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INTRODUCTION

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LEARNING OBJECTIVES

  1. Describe the etiology, pathophysiology, clinical manifestations, and sequelae of Parkinson's disease.

  2. Identify and describe the examination procedures used to evaluate patients with Parkinson's disease to establish a diagnosis, prognosis, and plan of care.

  3. Describe the role of the physical therapist in assisting a patient with Parkinson's disease in terms of direct interventions and patient and family/caregiver-related instruction to maximize function.

  4. Describe appropriate elements of the exercise prescription for patients with Parkinson's disease.

  5. Identify the neuropsychological effects and social impact of Parkinson's disease and describe appropriate interventions to maximize quality of life.

  6. Analyze and interpret patient data, formulate realistic goals and outcomes, and develop a plan of care when presented with a clinical case study.

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Parkinson's disease (PD) is a progressive disorder of the central nervous system (CNS) with both motor and nonmotor symptoms. Motor symptoms include the cardinal features of rigidity, bradykinesia, tremor, and, in later stages, postural instability. Non-motor symptoms may precede the onset of motor symptoms by years. Early symptoms can include loss of sense of smell, constipation, rapid eye movement (REM) sleep behavior disorder, mood disorders, and orthostatic hypotension. Other nonmotor symptoms include altered bladder function, excessive saliva, integumentary changes, difficulty speaking and swallowing, and cognitive problems (slowed thinking, confusion, and in some cases dementia). Onset is insidious with a slow rate of progression. Disruptions in daily functions, roles, and activities, as well as depression, are common in individuals with PD.

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INCIDENCE

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PD is a common disease that affects an estimated 1 million Americans and an estimated 7 to 10 million people worldwide. More than 2% of people older than 65 years of age have PD, second only to Alzheimer's disease among neurodegenerative disorders. The prevalence of the disease is expected to increase substantially in the coming years due to the aging of the population. The average age of onset is 50 to 60 years. Only 4% to 10% of patients are diagnosed with early-onset PD (less than 40 years of age). Young-onset PD is classified as beginning between 21 and 40 years of age, and juvenile-onset PD affects individuals less than 21 years of age. Men are affected 1.2 to 1.5 times more frequently than women.1,2

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ETIOLOGY

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The term parkinsonism is a generic term used to describe a group of disorders with primary disturbances in the dopamine systems of basal ganglia (BG). Both genetic and environmental influences have been identified. Parkinson's disease, or idiopathic parkinsonism, is the most common form, affecting approximately 78% of patients. Secondary parkinsonism results from a number of different identifiable causes, including viruses, toxins, drugs, tumors, and so forth (Box 18.1). The term parkinsonism-plus syndromes refers to those conditions that mimic PD in some respects, but the symptoms are caused by other neurodegenerative disorders.3

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Box 18.1 Classification of Parkinsonism

Idiopathic Parkinson's Disease

Late-onset (>40 years; ...

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