1. Diagnosis
1.1. Once motor s/sx are clinically present referred for stage classification
1.2. Referred to a neurologist to be diagnosed.
1.2.1. Overview of s/sx, med hx, performed a physical and neurological exam
1.2.1.1. Pt. may be prescribed carbidopa-levodopa (Parkinson's med) to see if there are improvements to confirm diagnosis.
1.3. No specific test.
1.3.1. Other tests are done to rule out alt. disease.
1.3.1.1. Blood test
1.3.1.2. Imaging test
2. Phases
2.1. Early Disease
2.1.1. Motor Phase
2.1.2. Minor tremors or stiffness
2.2. Moderate Disease
2.2.1. Mild to moderate tremors and limited movement
2.3. Advanced
2.3.1. Significant limitations in activity with treament
3. Manifestations
3.1. As a result of a loss of neurotransmitters; dopamine
3.1.1. Symptoms worsen as more cells are lost
3.1.2. Course of disease is variable
3.2. S/Sx
3.2.1. Resting tremors
3.2.2. Bradykinesia
3.2.3. Rigidity
3.2.4. Postural Instability
3.2.5. Gait Abnormalities
3.2.6. Stiff muscles
3.2.7. Fatigue
3.2.8. Dizziness
3.2.9. Impaired speech
3.2.10. Depression
4. Treatments
4.1. Medications
4.1.1. Carbidopa-levodopa
4.1.1.1. Most effective; converts to dopamine in the brain
4.1.2. Duopa
4.1.2.1. infusion through feeding tube
4.1.3. Dopamine agonist
4.1.3.1. Mimics effects of dopamine in the brain
4.1.4. MAO-B inhibitors
4.1.4.1. Prevent dopamine breakdown
4.1.5. COMT inhibitors
4.1.5.1. Prolongs effects of levodopa
4.1.6. Anticholinergics
4.1.6.1. Controls tremors
4.1.7. Amantadine
4.1.7.1. Early stages
4.2. Surgery
4.2.1. Deep brain stimulation
4.2.1.1. Usually performed on advanced disease
4.3. Lifestyle
4.3.1. Exercise
4.3.1.1. Precautions/Considerations
4.3.1.1.1. Keep floor clear
4.3.1.1.2. Use a gait belt for balance issues
4.3.1.1.3. Nearby parallel bars available
4.3.1.1.4. Severity of exercise should be based off stage of PD
4.3.1.1.5. Maintaining ADLs
4.3.1.1.6. Consider medication side effects
4.3.1.2. ACSM Exercise Testing
4.3.1.2.1. Balance testing
4.3.1.2.2. Gait testing
4.3.1.2.3. ROM and Flexibility
4.3.1.2.4. Multiple muscle groups
4.3.1.2.5. Plan for poor balance
4.3.1.2.6. Neuromuscular enhancement
4.3.1.3. ACSM Ex. Prescription Guidelines
4.3.1.3.1. Considered individual progression
4.3.2. Healthy eating
4.3.3. Avoiding falls
4.3.4. Performing ADLs
5. Pathogenesis
5.1. Neurordegenerative
5.1.1. Chronic & Progressive
5.2. Damage to the dopaminergic nigrostriatal pathway of the midbrain
5.2.1. Reduction in neurotransmitter Dopamine
5.3. Cause is unknown
5.3.1. Genetics and environment thought to be a factor
5.3.2. Possible Contributors
5.3.2.1. Aging
5.3.2.2. Autoimmune Response
5.3.2.3. Mitochondrial Density
5.3.3. Largely idiopathic
5.4. Identifying PD Stage through S/Sx
5.4.1. Stage 1
5.4.1.1. Mild symptoms that don't effect ADLs, tremor occur on only one side of the body, changes in posture, facial expressions, and walking.
5.4.2. Stage 2
5.4.2.1. Tremors, rigidity, and other body movements; affects both sides of the body, ADLs are difficult, person can live alove
5.4.3. Stage 3
5.4.3.1. "mid stage"
5.4.3.2. Loss of balance and slow movements, falls are common, symptoms impair ADLs
5.4.4. Stage 4
5.4.4.1. Movement requires a walker, person is unabale to live alone, needs assistance with ADLs
5.4.5. Stage 5
5.4.5.1. Stiffness of legs impair ability to stand or walk, hallucinations or delusions present, 24/7 care
6. ACSM Staging Scale
6.1. 0.0
6.1.1. No signs of disease
6.2. 1.0
6.2.1. Unilateral disease
6.3. 2.0
6.3.1. Bilateral disease, without balance impairment
6.4. 2.5
6.4.1. Mild bilateral disease, with recovery on pull test
6.5. 3.0
6.5.1. mild to moderate bilateral disease; some postural instability; physically independent
6.6. 4.0
6.6.1. Severe disability; still able to walk or stand unassisted
6.7. 5.0
6.7.1. Wheelchair bound or bedridden unless aided