Parkinsons and Alzheimers Disease
Congenital defects, tumors, chemical imbalances, vascular alterations, infections, and trauma give rise to disorders of the nervous system which manifest in physical and psychological symptoms (Dluglasch & Story 2024). The two disorders of focus in this discussion are Parkinsons Disease and Alzheimers Disease. Both disorders are incurable and progressive eventually leading to neural, musculoskeletal, and cognitive malfunctions.
Pathophysiology
Parkinsons Disease is a brain disorder that damages dopamine-producing neurons. Initially, cellular alterations in the structures of the basal ganglia in the cerebrum like inflammation, oxidative stress, mitochondrial dysfunction, and excitotoxicity malfunctions leading to the disorder (Dluglasch & Story 2024). On the other hand, Alzheimers Disease is an autosomal inheritance that develops as a result of amyloid plaques, neurofibrillary tangles, and clumping tau which lead to malfunctioning neurons and brain tissue atrophy (Dluglasch & Story 2024). Although etiology is not exactly known, beta amyloid peptides production is significant to the development of Alzheimers. Alzheimers disease exhibits reduced levels of acetylcholine in the brain.
Clinical Manifestations
Brains cells that control muscle movement use dopamine therefore in Parkinsons disease, lack of dopamine will affect control of muscle movement and explains the tremors commonly seen. Disabling clinical manifestations such as bradykinesia, loss of dexterity, rigidity, and diminished reflexes can be observed in physical assessment. Cognitive symptoms of Parkinsons include cognitive dysfunction, dementia, and mood changes (Dluglasch & Story 2024). Comparatively, the clinical manifestations of Alzheimers Disease deal with memory impairment. Alterations in the hippocampus, temporal lobe, and parts of the cortex affect memories of facts and events while degradation of the amygdala, cerebellum, striatum, and cortex affect implicit memories (Dluglasch & Story 2024).
Treatment Strategies
Treatment strategies imperative for Parkinsons is increasing dopamine levels in the brain with dopaminergic medications like Amantadine, Pramipexole, and Ropinirole. Dopamine agonists still trigger cellular reactions and can be given in combination, with levodopa, to improve efficiency. Unfortunately, medications reach maximum efficacy while the disease progresses. Deep brain stimulation, physical, occupational therapy, and assistive devices are some additional modalities to support maintaining function (Dluglasch & Story 2024). Managing symptoms pharmacologically with cholinesterase inhibitors like Aricept, rivastigmine, and galantamine can help to slow the progression. A new medication, donanemab, a humanized immunoglobulin y1 monoclonal antibody found to remove amyloid plaques causing Alzheimers (Kang, C., 2024). Similarly, Alzheimers pharmacological approach loses and the disease takes over. Treatment goals for both Parkinsons and Alzheimers are to maintain quality of life.
Role of the Nurse Practitioner
The increasing rates of Parkinsons and Alzheimers Disease has efforts worldwide to research preventative, curative, and treatment. Advanced practice nursing can support these efforts by recognizing early symptoms, initiating treatment, and educating family members. Staying updated on new treatments like donanemab will show patients the dedication to their wellness. Patient and family education on disease process and complications are essential. Additionally, caregivers must be included in the treatment plan due to the significant participation in the patients care they provide. Coping mechanisms to decrease stress and anxiety are essential for both patient and family members (Dluglasch & Story 2024). End stage Parkinsons and Alzheimers topics and advanced directives should also be discussed.
References
Dluglasch, L., & Story, L. (2024). Applied Pathophysiology for the Advanced Practice Nurse. Jones and Bartlett Learning, 2nd edition, p 486, 542-544, 548.
Kang, C. (2024). Donanemab: First Approval. Drugs, 84(10), 13131318.
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