This week’s case study is about a 67-year-old man who was diagnosed with Parkinson’s disease. The patient presented with tremors, stiffness, masklike immobile face, uneven gait, jerky cogwheeling movements, and episodes of nonactivity-related extreme sweating. The purpose of this case study is to describe the pathophysiology, the ethnic variables that impact the physiological functioning of PD patients, and their effects on the patients.
The predisposing factors of PD include age, environmental conditions like smoking, MPTP exposure, pesticide and herbicide exposure, and being male. There are two main pathophysiologic processes in the neurological and musculoskeletal presentation of PD.
These include the loss of the pigmented cells from the substantia nigra pars compacta that produce dopamine and the presence of eosinophilic inclusions in the cytoplasm of neurons, Lewy bodies and Lewy neurites (Mccance & Huether, 2019). There has to be a substantial loss (60%-80%) of the pigmented cells from the substantia nigra pars compacta for symptoms of gross neurologic dysfunctions to occur.
In early disease, there is decreased affinity to the dopaminergic receptors leading to an increase in the number of receptors for compensation. Further disruption in the regulatory mechanisms in the musculoskeletal and nervous systems leads to the increased synthesis of dopamine from the remaining cells.
The endogenous toxin hypothesis proposes a direct injury to the neural cells by the reactive oxygen species and highly reactive radicals formed in the degradation of dopamine. (Mccance & Huether, 2019). Other mechanisms include programmed cell death of the dopaminergic neurons. Protein aggregation occurs as the α-Synuclein bind the Aβ-38 to form amyloid that resembles Lewy bodies.
Lewy bodies express ubiquitin and proteosomes, which are proteins implicated in the cellular degradation of protein aggregates. Neuron loss is not confined to the dopaminergic neurons but extends to the sympathoadrenal, serotonergic, cholinergic, and catecholaminergic cells (Walsh, 2019). This wide range of loss of cells brings out the multisystemic nature of PD.
In normal movement, the basal ganglia modulate the output from the cerebral cortex. Dopamine from the SNpc activates the direct pathway and inhibits the indirect pathway in the basal ganglia. Decreased dopamine levels in the nigrostriatal pathway inhibit the direct and indirect pathways in the basal ganglia. Increased inhibition suppresses movement.
Degeneration of the substantia nigra due to damage to the dopaminergic neurons confers an alteration in the neuronal output from the globus pallidus (Zafar & Yaddanapudi., 2022). As a result, there are functional changes in the motor pathways that link the motor cortex to the basal ganglia (Kouli et al., 2018).
This causes difficulty in performing sequential movements hence the stiffness, shuffling, and reduced facial expressions. Autonomic dysfunctions like constipation, sexual dysfunction, urinary incontinence, increased sweating, reduced sweating, and abnormal temperature control result from abnormal signaling of the autonomic nervous system.
PD is more prevalent among whites, 54 per 100,000 among whites, 23 per 100,000 among African Americans, and 40 per 100,000 among Latinos (Kouli et al., 2018). There are also disparities in treatment and care where more whites received PD treatment compared to African Americans (Stoker & Greenland, 2018). African Americans have a higher disability and disease severity compared to Caucasians.
The discussion brings out a broader perspective of PD, a multisystemic disorder that culminates in increased morbidity and mortality (Simon & Brundin, 2020). A disturbance in the autonomic relation causes increased sweating leading to dehydration, constipation, poor regulation of temperature, and urinary incontinence.
Neuropsychiatric manifestations of PD range from dementia to anxiety, hallucinations, and depression. The musculoskeletal aspects interfere with the patient’s movement and ability to perform tasks and fend for themselves. All these factors decrease patients’ self-esteem, reduce health seeking, and are causes of morbidity and mortality among these patients.
Parkinson’s Disease is a chronic progressive neurodegenerative disorder. The prevalence of PD increases with age and has a male predominance. PD is a multisystemic disease. The diagnosis mainly depends on the history and physical examination. The diagnosis requires the presence of two out of resting tr
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