The lack of dopamine impairs
movement by decreasing a
person's control over their
body. These symptoms are
known as Parkinsonian Motor
Symptoms.
Parkinsonian
Motor Symptoms
Muscular Rigidity
The inability for the
muscles to relax normally,
causing pain
Postural and gait
impairment
Causes unsteady
movements, shuffling
and dragging when
mobilising and a
stooped posture
Bradykinesia
Is the slowness of initiation of
voluntary movement with
progressive reduction in speed
and amplitude of repetitive
actions
Rest Tremor
Is most common in the hands
and forearms. It appears when
the limbs are relaxed and it
disappears with active
movements
Lack of norepinephrine reduces the
body's fight or flight system resulting in
slower actions
Pathophysiology
Causative factors of Parkinson's remain
unknown. But Parkinson's is a
neurodegenerative condition due to a
deficiency of not only dopaminergic cells,
but also cholinergic, noradrenergic,
serotonergic, histaminergic and
glutaminergic cells, accounting for the
wide clinical spectrum motor and
non-motor functions that are affected
Non-motor features include
cognitive impairment,
depression, constipation,loss of
sense of smell, sleep, swallowing
and speech problems
A decrease in dopamine
production leads to the
impairment of motor function
Cholinergic cells are
responsible for the
activation during
both wakefulness
and rapid eye
movement sleep
Serotonin has several functions
in the body that include the
regulation of mood, appetite, and
sleep as well as memory and
learning
The general function of
norepinephrine is to mobilise
the brain and body for action
Glutamate It is responsible for
sending signals between nerve
cells, and under normal
conditions it plays an important
role in learning and memory.
Spiritual
Apathy might potentially include
loss of motivation for religious
practices.
The person may require support from
their local religious group, family and
friends, in order to keep in touch with
their beliefs
Reduced mobility and possible
cognitive impairment, combined with
social and emotional factors, may
impact the religious or spiritual life
Social
Loss of interest in socialising due to
tiredness and daytime sleepiness
caused by sleep deprivation and
depression
Rest tremors may prevent a person
from sleeping next to their loved
one as it may cause disturbance
throughout the night
Speech disturbances like hypophonia and festinating
may be present in Parkinson's due to motor
disruptions, which can affect communication
Bradyphrenia, a slowness of thought can also affect communication
Inability to perform daily living activities such as cooking,
showering and eating due to uncontrollable movements, difficulty
when mobilising and pain limits a person's abilities which can
affect mood, motivation and confidence
Due to the affected non-motor functions, loss of full capability to handwrite
may impact ability to sign important
documentation etc.
The person may feel demanding due to their loss
of independency and increasing dependency as
their Parkinson's progresses and may result in
depression and isolation
Cognitive
Sleep Deprivation due to lack of
cholinergic cells in the body as well as
the uncomfortable and
uncontrollable effects of rest tremors
and the pain caused by muscular
rigidity
A sleepy fatigued person is
accident prone, has poor memory,
is judgement impaired and more
likely to make mistakes, bad
decisions and have a loss of
motivation
Depression due to lack
of Serotonin
Memory Loss due to
lack of serotonin
and glutamate
Communication deficits such
as soft speech (hypophonia)
and rapid speech (festinating)
may cause frustration due to
difficulty in conversing
Anxiety may arise due to an increase in
inability to control own self, perform own
tasks and mobilise confidently
Insecurity of self as facial expressions are reduced.
Drooling and unblinking eyes are also common
Effect on Family
Carers especially older spouses may find it difficult to
assist the person suffering from Parkinson's and may
require an increased level of support from the
community
Financial hardship may occur due to the increased care needed and
thus results in stress for the family and the person
The person's inability to work due to physical limitations will decrease
financial income, this may also result in a role change, especially so if the
person was the main source of financial income
Because Parkinson's mainly affects the older population, early onset of memory loss can
cause grief for familes due to forgetfulness and the inability to recognise family and
friends in worse cases
Families may be given assistance from the
Government as well as community services such as
Blue Care and Meals on Wheels to assist with daily
living and expenses
Health
Industry
As there is no current cure for Parkinson's,
maintenance of quality of life through
suppression of symptoms in medications is
vital
Falls risk prevention and education is key in keeping
client's safe due to unsteady gaits and limited mobility
Length of admission in hospitals may increase due to risks of
aspiration pneumonia, constipation, falls and altered mental
health
A multidisciplinary team is vital for the management of
care of Parkinsons. These include Speech Pathologists (to
assess swallowing ability), Physiotherapists (to aid in gait
and assess mobility) and Social Workers (to provide
support regarding community cares and financial needs)