PERSPECTIVES ON PARKINSONS Terry Watkins MSN CRNP 1

PERSPECTIVES ON PARKINSON’S Terry Watkins MSN, CRNP 1

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HISTORY An Essay on the SHAKING PALSY By James Parkinson London 1817 1500 - Leonardo De Vinci identified a “paralytic” condition involving a tremor in the limbs 1700 - John Hunter, a British surgeon described patients with a severe tremor 1817 - James Parkinson published the Essay on the Shaking Palsy 3

Brain Image of the Substantia Nigra 4

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Genes: A vast majority are not directly inherited, but researchers have discovered several genes that can cause PD in a small number of families. Inflammation/ infection and or Brain injury Environment: 39% higher risk with exposure to herbicides 6

Signs of PD ● ● ● No Biomarker to diagnose the disease Tremor-Not every tremor is PD Rigidity- test with passive resistance of joint Bradykinetic- “Slow movers” Postural Instability- flexed knees and head Autonomic symptoms seen early on: anosmia, RBD, constipation, RLS, akathisia ●T R A P- YOU GOT IT!! 7

TREATMENT FOR PD- Old and New ● ● ● Levadopa Carbadopa- “Gold standard” Rule is to “go slow. ” Can do a trial run Rytary- extended release Duopa- Used in Advanced disease, Peg tube Consider: Drug Induced Parkinson’s- a number of drugs interfere with dopaminergic transmission THE DISEASE MOVES ON DESPITE TREATMENT 8

How Medications Work in Parkinson's Disease 9

DOPAMINE AGONISTS ● ● Dopamine Agonists-stimulate dopamine receptors. Are direct agonist. Monotherapy- useful in early disease Adverse effects are similar to those of levodopa Impulse Control Behaviors- prescribers should specifically ask pt and caregivers about the development of new or ICB while being treated 10

Examples of Impulse Control Behaviors ICD punding Hobbyism Excessive spending Eating disorders Hpersexuality Gambling Examples of Behaviors purposeless repetitive behaviors, like rearranging objects intensive or hyper focused time spent on specific hobbies large purchases taking things apart or putting things together crafting and knitting of long hours , excessive generosity, purchasing excessive amounts of the same thing binge eating and frequent hiding foods Pathological hypersexuality, obsession with porn, lewd inappropriate demands behaviors, sexual demands excessive casino gambling internet gambling, risky investments 11

Wake Up, there is More to Come 12

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Tips for Advanced Practitioners Exercise is Vital Do not skip or postpone doses Be alert to ICD and Psychosis Refer to a Neurologist, if needed 27

Parkinson Association of Central Alabama www. parkinsonaca. org Montgomery Parkinson’s Support Group Meets at Frazier United Meth. Church 4 th Thursday of every month 6 pm National Parkinson Foundation www. parkinson. org Michael J. Fox Foundation www. michaeljfox. org 28

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Hang On To What is Important 30