An 83 year old male patient was admitted to the ward via emergency department. He was brought after vomiting dark colored brown fluids with blood clots. The patient has medical history of Parkinson’s disease, community acquired MRSA, depression, renal calculi, osteoporosis, recurrent UTI, constipation, dysphagia, depression, multiple skin tear and conjunctivitis. The patient’s UTI led to renal calculi. Parkinson’s disease Parkinson’s disease is a disease of the basal ganglia characterized by slowing down in the initiation and execution of movement (bradykinesia), increased muscle tone (rigidity), tremor at rest and impaired postural reflexes.
It is the most common form of Parkinsonism (a syndrome characterized by similar symptoms). The pathological process of Parkinson’s disease involves degeneration of the dopamine producing neurons in the substantial nigra of the midbrain which in turn disrupts the normal balance between dopamine and acetylcholine Ach in the basal of ganglia. DA is a neurotransmitter essential for normal functioning of the extra pyramidal motor system including control of posture, support and voluntary motion.
Symptoms of PD do not occur until 80% of neurons in the substantial nigra are lost. Many complications of Parkinson’s disease are caused by the progressive deterioration and loss of spontaneity of movement, Swallowing may become very difficulty (dysphagia) in severe cases like in this patient, leading to malnutrition or aspiration. General debilitation may lead to pneumonia, urinary tract infections and skin breakdown. Mobility is greatly decreased. The gait usually consists of rapid, shuffling ministeps.
The posture is that of the old man image, with head and trunk bent forward and the legs constantly flexed. The lack of mobility can lead to constipation, ankle oedema and more seriously, contractures. Orthostatic hypotension may occur in some patients along with loss of postural reflexes, may result in falls or other injury. Troublesome complications include seborrhea (increased oily secretion of the sebaceous glands of the skin), dandruff, excessive sweating, conjunctivitis, difficulty reading, insomnia, incontinence and depression.
Due to dsyphagia in this patient, he was on PEG feeds. Dysphagia is associated with a wide range of medical and surgical conditions. It frequently goes unrecognized and can occur as a result of damage to the central nervous system or muscles of the head and neck. Dysphagic patients are at high risk of developing serious complications such as under nutrition, dehydration and aspiration. The multi-disciplinary approach is crucial in appropriate patient care. Drug Therapy
Drug therapy aimed at correcting an imbalance of neurotransmitters within the CNS. Anti parkinsonian drugs either enhance the release or supply DA (dopaminergic) or antagonize or block the effects of the overactive cholinergic neurons in the striatum (anticholinergic) Levodopa with carbidopa is often the first drug used. However diet is of major importance to the patient with Parkinson’s disease because malnutrition and constipation can be serious consequences of inadequate nutrition.