Parkinson's disease Final presentation: Laboratory for Diagnosis, Symptom and \ Illness Management. 1 Yisel Castro Lianne Blanco Patient information Name: Luis Morel Age: 62 years Gender: Male RACE: HISPANIC MARITAL Status: Married Medication Intolerance: Denied Allergies:  Seafood. Chronic Illnesses/Major traumas: Controlled Hypertension Hospitalizations/Surgeries: Inguinal Hernia (2 years ago). Immunization: Updated (PCV13, Influenza, RZV,). Hospitalizations/Surgeries: Denied  2 Epidemiology of Parkinson Disease First symptoms appear usually after age of 40 years but have been reported cases in children’s and is called Juvenile Parkinsonism. Aged 50 years and over are affected in 1 %, this number increased in 10 % in person 60 years and over about 1½ times more common in men than in women.  The causes of Parkinson's disease (PD), the second most common neurodegenerative disorder, are still largely unknown. Current thinking is that major gene mutations cause only a small proportion of all cases and that in most cases, non-genetic factors play a part, probably in interaction with susceptibility genes. Numerous epidemiological studies have been done to identify such non-genetic risk factors, but most were small and methodologically limited. Larger, well-designed prospective cohort studies have only recently reached a stage at which they have enough incident patients and person-years of follow-up to investigate possible risk factors and their interactions. 3 Etiology Primary (idiopathic- most common): unknown origin but not induced by obvious stimulus. Secondary (parkinsonism): related to drugs, stroke, or trauma, other stimuli Familial: Genetics related, are included 20 % of the existing cases diagnosed 4 Risk Factors Heredity. Age. (60 or older) Sex. Autoimmune factors Exposure to toxins 5 Thinking difficulties Depression and emotional changes Swallowing problems Chewing and eating problems Sleep problems and sleep disorders Bladder problems Constipation Blood pressure changes Smell dysfunction Sexual dysfunction fatigue  Associated conditions 6 PATIENT history Patient is 62 years old, male, Hispanic descendent, recently discharged from US Army after 25 years of service. He is today looking for medical advice after has been notice a little resting tremor in both hands more marked in right hand, also noted slow motion in some movement mainly with changes of position and some incoordination when he walks. He is concerned because his paternal Grandfather died after suffering for many years with Parkinson’ s disease related disabilities, his father died at 43 years old in a motor vehicle accident and no time to development the disease and he hears that Parkinson’s Disease has some genetics implication. His medical history is only remarkable for a 10 years history of well cont.

1. Parkinson's
disease
Final presentation:
Laboratory for Diagnosis, Symptom and
Illness Management.
1
Yisel Castro
Lianne Blanco
Patient information
Name: Luis Morel
Age: 62 years

2. Gender: Male
RACE: HISPANIC
MARITAL Status: Married
Medication Intolerance: Denied
Allergies: Seafood.
Chronic Illnesses/Major traumas: Controlled Hypertension
Hospitalizations/Surgeries: Inguinal Hernia (2 years ago).
Immunization: Updated (PCV13, Influenza, RZV,).
Hospitalizations/Surgeries: Denied
2
Epidemiology of Parkinson Disease
First symptoms appear usually after age of 40 years but have
been reported cases in children’s and is called Juvenile
Parkinsonism.
Aged 50 years and over are affected in 1 %, this number
increased in 10 % in person 60 years and over about 1½ times
more common in men than in women.
The causes of Parkinson's disease (PD), the second most
common neurodegenerative disorder, are still largely unknown.
Current thinking is that major gene mutations cause only a
small proportion of all cases and that in most cases, non-genetic
factors play a part, probably in interaction with susceptibility
genes. Numerous epidemiological studies have been done to
identify such non-genetic risk factors, but most were small and
methodologically limited. Larger, well-designed prospective
cohort studies have only recently reached a stage at which they
have enough incident patients and person-years of follow-up to
investigate possible risk factors and their interactions.

3. 3
Etiology
Primary (idiopathic- most common):
unknown origin but not induced by obvious
stimulus.
Secondary (parkinsonism): related to drugs, stroke, or trauma,
other stimuli
Familial: Genetics related, are included 20 % of the existing
cases diagnosed
4

4. Risk Factors
Heredity.
Age. (60 or older)
Sex.
Autoimmune factors
Exposure to toxins
5

5. Thinking difficulties
Depression and emotional changes
Swallowing problems
Chewing and eating problems
Sleep problems and sleep disorders
Bladder problems
Constipation
Blood pressure changes
Smell dysfunction
Sexual dysfunction
fatigue
Associated conditions
6
PATIENT history
Patient is 62 years old, male, Hispanic descendent, recently
discharged from US Army after 25 years of service. He is today
looking for medical advice after has been notice a little resting
tremor in both hands more marked in right hand, also noted
slow motion in some movement mainly with changes of position
and some incoordination when he walks. He is concerned
because his paternal Grandfather died after suffering for many
years with Parkinson’ s disease related disabilities, his father
died at 43 years old in a motor vehicle accident and no time to
development the disease and he hears that Parkinson’s Disease
has some genetics implication. His medical history is only
remarkable for a 10 years history of well controlled High Blood
Pressure and not remarkable Family History except for what we
mention before. He is happily married for 25 years and has 2
healthy sons studying in college for whom he is worried too in

6. case that this has some degree of genetics transmition.
7
Physical Examination
Weight: 187 p0unds
Height 5’11”
BMI: 26.1
Temp: 97.9 f
PULSE: 76
RESPIRATION: 18
BP: 125/ 75 MMHG
Physical Exam:
General Appearance: Healthy appearing adult male in no acute
distress. Alert and oriented; answers questions appropriately.
Skin: Skin is normal color for ethnicity, warm, oily, clean and
intact. No rashes or lesions noted.
HEENT: Head is norm cephalic, hair with frontal alopecia.
Neck: Supple. Full ROM. Teeth are in good repair.
Cardiovascular: S1, S2 with regular rate and rhythm. No extra
heart sounds.
Respiratory: Symmetric chest walls. Respirations regular and
easy; lungs clear to auscultation bilaterally.

7. Gastrointestinal: Abdomen round; BS active in all 4 quadrants.
Abdomen soft, no tender. No hepatosplenomegaly.
Genitourinary: Skin normal for ethnicity. Penis and testis with
no apparent lesions, no discharge. No adenopathy .
Musculoskeletal: Resting tremors. Rigidity seen in all 4
extremities as patient moved about the exam room.
Neurological :Speech clear. Good tone. Postural instability ;
gait abnormal with uncoordinated arms balance.
Psychiatric: Alert and oriented. Dressed in clean clothes.
Maintains eye contact. Answers questions appropriately.
9
Differential Diagnosis :
Neurologic Disorder:
Spinocerebellar ataxia
Huntington’s disease
Essential tremor
NON-NEUROLOGIC DISORDERS:
Arthritis
Depression
Obsessional slowness

8. 10
Test:
No specific test exists to diagnose Parkinson's disease. We can
diagnose Parkinson's disease based on your medical history, a
review of signs and symptoms, and a neurological and physical
examination. may suggest a specific single-photon emission
computerized tomography SPECT scan called a dopamine
transporter (DAT) scan. Although this can help support the
suspicion that you have Parkinson's disease, it the symptoms
and neurologic examination that ultimately determine the
correct diagnosis. Most people do not require a DAT scan. We
can order too blood tests, to rule out other conditions that may
be causing the symptoms.
Imaging tests — such as MRI, CT, ultrasound of the brain, and
PET scans — may also be used to help rule out other disorders.
Imaging tests aren't particularly helpful for diagnosing
Parkinson's disease.
In addition to the examination, we can prescribe carbidopa-
levodopa (Rytary, Sinemet, others), a Parkinson's disease
medication, and must be given a sufficient dose to show the
benefit, as low doses for a day or two aren't reliable. Significant
improvement with this medication will often confirm your
diagnosis of Parkinson's disease.
Sometimes it takes time to diagnose Parkinson's disease. we
may recommend regular follow-up appointments with
neurologists trained in movement disorders to evaluate your
condition and symptoms over time and diagnose Parkinson's
disease.

9. Treatment
Lifestyle modification:
Healthy eating
Exercise
Avoiding falls
Daily living activities
Medications:
Carbidopa-levodopa
MAO inhibitors ((Eldepryl, Zelapar), rasagiline (Azilect) and
safinamide (Xadago)
Catechol O-methyltransferase (COMT) inhibitors (Entacapone)
Anticholinergics. (benztropine (Cogentin) or trihexyphenidyl.)
Surgical procedures
Deep brain stimulation
12
Prognosis:
Risk of Dementia
Mortality Risk

10. Especially patients with Parkinson disease who carry
an APOE ε2 allele have an increased risk of developing
dementia. Increased mortality risk in Parkinson disease is
dependent on disease duration and is only modest in the absence
of dementia.
The prevalence of Parkinson disease (PD), the second most
common neurodegenerative disorder, is expected to increase as
populations worldwide age. Insight into the prognosis is
therefore desirable. Parkinson disease has been associated with
an increased risk of developing dementia and a reduced life
expectancy.
references
Giesbergen, PC,. MCHofman, AKoudstaal PJBreteler.
MM Incidence of parkinsonism and Parkinson disease in a
general population: the Rotterdam
Study. Neurology. 2015;631240- 1244
Ruitenberg, A., Avan, S.,Hofman, ABreteler, M. Incidence of
dementia: does gender make a difference? NeurobiolAging
2011;22, 575- 580.
Nakazato Y, Sasaki A, Hirato J, Ishida Y. Immunohistochemical
localization of neurofilament protein in neuronal degenerations.
Acta Neuropathol 2012; 64:30-6.