Parkinson's Disease for Nurse Practitioner (NP) Licensing Exam
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Clinical Presentation
- Motor Symptoms:
- Bradykinesia: Significant reduction in speed and amplitude of voluntary movement.
- Rigidity: Stiffness felt uniformly in the limbs and trunk.
- Resting Tremor: Typically presents as a "pill-rolling" tremor of the hands at rest.
- Postural Instability: Increased risk of falls, evident in later stages.
- Non-Motor Symptoms:
- Cognitive decline, including memory difficulties and slowed thinking.
- Mood disorders such as depression and anxiety.
- Autonomic dysfunction, manifesting as urinary urgency, constipation, and orthostatic hypotension.
- Sleep disturbances, including REM sleep behavior disorder.
Diagnostic Approach
- Clinical diagnosis based on the presence of cardinal motor symptoms and response to dopaminergic medication.
- Imaging and additional tests:
- DaTscan can be helpful in uncertain cases by showing reduced striatal dopaminergic activity, although not routinely used.
- MRI to rule out other causes of symptoms.
Management
- Pharmacological Treatment:
- Levodopa/Carbidopa: Gold standard for symptomatic control.
- Dopamine Agonists (e.g., pramipexole, ropinirole) used especially in younger patients or early stages.
- MAO-B Inhibitors (e.g., selegiline, rasagiline) for mild symptoms or as adjuncts.
- COMT Inhibitors (e.g., entacapone) to enhance and prolong the effect of levodopa.
- Non-Pharmacological Interventions:
- Physical therapy to improve mobility and balance.
- Occupational therapy for assistance with daily activities.
- Speech therapy for speech and swallowing issues.
Complications
- Motor fluctuations and dyskinesias due to long-term use of levodopa.
- Psychiatric complications including hallucinations, delusions, particularly in the elderly or those on high doses of medication.
Prognostic Considerations
- Progressive nature of the disease with gradual worsening of symptoms.
- Regular monitoring and adjustment of treatment necessary to manage progression and side effects.
Commonly Tested Items on the NP Licensing Exam
1. Identification of cardinal motor symptoms of PD and their management.
2. Differentiation of PD from other causes of parkinsonism such as drug-induced parkinsonism and atypical parkinsonian disorders.
3. Management strategies involving both pharmacologic and non-pharmacologic treatments.
4. Role of the nurse practitioner in managing chronic neurological conditions, focusing on interdisciplinary care and patient education.