecaregivers.
Parkinson’s Disease
General Characteristics
Parkinson’sdisease(PD)usuallybeginsbetweenages40
and70years,withapeakinthesixthdecadeoflife.Sev-
eral years prior to the onset of symptoms, patients may
complainofconstipation,depression,andalossofsense
ofsmell.
17
The exactcause is unknown,but riskfactors
includefamilyhistoryofPDandexposuretopesticides.
Thepathophysiology ofPDis theloss of graymatter of
theextrapyramidalsysteminthebrain.Associatedchanges
are decreased levels of dopamine that result from the
destruction of the pigmented neuronal cells in the sub-
stantianigrainbasalganglia.Withthelossofdopamine
storesinthisareaofthebrain,theresultisanimbalance
thataffectsvoluntarymovement.
18
Figure 14–3 MRI demonstrating cerebral atrophy. Source:
©
PHOTOTAKE
Inc./Alamy Images.
Signs, Symptoms, and Diagnosis
PD consists of a tetrad of signs and symptoms. These
includearestingtremor,cogwheelrigidity,bradykinesia/
akinesia,andposturalrelaximpairment.
Acarefulphysicalexamisthekeytodiagnosis.Most
PD patients present with unilateral bradykinesia. The
tremorshould be at rest and can be absent in up to 35
percentofcases.Atremorthatiswithmovementisprob-
ably an intention tremor and not PD. Patients with PD
exhibit masked faces, micrographic handwriting, and
decreasedarmswingwithgait.Patientswithnewlydiag-
nosedPDshouldhaveaCTscanofthebraintoruleout
a structural process. A careful review of the patient’s
medicationsisnecessary tobesurethepatientdoesnot
have drug-induced parkinsonism. These medications
includeantipsychoticsandantiemetics.
Management
Thehallmarkoftreatmentisusingdopamineagonistsand
carbidopa–levodopa.Thesemedicationsshouldbetitrated
tothepatientandadjustedasneeded.Therefore,themedi-
cationsshouldbestartedatalowdoseandslowlyincreased.
Patientsshouldbecheckedfororthostatichypotensionand
askedabouthallucinationsormemorydifculties,aswell
asmemorydifcultiesafterprolongeduseofmedications.
Lifestyle Changes: Practical Tips for Your
Patients
Mostpatientswillrequireanantidepressantatsome
pointintheirtreatment.Allpatientsshouldhavean
active physical therapy program and daily exercise.
Occupational and speech therapy play a role in the
laterpartofthedisease.Caregiversshouldcontactthe
localPDassociationforsupportgroupinformation.
Acknowledgment
This chapter was rewritten fromthe rst edition manu-
scriptbyAngelaWegmann.
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