Parkinson’s disease (PD) impacts people in different ways. Not everyone will experience all the
symptoms of PD; even if people do, they won’t necessarily experience the symptoms in quite the same order or at the same intensity. While symptoms and disease progression are unique to each person, knowing the typical stages of Parkinson’s can help you cope with changes as they occur. Some people experience the changes over 20 years or more. Others find the disease progresses more quickly. It is difficult to accurately predict the progression of Parkinson’s. Following a diagnosis,
many people experience a good response to medications, such as levodopa. This optimal
timeframe can last many years and varies for everyone. However, as the disease progresses, people with Parkinson’s often need to work alongside their doctor to adjust levodopa dosages. In this timeframe, they may experience new or worsening movement symptoms and fluctuations, levodopa-induced
dyskinesia,
swallowing problems,
freezing of gait, falls and imbalance. People with young-onset PD are more prone to levodopa-induced dyskinesia and changes in movement (called motor fluctuations), while those diagnosed later in age may experience more cognitive changes and non-movement symptoms. Motor fluctuations can become an issue five to 10 years after diagnosis. Postural instability (trouble with balance and falls) typically occurs after about 10 years. 5 StagesIn 1967, Hoehn & Yahr defined five stages of PD based on the level of clinical disability. Clinicians use it to describe how motor symptoms progress in PD. On this scale, stages 1 and 2 represent early-stage, 2 and 3 mid-stage, and 4 and 5 advanced-stage PD. Recently, the Movement Disorder Task Force also recognized three stages in early PD.Learn about more Parkinson's symptoms: The degeneration of the dopamine producing neurons has already begun, but no clinical symptom is evident yet. Prodromal PhaseSome symptoms are present, but they are insufficient for the clinician to make a diagnosis of PD. Clinical PhaseParkinsonian symptoms have manifested and are clearly recognizable. Rating ScalesDoctors use clinical rating scales to characterize the movement and non-movement symptoms of PD, how severe they are, and their impact on a person’s daily activities. Clinical scales also help doctors track the progression of PD and are used in clinical trials. In addition to the Hoehn and Yahr Scale described above, examples of widely used clinical scales for PD include: Theory of PD Progression: Braak’s HypothesisResearchers believe a combination of genetic and environmental factors cause Parkinson’s. In 2003, Heiko Braak, MD, hypothesized that an unknown pathogen (a bacteria, virus or other microorganism that causes disease) in the gut could be the cause of PD. This was followed by a more extensive hypothesis, stating that PD starts in two places: the neurons of the nasal cavity and the neurons in the gut. This is now known as Braak’s hypothesis. In this theory, the pathogen enters the body via the nose and/or gets swallowed and reaches the gut. The pathogenic products thus come into contact with the olfactory (smell) and/or enteric (gut) neurons, triggering the aggregation of an abnormal protein called α-Synuclein. The aggregated α-Synuclein (called Lewy body) then spreads toward the central nervous system (namely the brain), and eventually arriving in and causing the degeneration of the dopaminergic neurons in the area of the brain called the substantia nigra. This theory is supported by evidence that non-movement symptoms, such as a loss of sense of smell, sleep disorders and constipation, may appear several years ahead of movement symptoms. For this reason, researchers focus on these non-motor symptoms to detect PD as early as possible and to look for ways to stop its progression. Page reviewed by Dr. Jun Yu, Movement Disorders Fellow at the University of Florida, a Parkinson’s Foundation Center of Excellence. Support
ground-breaking research, care and community outreach What are the clinical manifestations of Parkinsons disease?Parkinson's has four main symptoms: Tremor in hands, arms, legs, jaw, or head. Muscle stiffness, where muscle remains contracted for a long time.. Depression and other emotional changes.. Difficulty swallowing, chewing, and speaking.. Urinary problems or constipation.. Skin problems.. Which clinical manifestation does the nurse expect a client with Parkinson's disease to exhibit?The cardinal clinical symptoms of Parkinson disease - limb tremor, shuffling gait, slowness, stiffness, and postural instability - can be accompanied by autonomic nervous system dysfunction, depression, dementia and psychosis.
Which clinical manifestation would be required to confirm the diagnosis of Parkinson disease?Shaking or tremor: Called resting tremor, a trembling of a hand or foot that happens when the patient is at rest and typically stops when he or she is active or moving. Bradykinesia: Slowness of movement in the limbs, face, walking or overall body. Rigidity: Stiffness in the arms, legs or trunk.
Which assessment finding would the nurse expect to see with Parkinson disease?Assess for the four key PD symptoms: tremor, rigidity, postural instability and bradykinesia or akinesia. Observe the patient's gait, posture and ability to ambulate. THINK PATIENT SAFETY! You want to increase mobility as much as possible, but also want the patient to be safe and avoid falls.
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Which clinical manifestation would the nurse expect to find when assessing a client with Parkinson disease?
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