– Postural Instability
The patients intellectual function usually remains intact, however, they can appear with decreased tears, constipation and incontinence
– Pin rolling: Thumb against forefinger
This symptom will be triggered if the patient is anxious or in deep concentration. It will vary in intensity and can be reduced or abolished by voluntary movement.
– Stiffness in extremities
The patient becomes *Wax-Like* and sometimes drools because they have difficulty swallowing. Their head is forward, and they have a slow-shuffled gait.
– No movement
– on and off response
The patient will be active and moving (ON), then suddenly will be frozen in place for 1-2 minutes (OFF)
There is a rapid fluctuation of these symptoms.
– Slow, monotone, low pitch
– Change in handwriting
– A good patient history
– Neuro Exam
– Decreased dopamine in the urine
– Levadopa (Precursor to Dopamine)
– Sinemet (carbidopa/levadopa)
Therapeutic control of symptoms: quicker, lower dose, fewer s/e
– This medication is given orally before meals to increase absorption.
– No vitamin B-6
– With this medication, you start with a low dose, and then increase. The therapeutic level of this is determined when symptoms disappear.
– Swelling of the mouth and lips (Watch ABC’s)
– Thick secretions
– Red, Brown, Black urine, sweat, and saliva
– Frequent episodes of freezing in place
Drug Holiday (In the Hospital)
– Decrease the patients medication, the symptoms reappear, then restart the medication.
For constipation, give colace.
For nutrition – make sure they have a proper gag reflex (If not-Aspiration Pneumonia)
For Saftey, use a raised toilet, no rugs, cane, walker, etc.