Updated January 2007 Produced by Parkinsons Victoria www.parkinsons-vic.org.

au
When your Patient has Parkinsons When your Patient has Parkinsons
Parkinsons is a progressive and fluctuating neurological condition. n !ustralia it is
t"oug"t t"at one in #00 people "as Parkinsons$ %aking it one of t"e %ost co%%on of t"e
neurological disorders. &"ere is no known cause or cure.
Parkinsons disease occurs w"en cells are lost fro% t"e part of t"e brain t"at controls
%ove%ent. &"ese lost cells produce dopa%ine$ a c"e%ical %essenger or 'euro-
tra%s%iter$ w"ic" enables people to perfor% s%oot"$ co-ordinated %ove%ents by
trans%itting %essages between nerve cells and %uscles. ("en a "ig" percentage of t"e
dopa%ine producing cells are lost$ t"e sy%pto%s of Parkinsons appear and t"e level of
dopa%ine will continue to fall slowly over %any years. t is currently not known w"y
people wit" Parkinsons lose t"e dopa%ine-producing cells.
Parkinsons is a very individual condition. ts sy%pto%s and rate of progression will vary
fro% person to person
Main Physical Symptoms
Slowness of movement ) initiating %ove%ents beco%es %ore difficult or it takes longer
to perfor% t"e%. *ack of co-ordination can also be a proble%. &"is sy%pto% is so%e
ti%es referred to as +radykinesia.
Muscular rigidity or stiffness ) is a co%%on early sign in people wit" Parkinsons.
,y%pto%s %ig"t include proble%s turning around$ getting up fro% a c"air$ turning over in
bed or %aking fine finger %ove%ents suc" as fastening a button due to rigidity. ,o%e
people find t"eir posture beco%es stooped$ or t"eir face beco%es stiff$ %aking facial
e-pressions %ore difficult. ,tiffness can at ti%es be painful. .uscular stiffness can also
worsen ot"er conditions suc" as !rt"ritis. n so%e cases %uscles can beco%e very stiff
and t"is is known as /ystonia.
Tremor ) !round 70 percent of people wit" Parkinsons "ave a tre%or. t is slig"tly less
co%%on in younger people wit" Parkinsons. t %ay begin in one "and or ar% and is
%ore likely to occur w"en t"e affected part of t"e body is at rest. &re%or will usually
decrease or disappear w"en t"e affected part is being used and often beco%es %ore
noticeable w"en a person is an-ious or e-cited.
Other Symptoms
!s well as t"ese %ain p"ysical sy%pto%s t"ere are ot"ers suc" as tiredness and sleep
proble%s$ depression$ balance issues$ constipation and difficulties wit" "andwriting and
ot"er for%s of co%%unication suc" as speec" and facial e-pression.
Some further symptoms and common terms used to describe Parkinsons
Symptoms
Dyskinesia nvountary wrthng movements caused by an erratc response to ong-
term drug therapy. Dysknesas are a resut of varyng eves of Dopamne that are
avaabe
Dystonia panfu fxed contractons of musces.
Bradykinesia decreasng speed and amptude of sef-paced repettve movements
e.g. sow and decreasng cappng.
Wearing Off s the term used when drugs wear off before the next dose s due.
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Updated January 2007 Produced by Parkinsons Victoria www.parkinsons-vic.org.au
On s when the drugs are workng and the symptoms are treated. Patents may
suffer from dysknesa when they are ON.
Off s when the symptoms of Parknsons are not controed and a person can
experence reduced mobty or mmobty and requre more assstance, ths s often
known as freezing.
On/Off Phenomenon s when a person goes from on to off often qute qucky
and wthout warnng; ke a swtch beng fcked.
Non otor and Psychiatric symptoms
Depresson s ncreasngy consdered to be part of Parknsons dsease, and patents
w often deveop symptoms of depresson as ther Parknsons deveops, as we as a
reactve depresson to the dagnoss of Parknsons. Depresson n Parknsons needs
to be screened for and treated carefuy as many ant-depressants w worsen the
symptoms of Parknsons.
Some patents may deveop dsnhbted behavours, or compan of an ncreased sex
drve; ths s known as Hyper sexuaty. Deveopng a dffcut to contro urge to
gambe can aso occur n advanced dsease or n response to some medcaton.
Some patents wth Parknsons can deveop vsua haucnatons or deusons. Ths
can be a resut of takng ant-Parknson medcaton for many years or from a condton
cosey reated to Parknsons caed Lewy body dementa. Sometmes an nfecton or
anaesthetc can exacerbate ths probem.
Many peope never vounteer the fact that they experence vsua haucnatons so t
may be worth askng your patent f they ever see thngs that arent there. Someone
experencng vsua haucnatons and deusons shoud have ther drugs revewed as
ad|ustments to ther drug regmen by ther specast can reduce or emnate ths
probem.
It s mportant to remember that someone experencng Haucnatons does not have
a psychatrc ness ke schzophrena, and shoud aways be encouraged to dscuss
ths symptom wth ther treatng Neuroogst.
!"treme caution needs to be taken if considering treatment #ith
psychotropic medication$ as these medications can #orsen Parkinsons
symptoms%
&he ro'e of edications
Drugs are the man treatment to hep contro the symptoms of Parknsons.
Surgery may be approprate for a sma number for whom drug therapy does not
gve symptoms adequate contro. There are severa categores of drugs for
Parknsons treatment. Patents are often prescrbed medcaton from many
categores sted and a have to be gven at specfc tmes.
(e)odopa
Ths repaces the mssng chemca dopamne n the bran. Exampes of ths drug
ncude Madopar or Snemet. These drugs aso contan an extra substance that
prevents evodopa beng changed to dopamne before t reaches the bran.
Madopar contans evodopa pus benserazde and Snemet contans evodopa pus
carbdopa.
There are dfferent preparatons of each drug. Madopar has a dspersbe form
whch may be swaowed whoe or dssoved n water. NB Madopar capsules should
NOT be broken. Snemet has no dspersbe form but standard Snemet can be
crushed. For detas of controed reease (CR) optons, pease see MIMS or the
Medaton nformaton sheets on the better Heath Channe.
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Updated January 2007 Produced by Parkinsons Victoria www.parkinsons-vic.org.au
In a sma number of peope proten seems to nterfere wth the effectveness of
evodopa medcaton, reducng the absorpton of evodopa by the dgestve system. In
these cases peope may beneft from takng ther evodopa 45 mnutes before meas.
Dopamine *gonists +ora',
These drugs stmuate dopamne receptor stes. Exampes of the drug ncude
Cabaser (Cabergone) Permax (Pergode), Parode (Bromocrptne)
Requp (Ropneroe) may be prvatey mported by some patents.
Symmetre (Amantadne) s an NMDA antagonst avaabe as capsues or a syrup
form. It promotes reease of dopamne and aows t to stay onger at ts ste of acton.
-ombination drug therapy
Staevo
A preparaton caed Staevo was ntroduced n November 2003. It s a combnaton
drug contanng evodopa, carbdopa and entacapone n one tabet.
Dopamine *gonists +in.ection,
Apomne (Apomorphne) s devered subcutaneousy by n|ecton or pump and can
ony hep those wth Parknsons who show a response to Snemet or Madopar. It can
aso cause nausea so t s taken wth domperdone.
NB/ *pomine0 +*pomorphine, is not a Narcotic$ and is not re'ated to Opioid
preparations in any #ay
*nticho'inergics
These are used to bock acetychone n the bran .Exampes of ths drug ncude
Akneton (Bperden Hydrodhorde), Artane ( benzhexo Hydrochorde)
Benztrop and Cogentn (Benztropne)
-O& 1nhibitors
These drugs bock the enzyme catecho-O-methy transferase (COMT) whch breaks
down evodopa. Exampes of ths drug ncude Comtan (Entacopone). COMT
nhbtors are prescrbed to be used aong wth evodopa. Tasmar, Tocapone s
prvatey mported by some patents.
*O2B 1nhibitors
Edepry /Zeapar (Seegane) work by bockng the enzyme monoamne type B
(MAO-B) whch breaks down dopamne n the bran. They are often prescrbed to be
taken n the mornng as t s a stmuant and may keep peope awake f t s taken too
ate at nght.
Physica' therapies
Some drugs may brng on Parknsons-ke symptoms and shoud be avoded by
peope wth Parknsons uness they are specfcay recommended by a Parknsons
specast. rugs
edication not to be used for Peop'e 'i)ing #ith Parkinsons e"hau
sti)e/
3a'operido' +Serenace 3a'do',
-h'orpromazine +(argacti',
etoc'opramide +a"o'on,
Perphenazine +&riptafen,
4'upenthi"o' +4'uan"o'/Depi"o',
Pimozide +Orap,
Su'piride +Do'mati',
&hioridazine +e''eri',
Perphenazine +4entazin,
&rif'uoperazine +Ste'azine,
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Updated January 2007 Produced by Parkinsons Victoria www.parkinsons-vic.org.au
4'uphenazine ha'operido'
+oditen/Serenace/3a'do',
Proch'orperazine +Stemeti',
4'uphenazine #ith nortripty'ine +oti)a'/otipress,
&rany'cypromine #ith trif'uoperazine +Parste'in,%
The ony ora ant-sckness drug that can be safey taken s Domperdone (Motum).
NB this list is not exhaustive and you should always consult with your Doctor,
Pharmacist or Parkinsons !ssociation sta"" "or "urther in"ormation
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Updated January 2007 Produced by Parkinsons Victoria www.parkinsons-vic.org.au
!D1-*&1ON *N*5!!N&2 Get it on Time
Tmng of medcaton s vta for drugs to gve effectve contro of Parknsons
symptoms. Wherever possbe peope wth Parknsons shoud be aowed to sef
medcate. If ths s not possbe every effort needs to be made to ensure that
medcaton s gi)en to patients at the correct time. Tmngs w often dffer from
usua ward drug rounds and patents w have very ndvdua drug regmes, a usefu
anaogy s that Parknsons medcaton s ke petro n a car and wthout t the patent
wont go!
-are P'anning
-are P'anning
Nursng assessment of patents wth Parknsons s chaengng as "on" and "off"
perods, drug therapy and motor fuctuatons w determne dfferent needs at
dfferent tmes. Beow are some areas that shoud be consdered when care pannng.
Tak wth your patent and ther carer to get a pcture of how they are affected by
Parknsons and what effect ther medcaton has. Consderng them to be "experts" s
often a good approach to take.
Drug administration
When patents are nil by mouth, admnsterng the drugs to ensure a stabe drug
regme before, durng and after the surgery may be the man concern. If takng
tabets by mouth s mpossbe, consder aternatve routes. (Eg admnsterng a qud
preparaton rectay, or usng Apomorphne on a short term bass. If Apomorphne s
used t shoud be done n con|uncton wth domperdone (Motum).
&he best person to consu't in regards to a'tered medication regimes is the
patients neuro'ogist%
Most frequenty when patents are n oray, they w receve a ower dose of
medcaton - ths w drecty mpact upon ther motor functon and as a resut they
w need more assstance. If a patent s PEG or NG fed, medcaton shoud be gven n
qud form. Never crush Parknsons Medcatons wthout contactng the Hospta
Pharmacst before hand. Admnstraton of drugs needs to be dscussed wth a doctor
before the tube s ftted. NB Parknsons Medcaton w often shorten the fe of the
PEG tube and ths needs consderaton n ong term therapy.
It s mportant to rentroduce the ndvduas Parknsons medcatons as soon as
possbe once they are no onger n by mouth, however a gradua ncrease to norma
eves of medcaton s worth consderng as your patent s key to deveop some
dysknesa when Parknsons medcatons are re-ntroduced.
obi'ity
Your patent who has Parknsons may wak sowy wth a shuffng gat, have a
stooped posture, may freeze (sudden unpredcted nabty to move) and have a
runnng gat of sma unsteady steps (caed festnaton). Peope vng wth
Parknsons frequenty have an ncreased tendency to fa, especay n hgh traffc
and obstructed areas (most hospta corrdors and rooms). Some probems
assocated wth mobty ncude dffcuty n rsng from a char or bed, probems
turnng n bed and drug nduced dysknesas that can cause mmobty and nstabty.
Low bood pressure and Postura hypotenson wth dzzness on standng can aso be a
feature.
-ommunicating
Peope wth Parknsons can have a very quet voce wth poor artcuaton. They may
requre more tme to answer questons. Loss of faca expresson and body anguage
can aso make communcaton more dffcut, as often the vsua fed back of a sme or
grmace s not present. Handwrtng may become very sma and hard to decpher
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Updated January 2007 Produced by Parkinsons Victoria www.parkinsons-vic.org.au
(mcrographa). It may be of use to nvove a speech Pathoogst to assst n
deveopng an effectve communcaton strategy.
!ating and drinking
A person wth Parknsons may requre assstance at meatme due to reduced manua
dexterty, check that your patent s set up at mea tmes, as they may have dffcut
n takng the tops of ndvdua portons (E.g. |ams Mk). Tme shoud be aowed for
ndependent eatng whch may be sow. Chewng and swaowng can be affected and
there may be a rsk of chokng/aspraton.
If your patent s on a ower eve of medcaton than norma, consderaton shoud be
gven to provdng some addtona assstance at Mea tmes.
If your patent has dysknesa, be mndfu that they w have an ncreased caore
burn and may need some detary suppements or addtona snacks.
A referra to a speech and anguage therapst may be necessary. Fud ntake shoud
be montored to avod dehydraton.
!'imination
Hep may be requred due to mobty probems affectng abty to get to the toet.
Urnary urgency and frequency are common, and constpaton s a symptom of
Parknsons for many peope. Constpaton n partcuar w be worsened f your
patent has been on pan reef and f ther fud ntake s ess than usua. Montorng
bowe movement and ntroducng the approprate aperent w hep n avodng ths
probem.
S'eeping and night time care
Seep patterns may be affected by Parknsons and ts medcaton. Atered seep
patterns, sudden on set of day tme seep, fatgue and Drug nduced nghtmares can
aso occur.
An nabty to turn n bed may resut n a need for pressure area care. A person wth
Parknsons w need the nurse ca be very cose at hand as mobty s often
reduced over nght due to ower eves of medcaton. Consderaton shoud be gven
to usng an aternatng ce pressure reevng devce. It s often usefu to use a
Pressure Care score, such as a Norton or Waterow score.
Persona' hygiene
Agan due to reduced manua dexterty a person wth Parknsons may requre
assstance. Teeth ceanng and shavng can be partcuary dffcut. Immobty and
ack of stabty may mean the use of shower seatng rather than standng s requred.
Motor Performance can fuctuate, from day to day and hour to hour so an assessment
of the eve of assstance some one needs shoud be carred out pror to tasks.
Ensurng that your patent receves ther Parknsons Medaton on tme w hep n
reducng motor fuctuatons.
Pain
Pan s a probem n about 50% of a peope vng wth Parknsons. It s normay
muscuar pan and s worsened durng perods when patents are wearng off.
Crampng can aso occur and w be panfu. In some nstances patents can deveop
Dystona or nvountary contracton of the musces whch s aso very panfu.
!motions
Feengs of anxety, depresson and hopeessness may occur when the drugs are not
workng and these w ft once Parknsons medcaton s back at a norma eve.
Some Parknsons Medcatons can cause some out of character behavours, such as
Hyper sexuaty, or an ncreased urge to gambe. If you detect that these are evdent
n your patent you shoud ensure that they see ther Neuroogst.
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Updated January 2007 Produced by Parkinsons Victoria www.parkinsons-vic.org.au
Date of
Admission
Date of
irth!
Age!
"ame! #thnic Origin!
A$original% Torres straight
&sland '(ircle)
*anguage%*OT#!

Address! "e+t of ,in!
-elationship!

Address!
Telephone!
Telephone!
Treating Doctor! "eurologist!
Aware of Admission!
.eneral Practitioner!
Aware of Admission
Address! Address! Address!
Tel! Tel! Tel!
Mo$ile% Pager!
Date last Seen Date last Seen
Parkinsons /istory!
Date of Diagnosis! y Whom! '#0g0 "eurologist)
&nitial% Presenting Symptoms!
(urrent Signs% Symptoms
Tremor
-igidity
Dyskinesia
1ree2ing
1alls
(onstipation
/allucinations
Medication!
Drug%Other
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Updated January 2007 Produced by Parkinsons Victoria www.parkinsons-vic.org.au
Allergy
(urrent Medication! Dose! Times Taken!
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