PARKINSON'S DISEASE ( SYMPTOMS, ASSESSMENT, CAUSES,) PARKINSON-PLUS SYNDROME

 INRODUCTION:- It is a progressive disorder of the CNS with both motor and non-motor symptoms. The onset is gradual, basically after 50 years. The cause is disturbance in the Dopamine system in basal ganglia. A dopamine deficiency can be due to a drop in the amount of dopamine made by the body or due to reduction of receptors in the brain.

SYMPTOMS:- MOTOR SYMPTOMS include the cardinal features of rigidity, bradykinesia, tremors, and, in later stages postural instability, muscle weakness, festinating gait, etc.

              NON-MOTOR SYMPTOMS include sensory symptoms, dysphagia, speech disorder, cognitive dysfunction, depression and anxiety, autonomic dysfunction, sleep disorders.

ASSESSMENT:- 

COGNITION:- It examines the memory, orientation, conceptual reasoning, problem solving, judgement. A brief screen of cognitive function can be obtained using MMSE (Mini-Mental Status Examination).

PSYCHOLOGICAL FUNCTION:- It determines the level of depression, stress anxiety, insomnia, anorexia, sadness. All these symptoms should be asked to the patient. Instruments like- Geriatric Depression Scale and Beck Depression Inventory.

VISUAL FUNCTION:- It determines acuity, light and dark adaptation, and accomodation. Patient will experience blurring of vision and difficulty in reading which is not improved by corrective lens.

MOTOR FUNCTION:- A) RIGIDITY- Initially there is asymmetrical rigidity which affects shoulder and neck later affects trunk and extremities. In this, there is determination of type of rigidity whether the rigidity is sustained( lead pipe) or intermittent (cogwheel). 

  B) BRADYKINESIA- Initially movements are slow, and in later stages, movement become arrhythmic with frequent start hesitation and arrests(akinesia). A stopwatch can be used to count the movement time and reaction time (elapsed time between the patients desire to move and the actual movement response). Timed tests for Rapid Alternating Movements (RAM) can be used to determine the effects of bradykinesia.

C) TREMORS- The location, persistence and severity of tremors should be recorded. Upper limb functional skills such as drinking from a cup, feeding, dressing and writing can be used to test for the effects of tremors.

D) POSTURAL CONTROL- The therapist first observe the patients resting posture in sitting and standing which further changes with movement.

E) BALANCE- Berg Balance Scale (BBS)                                                                                                                          - Functional Reach Test (FRT)                                                                                                                      -Timed Up and Go Test (TUG)                                                                                                                      -Cognitive Timed Up and Go (CTUG)                                                                                                          -Dynamic Gait Index (DGI)

F) GAIT- Assess all parameters and characteristics of gait during walking on level surface include start time or gait initiation, speed of walking, stride length, etc.                                                                                       - 6-minute walking test

CARDIOPULMONARY FUNCTION- In this, pulmonary function test, breathing pattern, chest wall mobility and thoracic expansion are checked. Along with these, vital signs like B.P., Respiratory rate, etc are also assessed. 6- or 12- minute walk test can be used to determine endurance capacity. Treadmill, cycle ergometer (arm or leg) are also used.

DISEASE SPECIFIC MEASURES- Parkinson's Disease Questionnaire (PDQ-39) is a 39-item questionnaire. It focuses on eight health-related quality-of-life dimensions (mobility,ADLs, emotional well-being, stigma, social support, cognition, communication and bodily discomfort).