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Parkinson’s Disease

Parkinson’s Disease. Sarah Ehlers & Brendan Valentine. Description. A progressive disorder of the nervous system Symptoms: Tremors Slowed Movement ( bradykinesia ) Rigid Muscles Impaired Posture and Balance Loss of Automatic Movements Speech Changes Writing Changes (1). Stages.

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Parkinson’s Disease

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  1. Parkinson’s Disease Sarah Ehlers & Brendan Valentine

  2. Description • A progressive disorder of the nervous system • Symptoms: • Tremors • Slowed Movement (bradykinesia) • Rigid Muscles • Impaired Posture and Balance • Loss of Automatic Movements • Speech Changes • Writing Changes (1)

  3. Stages • Stage 1 - one side of the body is affected • Stage 2- both sides of the body affected; balance intact • Stage 3- balance impaired, but not independent functioning • Stage 4- walking or standing difficult with out assistance • Stage 5- bedridden or wheel chair bound with out assistance

  4. Examples

  5. Risk Factors • Age. Young adults rarely experience Parkinson's disease. It ordinarily begins in middle or late life, and the risk continues to increase with age. • Heredity. Having a close relative with Parkinson's disease increases the chances that you'll also develop the disease. However, your risks are still small unless you have many relatives in your family with Parkinson's disease. • Sex. Men are more likely to develop Parkinson's disease than are women. • Exposure to toxins. Ongoing exposure to herbicides and pesticides may put you at a slightly increased risk of Parkinson's disease.

  6. Etiology • Specific etiology is unknown (6) • Related to loss of brain chemicals • Cells in the substantianigra part of the brain degenerate • these cells make dopamine • Decreased dopamine lead to increased muscle tension and tremor (3,4)

  7. Diagnosis • Medical History and Clinical Examination • Motor Symptoms • Bradykinesia (slow voluntary movements • Tremors (involuntary movements) • Rigidity • Posture • Olfactory Dysfunction • Sleep behavior • Depression • Cognitive Decline • Diagnosis can only be certain post mortem (2)

  8. Statistics • Each year, approximately 60,000  Americans are diagnosed with Parkinson's disease.  • Prevalence Rate: approx 1 in 272 or 0.37% or 1 million people in USA • It appears to affect whites more than African Americans or Asians.  • Not even 10% of cases are diagnosed in adults under age 40. Most of the fresh diagnoses are in those above age 60. • Men are one and a half times more likely to have Parkinson's than women. • Medication costs for an individual person with PD average $2,500 a year, and therapeutic surgery can cost up to $100,000 dollars per  patient. (5)

  9. PD and Nutrition Increase Decrease Magnesium- deficiency symptoms similar to PD symptoms and sleep support Vitamin D- enhances brain-derived neurotropic factor (basically growth hormone for neurons) & anti-inflammatory Omega-3’s-Mood-boosting & anti-inflammatory Homocystein- toxic if elevated & found at high levels in people with PD folic acid, vitamins B12 and B6, zinc and tri-methyl-glycine (some co-factors dopamine production) (7)

  10. Affects on Nutrition Unintentional Weight Loss Long Term Increased EE: Tremors, Dyskinesia, Rigidity Reduced Intake: Olfactory changes Dysphasia Reduced peripheral ability Medicinal Complications (7) Increased Hospital Stays Decreased bone density Increased chances of fractures Depression Loss of muscle mass Introduction of new chronic disease Death (7)

  11. Treatment • Levodopa with dopadecarboxylase inhibitor • The most effective treatment available for Parkinson’s • Dopamine and Serotonin Inhibitor • Eventually a wearing off effect will occur • Results in dyskinesia (involuntary movements, tics) • Debate over when to start treatment in patients under 50 (8)

  12. Surgical Treatment Option • Deep Brain Stimulation (DBS) • Surgically places electrode in the brain • Does not damage healthy brain tissue • Blocks electrical signals from targeted areas in the brain. • Helps treat tremor, slowness, rigidness (10)

  13. Role of the Dietitian • Team Approach • Registered dietitian must work with the primary care physician, a neurologist and, the SLP when dysphasia is present • Develop a menu meeting the needs for: • Folic acid • Vitamins B12 and B6 • Zinc • Magnesium • Vitamin D • Omega 3’s • Work with the SLP on how the diet must be administered (7)

  14. Case Study Patient • 72 year old female • Stage 4 • Nursing home resident • Severe tremors • Holding silverware is difficult • Dysphasia present • Experiencing unintentional weight loss

  15. Treatment Options • Levodopamedication • Adaptive eating utensils • Pureed diet high in magnesium, vitamin D, and omega 3’s • Weight training, tai chi, yoga exercises (if cleared by doctor) with assistance • Swallowing techniques, exercises, rehab with SLP • Monitor and watch for signs and symptoms of weight loss, malnutrition, and act with the SLP to change diet accordingly

  16. References • Mayo Clinic. Parkinson's Disease. http://www.mayoclinic.com/health/parkinsons-disease/DS00295 (accessed April 14, 2013). • Lingor, P., Liman, J., Kallenberg, K., Sahlmann, C., Bahr, M.. Diagnosis and Differential Diagnosis of. Intech.2011;1(1):1-19 • http://www.palmbeachneurological.com/news/non-motor-symptoms-of-parkinsons-disease/ • http://students.cis.uab.edu/kelseycp/Parkinson%27s.html • http://www.pdf.org/en/parkinson_statistics • Gaenslen A, Gasser T, Berg D. Nutrition and the risk for Parkinson's disease: review of the literature. Journal Of Neural Transmission (Vienna, Austria: 1996) [serial on the Internet]. (2008, May), [cited April 15, 2013]; 115(5): 703-713. Available from: MEDLINE with Full Text. • http://www.foodforthebrain.org/nutrition-solutions/parkinsons-disease/about-parkinsons-disease.aspx • Holden, K.E.. Unintentional Weight Loss and Its Management. Nutrition in Clinical Care.2001;4(3):131-139 • Worth, P.F.. How to treat Parkinson's disease in 2013. Clinical Medicine.2013;13(1):93-96 • http://www.parkinson.org/Parkinson-s-Disease/Treatment/Surgical-Treatment-Options/Deep-Brain-Stimulation

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