Introduction to Parkinson’s Gemma Burgin

Agenda What is Parkinson’s? What does it look like? The effects of Parkinson’s Supporting people with Parkinson’s and their carers Trouble shooting Medication Summary

What is Parkinson’s? A neurological syndrome or disease caused by a lack of dopamine within the brain. It is incurable, degenerative and eventually impacts on all aspects of daily life. Dopamine is a neuro transmitter which ensures smooth movement of muscles. Symptoms of Parkinson’s begin to surface once 80% of the dopamine producing cells have died. There is a trend now to drop the disease element of the title of this illness. I describe it as a syndrome as it is a group of symptoms, but actually people are affected in different ways. PDUK classification

What is Parkinson’s? Neurological = involves the nervous system Neurotransmitter = chemical messenger which relays from the brain to the smooth muscles to give smooth, coordinated movement.

What does Parkinson’s look like? SLOWNESS* (bradykinesia) STIFFNESS* (rigidity) TREMOR* POSTURAL INSTABILITY* STOOPED POSTURE SHUFFLE LACK OF ARM SWING WHEN WALKING. LACK OF FACIAL EXPRESSION DEPRESSED OR LOW IN MOOD The four cardinal symptoms A person has to have at least 2 of these four to support a diagnosis of PD. Alternative diagnosis..Parkinsonism, PSP, MSA, LBD

The early stages of Parkinson’s Diagnosis/ Early Raise awareness and self management Education and consider therapy input Reduce symptoms and distress Acceptance of diagnosis Maintenance Promotion of normal activities. Maintenance of function and self care. Consider therapy referral Assess carer needs Symptom reduction, treatment compliance

The later stages of Parkinson’s Complex Adaptations to promote self-care Optimise symptom control/compliance with meds Assess for complications of medication and fluctuations MDT input/Annual review/Carer support Minimisation of disability Palliative Relief of symptoms Absence of distress/Carer support Maintenance of dignity Good nursing care. Analgesia, appropriate sedation, pressure care, continence, mouth care, communication. “It should be noted that patients may move between stages either way, according to drug therapy and general condition.” OK to stay initiative Power of attorney for health and finances DNAR Preferred place of death.

The effects of Parkinsons. Described in two ways…. MOTOR SYMPTOMS (physical capability) NON-MOTOR SYMPTOMS affect anything within the body which is governed by muscles. Symptoms will fluctuate from day to day and throughout the course of the day and night Think of all the muscles in your body and the things they are needed for…..speech, swallow, bladder and bowel control, walking, talking…. They are not being awkward it is a part of the disease, what they were able to do an hour ago maay now be impossible, and vice versa, you may have struggled to wash and dress someone only to watch them wandering around an hour later. ON/OFF end of dose wearing off. Give meds a chance to kick in to make your life easier!

Talking, communicating in a group, social isolation and embarrassment. Walking Talking, communicating in a group, social isolation and embarrassment. Non-verbal communication, lack of vocal tone. Facial expression Swallowing/saliva control . Eating in public. Bladder and bowel control Writing Buttons, zips Concentration, motivation, low mood Sleep problems Dementia, hallucinations Keeping up in conversation, reacting to jokes, quips in a timely manner. The bradykinesia affects mind and body and by the time a Pwp has had time to digest what has been said, and formulate a response, often the topic of conversation has moved on. Social withdrawal, Botox, kwells, atropine drops. Becoming needy, vulnerable, a burden to those you love. Dopamine is the pleasure/reward neurotransmitter…if there is not enough of it you can lack the ability to experience pleasure even of things yuo have previously enjoyed.

Parkinson’s Nurse Service I am the specialist nurse for people who see Dr Liddle, Dr Samaniego and Dr Kappur. I can be contacted on 07970351584. Please leave a message and I will get back to you as soon as I can within a few days. These are elderly care physicians with specialist interest in Parkinson’s. We tend to look after people with multiple co-morbidities. There is a team of nurses at RHH who work with the neurology consultants who deal with a range of movement disorders. Their number is 0114 2711704 Hand out service directory

Supporting people with Parkinson’s and their carers. Listen to and support those closest to the person with Parkinson’s… they are often the experts. Educate home care workers Be patient. Give time…..Easier said than done I know! Refer to specialists if you identify any difficulties with speech, swallow, dietary intake and obviously physio. For freezing, use techniques of queuing….marching, counting, something which creates a rhythm. Mobile phones, self administration of meds where possible.

Troubleshooting THINGS TO CHECK…. Do they have a UTI? Are they constipated? Have they been getting their medication? Any changes to their medication lately?