Parkinson’s disease
A typical patient with Parkinson’s disease is a 60-year-old older adult by the name Mercy, who claims of having shaking body over the last couple of months. The patient experiences the problem of impaired posture and balance since she cannot balance herself while walking (Tysnes & Storstein, 2017). There are also changes in her speech since she has developed a habit of speaking softly in a low tone.
Additionally, Mercy reveals that she used to work in a flower plantation, where she mainly involved in mixing chemicals used to spray both pests and herbs on the farm. However, she has no history of the disease in her family lineage (Tysnes & Storstein, 2017). The patient admits that the increase in the intensity of her body tremor has forced her to seek medical attention to help alleviate her from the complications associated with her health condition.
Epidemiology
PD is among the most general age-related neurodegenerative conditions. It is a slowly progressive brain disorder with no identifiable cause. The disorder affects one to two people within a population of 1000 individuals at any time. Moreover, its prevalence usually increases with age, and it is common among people who are 60years and above (Schrag et al., 2015). In the USA, at least half a million people suffer from the condition, and the frequency is anticipated to triple over the next five decades as the average age of the population rises.
Epidemiology of PD performs a vital role in investigating the cause of the disorder since it assists in locating the risk factors that offer a clue on the cause of PD. The descriptive epidemiology of PD based on its prevalence and incidence helped in the etiological investigation to locate the origin of Mercy’s condition (Schrag et al., 2015).
Etiology
The disorder is a multifactorial condition with both genetic and environs conditions playing a role in its establishment. The most significant risk factor for the condition is age, with the median age of commencement of the disease being 60 years (Ascherio & Schwarzschild, 2016). There are cross-cultural variations with the higher prevalence of the disorder recorded in the European nations compared to Africa, Asian, along with the Arabic countries.
Moreover, six distinct genes have been associated with the origin of familial PD. The genetics support the conception that customary pathogenetic mechanisms occur across the etiologic spectrum of the disorder (Ascherio & Schwarzschild, 2016). The alterations in the alpha-synuclein and parkin, in particular, induce PD with the Mendelian sequence of a bequest.
Picture illustrating signs of PD that Mercy suffers from.
Risk factors
The common risk factors of the woman’s condition include age, family history, and genetics, schrag et alto environmental factors, head trauma, together with ethnicity (Berg et al., 2015).
The Mercy’s serves as a risk factor for her condition since the incidence of the disorder enhances with age. PD affects one percent of the populace above the age of 60 years (Schrag et al., 2015). Hence her age greatly exposed her to PD. Likewise, environmental exposure to pesticides and herbicides also exposed Mercy to the risk of PD.
Associated conditions
The health conditions associated with PD that the woman suffers from include but are not limited to cardiovascular disease, musculoskeletal conditions, diabetes, and skin cancer. Cardiovascular disease involves the narrowing of the blood vessels, thus causing a heart attack or stroke. The woman also suffers from a heart attack, and this was evident through her shortened breath, fatigue, and sudden dizziness (Schrag et al., 2015).
Moreover, Mercy also suffers from arthritis, which has exposed her to low back pain and joint pain (Berg et al., 2015). She also has diabetes.
History
PD was initially identified in James Parkinson’s 1817 definitive study on the shaking palsy. Parkinson, who was a physician in London, discerned the classic manifestations of the disorder in three of his clients together with the individuals he saw on the street (Schrag et al., 2015). The people established some of the primary clinical manifestations of PD, which include postural volatility, tremors, and rigidity.
Moreover, the doctor postulated that the disorder typically develops due to the challenge in the medulla region of the brain (Schrag et al., 2015). Parkinson’s finding on the disease found a little attention from the medical community until 1861 when Jean-Martin Charcot and his peers differentiated the condition from the neural disorders and named it PD.
Physical exam
The physical exams performed on Mercy involved passive manipulation of limbs, lower extremity testing, rapid alternating movements, and toe-tapping. Quick alternating movements are usually done to test for the presence of bradykinesia, which involves slowness of movement (Lill, 2016). The slow movement is habitually one of the signs of PD, thus carrying out a rapid alternating movement test assisted in examining for the presence of PD in Mercy.
Differential diagnosis
The differential diagnosis performed on Mercy include a diagnosis for bradykinesia, rigidity, tremor, and non-motor features. Bradykinesia is the lack of spontaneous movement. Patients with bradykinesia usually report difficulty with fine motor tasks, which entails infrequent swallowing and change in speech (Lill, 2016). Diagnosis of the bradykinesia was essential since it would help to diagnose the action cause of the Mercy’s condition.
Furthermore, non-motor features of PD contribute towards the certainty of diagnosis of the disorder. The features present proof of the pre-motor phase that represents the beginning of PD. Patients with PD commonly have experienced depression, anosmia, and sleep behavior disorder in years before being diagnosed with PD (Lill, 2016). Hence the differential diagnosis on the non-motor features will eventually help in the diagnosis of the woman’s condition.
Tests
The diagnostic tests performed on Mercy include a blood test, CT scan, PET scan, and SPECT scan. A blood test is habitually done to rule out other conditions with the same clinical manifestation as PD. CT scan is usually done to check for signs of a stroke or brain tumor that might result in PD (Tysnes & Storstein, 2017). Likewise, Mercy was exposed to a PET scan, which usually performed to detect low levels of dopamine in the brain.
Treatment
The condition is incurable. However, various medications can be administered to assist in controlling the symptoms of PD and its complications (Berg et al., 2015). The medications that may be used to control Mercy’s condition include carbioda-levodoa, dopamine agonists, and MAO B inhibitors.
Carbidopa-levodopa is the most productive medication for PD. It is an ordinary compound that flows into the cerebrum, where it is transformed into dopamine (Berg et al., 2015). The medication assists in protecting levodopa from the premature transformation into dopamine outside the cerebrum. Additionally, dopamine agonists operate through mimicking dopamine effects in the brain to help in controlling the symptoms of PD.
Prognosis
The disorder is not a fatal disease, and it has an average life expectancy similar to those without the disease. However, the disease may progress to five distinct stages, with the fifth stage being the most advance stage of the disease (Ascherio & Schwarzschild, 2016). At the fifth stage, an individual with the disease is unable to walk and will require full-time assistance with living. It is the most severe stage in the development process of PD.
Picture illustrating the prognosis of PD