Parkinsons Disease

Sarah Ehlers&Brendan ValentineParkinsons Disease1DescriptionA progressive disorder of the nervous systemSymptoms:TremorsSlowed Movement (bradykinesia)Rigid MusclesImpaired Posture and BalanceLoss of Automatic MovementsSpeech ChangesWriting Changes (1)

2StagesStage 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 assistance3Examples

4Risk FactorsAge. 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.5

EtiologySpecific etiology is unknown (6)Related to loss of brain chemicals Cells in the substantia nigra part of the brain degeneratethese cells make dopamineDecreased dopamine lead to increased muscle tension and tremor (3,4)

6DiagnosisMedical History and Clinical ExaminationMotor SymptomsBradykinesia (slow voluntary movementsTremors (involuntary movements)RigidityPostureOlfactory DysfunctionSleep behaviorDepressionCognitive DeclineDiagnosis can only be certain post mortem (2)

7StatisticsEach 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 USAIt 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)8PD and NutritionIncreaseDecreaseMagnesium- deficiency symptoms similar to PD symptoms and sleep supportVitamin D- enhances brain-derived neurotropic factor (basically growth hormone for neurons) & anti-inflammatory Omega-3s-Mood-boosting & anti-inflammatory

Homocystein- toxic if elevated & found at high levels in people with PDfolic acid, vitamins B12 and B6, zinc and tri-methyl-glycine (some co-factors dopamine production) (7)

9Affects on NutritionUnintentional Weight LossLong TermIncreased EE:Tremors, Dyskinesia, RigidityReduced Intake:Olfactory changesDysphasiaReduced peripheral abilityMedicinal Complications (7)

Increased Hospital StaysDecreased bone densityIncreased chances of fracturesDepressionLoss of muscle massIntroduction of new chronic diseaseDeath (7)10TreatmentLevodopa with dopadecarboxylase inhibitorThe most effective treatment available for ParkinsonsDopamine and Serotonin InhibitorEventually a wearing off effect will occurResults in dyskinesia (involuntary movements, tics)Debate over when to start treatment in patients under 50 (8)

11Surgical Treatment OptionDeep Brain Stimulation (DBS)Surgically places electrode in the brainDoes not damage healthy brain tissue Blocks electrical signals from targeted areas in the brain.Helps treat tremor, slowness, rigidness (10)

12Role of the DietitianTeam ApproachRegistered dietitian must work with the primary care physician, a neurologist and, the SLP when dysphasia is presentDevelop a menu meeting the needs for:Folic acidVitamins B12 and B6 ZincMagnesiumVitamin DOmega 3sWork with the SLP on how the diet must be administered (7)

13Case Study Patient72 year old femaleStage 4Nursing home residentSevere tremorsHolding silverware is difficultDysphasia presentExperiencing unintentional weight loss14Treatment OptionsLevodopa medicationAdaptive eating utensils Pureed diet high in magnesium, vitamin D, and omega 3s Weight training, tai chi, yoga exercises (if cleared by doctor) with assistanceSwallowing techniques, exercises, rehab with SLPMonitor and watch for signs and symptoms of weight loss, malnutrition, and act with the SLP to change diet accordingly

15ReferencesMayo 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):1-19http://www.palmbeachneurological.com/news/non-motor-symptoms-of-parkinsons-disease/http://students.cis.uab.edu/kelseycp/Parkinson%27s.htmlhttp://www.pdf.org/en/parkinson_statisticsGaenslen 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.aspxHolden, K.E.. Unintentional Weight Loss and Its Management. Nutrition in Clinical Care.2001;4(3):131-139Worth, P.F.. How to treat Parkinson's disease in 2013. Clinical Medicine.2013;13(1):93-96http://www.parkinson.org/Parkinson-s-Disease/Treatment/Surgical-Treatment-Options/Deep-Brain-Stimulation16