Parkinson’s disease (PD) case study

Number 1 post: PG

Parkinson’s disease (PD), an advancing neurodegenerative disorder, is the second (leading) neurodegenerative disorder behind Alzheimer’s disease (Vice, 2020). Genetics and environmental influences increase the risk of the illness (Vice, 2020). A deficiency in dopamine, a neurotransmitter, is the cause of the deterioration (Emamzadeh & Surguchov, 2018). Moreover, MacMahon Copas et al. (2021) described this disease as neuroinflammation, degeneration of dopaminergic neurons in the substantia nigra pars compacta, and the accumulation of misfolded synuclein proteins in Lewy bodies and neurites. Moreover, microglia and astrocytes play a vital role in maintaining homeostasis within the central nervous system (CNS), including protecting the gliosis (MacMahon Copas et al., 2021). In this discussion, how does bradykinesia manifest? What causes postural instability in this patient? Compare and contrast pyramidal versus extrapyramidal and compare and contrast myelinated and unmyelinated fibers.

How does bradykinesia manifest?

One of the clinical findings in Parkinson’s disease is bradykinesia. Bradykinesia is the motor decline one sees in the Parkinson’s disease patient. According to Dlugasch and Story (2021), the manifestation of the disorder varies depending on the dopamine decline. Dlugasch and Story (2021 informed that the disorder’s generalized sluggish movement is known as bradykinesia. Also, bradykinesia in Parkinson’s disease may show in individuals as difficulty with gait, loss of dexterity, for instance, typing or buttoning clothes, and tying shoelaces (Dlugasch & Story, 2021). Bologna et al. (2020) informed that bradykinesia clinical assessment is presently based on the MDS Unified Parkinson’s Disease Rating Scale, part III (Bologna et al., 2021: Goetz et al., 2008). Additionally, Dlugasch and Story (2021) discussed that with this disease, approximately 80% of patients with Parkinson’s typically occurs in the limbs at rest (resting tremors). However, finger-thumb rubbing (pill-rolling) could also be present (Dlugasch & Story, 2021).

What causes postural instability in this patient?

Postural instability appears later in the disease, and postural instability means not maintaining balance or homeostasis in one’s movement. Appeadu & Gupta (2021) state that “postural instability is the inability to maintain equilibrium under dynamic and static conditions such as preparation movements, perturbations, and quiet stance.” (Para 2). The condition

occurs due to hypo-dopamine in the brain. Moreover, the basal ganglia are involved (which plays a role in maintaining balance), and there are hypo-dopaminergic conditions with Parkinson’s disorder (Appeadu & Gupta, 2021). In essence, the patient could result in falls due to the motor impairment caused by the disease. Dlugasch and Story (2021) indicated that normal postural reflexes maintain balance; however, in Parkinson’s, the reflexes are eventually lost, and the patient could have falls that result in disability.

Compare and contrast pyramidal versus extrapyramidal.

According to de Oliveira-Souza (2017), pyramidal refers to motor neurons originating in the cerebral cortex. The neurons (pyramidal track) pass thru the medulla, and they function as voluntary (only) control of muscles in the body (de Oliveira-Souza 2017). In contrast, the extrapyramidal focus is on the involuntary and automatic controls in muscles such as tone, posture, balance, and locomotive (de Oliveira-Souza, 2017). The difference is pyramidal controls voluntary, and extrapyramidal can do more functions. Other extrapyramidal functions include inhibiting involuntary movements such as hyperkinesias and assisting in making voluntary movements more natural (Lee & Muzia, 2021). Both are involved as motor neurons that are pathways to send signals to lower neurons (de Oliveira-Souza, 2017).