Parkinsons Disease and related Movement Disorders[1]
The above slides will give you a guide to caring for those with these movement disorders. For people looking at these who may be living with a movement disorder or as a relative or carer I have produced them in easy to understand language. It is important that you understand each person with a movement disorder are individual and although they may have a diagnosis the progression and response to treatment is very individual. I have added in these slides to help out new nurses who as part of their role as a PDNS or as a professional with a special interest in Parkinsons you will need to be educating PWP and colleagues. I have added a few slides on MSA PSP CBD and on the dementias. Many nurse working in the field of Parkinsons will also be caring for people with other related movement disorders and should find these slides helpful.
Multiple system atrophy (MSA) is a neurological disorder that affects adult men and women. It is caused by degeneration or atrophy of nerve cells in several areas of the brain. PSP is known as Progressive Supranuclear Palsy (PSP) and is a neurological condition caused by the premature loss of nerve cells in certain parts of the brain. Corticobasal Degeneration (CBD) is a degenerative brain disease affecting people from the age of 40 onwards. Although there are similarities to PSP, with similar nerve cell damage and the build-up of a protein called tau in certain parts of the brain, the classical clinical picture is quite distinct. However people diagnosed with CBD may go on to develop features of PSP and vice versa.
Dementia with Lewy bodies (DLB) is a type of dementia accompanied by changes in behaviour, cognition and movement.[ Memory loss is not always present early. The Dementia steadily worsens over time and the condition is diagnosed when cognitive decline interferes with normal daily functioning. A core feature is REM sleep behaviour disorder (RBD), in which individuals lose normal muscle paralysis during REM sleep, and act out their dreams. RBD may appear years or decades before other symptoms.[ Other frequent symptoms include visual hallucinations; marked fluctuations in attention or alertness; and slowness of movement, trouble walking, or rigidity. The autonomic nervous system is usually affected, resulting in changes in blood pressure, heart and gastrointestinal function, with constipation as a common symptom Mood changes such as depression and apathy are common.
Parkinson’s Disease Dementia is a decline in thinking and reasoning that develops in someone diagnosed with Parkinson’s disease at least a year earlier. Common symptoms include:
- Changes in memory, concentration and judgment
- Trouble interpreting visual information
- Muffled speech
- Visual hallucinations
- Delusions, especially paranoid ideas
- Depression
- Irritability and anxiety
- Sleep disturbances, including excessive daytime drowsiness and rapid eye movement (REM) sleep disorder
Neuropsychological testing
There is no definitive medical test that confirms cognitive decline or dementia in Parkinsons. The most accurate way to measure cognitive decline is through neuropsychological testing. The test involves answering questions and performing tasks which have been carefully designed for this purpose. These tests are carried out neuropsychologists. The tests assesses the individuals moods anxiety level and hallucinations illusions and psychosis which they may be experiencing. Cognitive ability such as memory attention orientation to time and place the use of language and the ability to carry out every day task. Reasoning is assessed along with abstract thinking and problem solving. These tests can take up to 4 hours to complete and gives a more accurate diagnosis of the problems and guides the clinicians to the correct treatments and care planning.
Imaging studies
CT Scans and MRI Scans are of little use in diagnosing dementia in people with Parkinsons . Positron emission tomographic (PET) may help distinguish dementia from depression.
Treatments for Dementia
There are many treatments for cognitive impairment and dementias in Parkinsons which are often different to the general population. For instance haloperidol which can be used in general dementias cannot be used in Parkinsons as it blocks dopamine transmitting. Aricept (Donezepil) Rivastigmine (Exelon) Galantamine (Reminyl) Clozapine (Clozarile ) Quetiepine (Seroquence ) are all suitable for treating Parkinsons dementia and Diffused Lewy Bodies Disease but need to be prescribed and supervised in used by a Parkinsons specialist team and or a GP with an understanding of Parkinsons. These treatments need regular monitoring by a clinician following them being prescribed.