Introduction To Parkinson’s disease Etiology of Parkinson’s disease Risk factors of Parkinson’s disease Epidemiology of Parkinson's disease Clinical Manifestations Diagnosis Treatment

2. PARKINSONISM’S DISEASE

3. Presented By :
• Ghalib hussain Khan
• bs. PhysiotheraPy
• institute of
PhysiotheraPy
luMhs JaMshoro sindh
• eMail:
dr.Khan127@GMail.coM
• facebooK:
www.facebooK.coM/Ghalib.Khan09

4. Outlines:
• Introduction
• Etiology
• Risk factors
• Epidemiology
• Clinical Manifestations
• Diagnosis
• Treatment

5. PPAARRKKIINNSSOONNIISSMM
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6. Parkinson’s disease
Parkinson’s disease (PD) is a progressive
neurodegenerative condition
•The second most common progressive neurodegenerative disorder
diagnosis is primarily clinical, based on history and
examination

7. History
• James Parkinson (1755-1824),
• Remembered for the disease state named after him by Charcot

8. History of Parkinson’s Disease
• His small but famous publication, "Essay on the Shaking Palsy",
appeared in 1817, 7 years before his death in 1824.

9. Pathophysiology
PD
IPD Secondary
PD

10. IPD (Idiopathic Parkinson disease )
• Idiopathic Parkinson Disease (also referred to as primary
or classical Parkinson disease), is a progressive
neurodegenerative disorder associated with decrease
dopamine in parts of the brain (nigrostriatal neurons).
• Affecting about 0.4% people>40y
• 1% people>65y
• 10%people>80y

11. Secondary PD:
 Age - the most important risk factor
 Positive family history
 Male gender
 Environmental exposure: Herbicide and pesticide
exposure, metals (manganese, iron), well water, farming,
rural residence, wood pulp mills; and steel alloy
industries
 Race
 Life experiences (trauma, emotional stress, personality
traits such as shyness and depressiveness)?
 An inverse correlation between cigarette smoking and
caffeine intake in case-control studies.

12. • Normally Dopamine & Ach neurotransmitters work together to enable motor neurons
to refine voluntary movement
• Parkinson's results from the degeneration of dopamine-producing nerve cells in
the brain, specifically in the substantia nigra and locus coeruleus
• Clients have lost 80% or more of their dopamine-producing cells by the time
symptoms appear

13. 13

14. 14

15. 15

16. Epidemiology

17. • 1-2% of population over age 65 years
• 85% sporadic, 10-15% familial clustering and <5% monogenic inheritance
• Advancing age is important risk factor
• Twin studies report similar concordance of 10-20% for monozygotic and
dizogtic twins.
• May be less prevalent in China and other Asian countries, and in African-
Americans.
• Prevalence rates in men are slightly higher than in women; reason
unknown, though a role for estrogen has been debated.

18. incidence and prevalence
•PD is estimated to affect 100–180 in 100,000 people
•annual incidence of 4–20 per 100,000
•rising prevalence with age
•higher prevalence and incidence of PD in males
•depression affects around 40% of PD patients

19. Clinical Manifestations

20. (shaking with tthhee lliimmbb aatt rreesstt))
 Most common first symptom, usually asymmetric and most
evident in one hand with the arm at rest.

21. stiffness, increased rreessiissttaannccee ttoo ppaassssiivvee
mmoovveemmeenntt ooff tthhee lliimmbbss oorr ttrruunnkk
 Muscle tone increased in both flexor and extensor muscles
providing a constant resistance to passive movements of the
joints; stooped posture, anteroflexed head, and flexed knees
and elbows.
((mmaayy pprroodduuccee mmuussccllee ppaaiinn,, eexxpprreessssiioonnlleessss,, mmaasskk--lliikkee ffaaccee,, ddiiffffiiccuullttyy cchheewwiinngg))

22. Aknesia:
Difficulty in initial movement

23. ( sslloowwnneessss ooff mmoovveemmeenntt))
 Difficulty with daily activities such as writing, shaving, using
a knife and fork, and opening buttons; decreased blinking,
masked facies, slowed chewing and swallowing.

24. Stoop Psoture
Postural instability: Due to loss of postural reflexes.

25. Other motor symptoms
• Gait
• Dystonia
• Hypophonia
• Drooling Choking, coughing,
• Dysphagia
• Dysarthria
• Fatigue
• Akathesia
• Micrographia :small, constricted handwriting
• Diminished arm swing
• Hypomimia

26. Non-motor Symptoms
• depression.
• Behavior—indirectly, e.g., a result of dementia, depression.
• Thinking-slowed reaction time and executive dysfunction
• Sensation—impaired sense of smell
• Excessive daytime sleep, insomnia, and sleep disturbances
• Vision problems
• Impaired proprioception
• Excessive salivation
• Excessive sweating
• Loss of bowel and/or bladder control
• Anxiety, depression, isolation
• Slow response to questions
• Cognitive impairment (mood swings...dementia)
• Weight loss
• Incontinence
• Constipation

28. Investigation & Diagnosis
• History
• Symptoms: Must have two or more of the primary symptoms, one of
which is a resting tremor or bradykinesia)
• Progression of symptoms
• CT-Scan
• MRI
• Autopsy

29. Features that support diagnosis
• Characteristic resting tremor
• Narrow-based gait with flexed/ stooped posture
• Reduced arm swing with tremor
• Sustained and significant levodopa effect
• Unilateral symptom onset

30. Goals of therapy:
• Minimize disability
• Maintain quality of life.
• Pt & family education & involvement in decisions.
• In patients with mild disease →drug not recommended if
disabilities haven’t developed.

31. Management
• Education
• Exercise
• Nutrition
• Psychiatric counseling

32. EXERCISE AND PHYSICAL THERAPY :
• Exercise will not slow the progression of akinesia,
rigidity, or gait disturbance, but it can prevent or alleviate
some secondary orthopedic effects of rigidity and flexed
posture such as
• shoulder, hip, and back pain
• and it may also improve function in some motor tasks..

33. • Brisk walks,
• swimming,
• water aerobic exercises
• are particularly useful.

34. Speech therapy :
• Dysarthria
• Hypophonia

35. Nutrition:
• Elderly patients with chronic illness are at risk for poor nutrition and
weight loss.
• Prompt recognition and management of this problem is important to
avoid loss of bone and muscle mass.
• No specific diet influences the course of Parkinson disease (PD),
• A high fiber diet and adequate hydration help manage the
constipation of PD.
• Large, high-fat meals should be avoided.

36. Psychological Counseling:
The emotional and psychological needs of the patient and
family should be addressed.
. Support for the caregiver is particularly important. Referral
of the patient and/or family to a psychologist or
psychiatric social worker experienced in dealing with
chronic illness may be appropriate in some cases.

37. Prognosis
• Parkinson's disease has no common prognosis with symptoms that vary for
each patient
• It is a disease that remains for the patients life time
• Symptoms can get worse over time

38. Celebrities with PD

39. Michael J Fox
Pope John Paul II Muhammad Ali
Sir Joh Bjelke-
Petersen
1

40. Funny Facts about PD

41. • People are much less likely
to get Parkinson's Disease if
they:
• Smoke cigarettes
• Drink alcohol
• Have high cholesterol
• Drink too much coffee.

42. ?? Questions ??