Parkinson Disease Concept Map: An Overview
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| Parkinson Disease Concept Map Download the whole map |
What is Parkinson Disease (PD)?
The map starts with the disease's definition, epidemiology, etiology, and signs and symptoms.
Parkinson disease is an idiopathic, slowly progressive, degenerative disorder that is characterized by resting tremor, stiffness (rigidity), slow and decreased movement (bradykinesia), and gait and/or postural instability. The etiology of Idiopathic Parkinson Disease (IPD) is unknown, but most likely IPD is a result of interactions between aging, genetic predisposition, and environmental factors.
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| Part of Parkinson Disease (PD) Concept Map - definition, epidemiology, etiology, and signs and symptoms |
Common motor signs of Parkinson disease include tremor, rigidity, bradykinesia, and postural instability. Each of these sings is stated in the map with corresponding features in the form of a table. For example, features of bradykinesia include:
- Smaller handwriting (micrographia)
- Infrequent blink
- Excessive drooling (sialorrhea) may contribute to disability
- Soft voice trails off
- Speech becomes hypophonic, ... etc.
Parkinson Disease Differential Diagnosis
Parkinson disease must be differentiated from other conditions presenting tremors, especially "Atypical Parkinsonism". As shown in the map, atypical parkinsonism refers to a set of symptoms typically seen in PD, but caused by other disorders. It is caused not only by cell loss in the substantia nigra pars compacta (SNc), but also by additional degeneration of cells in the parts of the nervous system that normally contain DA receptors (striatum). Also mentioned in the map:
- Common features of atypical parkinsonism that differentiate it from PD.
- Forms of atypical parkinsonism and associated conditions.
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| Parkinson disease vs atypical parkinsonism - PD differential diagnosis Zoom-out-pharmacotherapy |
Parkinson's Pathophysiology
On this part of the map, you'll find an inter-link (dotted line) between the disease's pathophysiology and treatment. Starting from disease's pathophysiology; the main pathological feature of PD is the death of dopaminergic neurons in the substantia nigra pars compacta (SNc), causing the motor manifestations of PD. This point helps in understanding the role of dopamine and dopamine metabolism in disease's pathophysiology and treatment.
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| Part of Parkinson Disease Concept Map - Pathophysiology and Treatment of Parkinson Disease |
Parkinson's Treatment
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| Dopamine metabolism and Antiparkinson drugs mechanisms of actions Download the whole map |
This part of the map links between dopamine metabolism in presynaptic neurons and antiparkinson drugs mechanisms of actions. Pharmacological treatment of PD aims to restore dopaminergic function in the brain using one or more of the following:
- Carbidopa/L-Dopa
- COMT Inhibitors
- MAO-B Inhibitors
- DA Agonists
- Anticholinergic Medications
- Amantadine
For each drug or drug class, its mechanism of action, efficacy against PD symptoms, adverse effects, precautions or drug interactions if present are explained.
It is important to state that treatment of PD doesn't prevent progression of the disease and drug choice is based on symptoms. For example, Levodopa is most effective at relieving bradykinesia and rigidity, although it often substantially reduces tremor. On the other hand, anticholinergic medications are effective against IPD tremor in about 50% of patients; not bradykinesia or rigidity.
Antiparkinson Drugs Table Comparisons
Beside using the way of concept mapping to build information upon each other (information about drugs mechanisms of action and indications are built upon dopamine metabolism), there are also table comparisons for antiparkinson drugs. There are three tables that compares:
- Catechol-O-methyl transferase inhibitors (COMT inhibitors): Tolcapone and Entacapone.
- Monoamine oxidase B inhibitors (MAO-B inhibitors): Selegiline and Rasagiline
- Nonergot dopamine agonists: Apomorphine, Pramipexole, Ropinirole, and Rotigotine transdermal.
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| Antiparkinson drugs table comparisons |
L-dopa motor complications
Despite its efficacy as a symptomatic treatment of Parkinson disease, long-term L-dopa therapy is associated with disabling motor complications. These complications includes:
- End-of-dose wearing off (motor fluctuation)
- "Delayed-on" and "no-on" response
- Freezing
- Dyskinesias
- "Off-period" dystonia
These complications are represented in the map through a table that contains clinical features, mechanism, and management approach for each of l-dopa motor complications.
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| Levodopa motor complications table - clinical features, mechanism, and management |
Surgical Management of Parkinson Disease
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| Surgical Management of Parkinson Disease |
Surgery should be considered as an adjunct to pharmacotherapy in case of PD symptoms are not adequately controlled with optimized medical therapy. The map briefly states surgical procedures for the treatment of PD, including the most common procedure which is Deep brain stimulation (Thalamic Stimulation) and its patient selection criteria.
Management of Special Situations
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| Hallucination and cognitive disorders associated with PD |
Parkinson disease is associated with nonmotor symptoms that may be caused by either the disease itself or the antiparkinson drugs. These nonmotor symptoms can be hallucinations/psychosis, cognitive disorders, sleep disorders, depression, agitation, anxiety, constipation, orthostatic hypotension, seborrhea, and blepharitis. The goal in the management of Parkinson disease is to improve motor and nonmotor symptoms
in order to improve the quality of life. This part of the map gives an overview of medications that can be used in the management of nonmotor complications and those that should be avoided in order not to worsen Parkinson symptoms.
We hope you find Parkinson Disease (PD) Concept Map helpful. And if you've any inquiries or suggestions, please don't hesitate to contact us or comment below.
Parkinson Disease (PD) Concept Map by Maha Atef, B Pharm, PGDip (ClinPharm), PGDip (TQM).
Last updated on: 26 October 2014
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