Parkinsons and Alzheimers Disease: Pathophysiology, Manifestations, Treatment, and Nursing Role
Pathophysiology of Parkinsons and Alzheimers Disease
Parkinson’s and Alzheimer’s diseases (PD and AD) are progressive neurodegenerative diseases that are predominantly observed in the elderly; they are quite similar in terms of differences in the pathophysiology. The main features of PD include the fact that the dopaminergic neurons of the substantia nigra pars compacta degenerate over time, leading to a decrease in dopamine concentration in the basal ganglia, which is a motor control part of the brain (Bloem et al., 2021). This causes the wastefulness of the excitatory and the inhibitory pathways, hence the interference with the movement processes.
Rather, the pathophysiology of AD is marked by the existence of amyloid-beta plaques and neurofibrillary tangles that consist of hyperphosphorylated tau protein. These pathological aggregates initially appear in the hippocampus and then extend to the cerebral cortex, rupturing the work of the synapses, resulting in the death of neurons (Breijyeh and Karaman, 2020). AD also involves a deficit of the cholinergic neurotransmission and loss of the volume of acetylcholine, in particular, which is a factor in impairment of memory and cognition (Breijyeh and Karaman, 2020). Whereas the dopaminergic circuits and motor dysfunction are the primary mechanisms of PD, the motor cortical networks, which deal with memory, language, and executive functions, are affected in AD.
Clinical Manifestations
PD is characterized by motor aspects in its clinical manifestation. Other cardinal symptoms include bradykinesia (slowness of movements), muscle rigidity, resting tremor, and postural instability (Bloem et al., 2021). Non-motor symptoms also exist, and these involve autonomic dysfunction, mood disorders, sleeping and cognitive disturbances, but later manifest or are less strongly affected than the motor dysfunction.
In comparison, AD usually develops with cognitive symptoms that gradually deteriorate. The initial symptoms are short-term memory loss, language impairment, disorientation, and impaired executive functioning (Breijyeh and Karaman, 2020). Further progression of the disease causes patients to become severely functionally impaired, behaviorally disturbed and finally unable to undertake activities of daily living. Motor symptoms do not feature as a major characteristic of AD and tend to manifest only in late stages, if at all.
Evidence-Based Treatment Strategies
The approaches to treatment of PD and AD are specific to the pathophysiologic mechanisms of this illness. Dopamine replacement or agonism is the primary form of therapy in PD. Levodopa is the most effective pharmacologic compound, which replenishes dopamine in the brain. Adjunctive treatments are dopamine agonists and monoamine oxidase-B (MAO-B) blocks to improve dopaminergic activity and improve motor fluctuations (Bloem et al., 2021). Refractory motor symptoms patients can be helped with advanced interventions like deep-brain stimulation.
The AD treatment plans are directed at the reduction of cognitive symptoms and the reduction of progression. One example of such a drug is called a cholinesterase inhibitor (e.g., donepezil), and it increases the amount of synaptic acetylcholine by inhibiting its breakdown, temporarily improving memory and cognitive functioning. Memantine is an NMDA receptor antagonist that can potentially save neurons because it has the capacity to regulate glutamate (Breijyeh and Karaman, 2020). Even though AD cannot be cured today, the disease-modifying agents of amyloid and tau pathology research have a future in the context of the ongoing research studies.
Role of the Nurse Practitioner
The nurse practitioner (NP) is very instrumental in the management of PD and AD. Early identification of symptoms will help in timely diagnosis and intervention that will help to enhance quality of life. In the case of PD, the NPs examine the motor symptoms, keep track of the medication response, and make physical and occupational therapy referrals. NPS in AD identify cognitive impairment, distinguish between age-related memory loss and dementia, and assist families through education and advanced care planning.
Pharmacologic treatment by NPs entails administering the right medications, adjusting discharges, side effects, and adherence. Also, NPs offer caregiver care, which involves the provision of resources, disease progression education, and behavioral management and safety at home. Through holistic provision of care, NPs lower the medical and psychosocial needs of patients with such chronic neurodegenerative diseases.
References
Breijyeh, Z., & Karaman, R. (2020). Comprehensive review on Alzheimers disease: Causes and treatment. Molecules, 25(24), 5789.
Bloem, B. R., Okun, M. S., & Klein, C. (2021). Parkinsons disease. The Lancet, 397(10291), 22842303.
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