Written Assessment: B (Science) (30%) ONWeight: 30%Length: 1,500 wordsCase Study 2 - Mr Patrick Drew...

Question

Written Assessment: B (Science) (30%) ON
Weight: 30%
Length: 1,500 words
Case Study 2 - Mr Patrick Drew is a 74 year old man (UR number XXXXXXXXXXHe was refe
ed by his GP to the neurology team for investigation and management of his Parkinson's disease, dysphagia and falls. On assessment he demonstrated
adykinesia, gaze limitations (in all directions) a persistent unilateral tremor in his right arm, and a shuffling gait (with limited arm swing). His limb rigidity is 'lead pipe rigidity' but he also has 'cogwheel rigidity' in his wrists. Link to Mr Drew Case
Discuss the following in relation to this case:
· Succinctly discuss the underlying pathophysiology in relation to the presenting signs and symptoms of either Mr Kwon or Mr Drew
· Discuss the pharmacological management in relation to symptom relief and ongoing management. Link your discussion to the relevant pathophysiology of the condition.
Structure and presentation:
This assignment is a piece of academic writing and needs to be structured as such, with an introduction and conclusion. You may use sub-headings as needed. It is a requirement of this assignment that 8 or more cu
ent relevant academic literatures, and peer reviewed evidenced based sources (other than the prescribed texts) are refe
ed to in your work.
Use the marking criteria to guide you with respect to aspects of presentation and formatting of this assignment.
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Case study
Mr Patrick Drew is a 74 year old man (UR number XXXXXXXXXXHe was refe
ed by his GP to the neurology team for investigation and management of his Parkinson's disease, dysphagia and falls.
Case study - Parkinsons disease
Signs and symptoms

    Radiographically Parkinson’s disease appears as nonspecific atrophy with enlarged lateral ventricles and widened sulci on CT. On MR, decreased width of the pars compacta between the pars reticularis and the red nucleus may be evident. Otherwise, no statistically significant differences in signal intensity or size of the pars compacta have been substantiated.
On PET imaging using 6-fluorodopa (FDOPA), decreased uptake is most evident in the posterior striatum, particularly in the putamen. Additionally, PET studies of cere
al glucose metabolism using 18F Fluorodeoxyglucose (FDG) show diffuse cortical hypometabolism most marked in the parietotemporal cortex.


On assessment he demonstrated
adykinesia, gaze limitations (in all directions) a persistent unilateral tremor in his right arm, and a shuffling gait (with limited arm swing). His limb rigidity is 'lead pipe rigidity' but he also has 'cogwheel rigidity' in his wrists. His wife Betty, described an increasing frequency in coughing and choking during the meals. His lung fields are clear and there is cu
ently no indication of aspiration pneumonia. Mr Drew has right sided facial
uising, including a large perio
ital haematoma, where he fell and hit his head earlier in the week. A CT scan ruled out head injury and the event was classified as unremarkable. His frequency of falls has also increased in the last few months. read on about his admission.
Health history
Mr Drews observations are as follows:
Temp XXXXXXXXXXC, HR 64, RR 14, BP 140/82, SpO2 97% RA.
Speech pathology and a barium swallow have been booked. He still requires a falls risk assessment and Waterlow pressure area assessment. He has been taking Sinamet CR (a combination of Levodopa and ca
idopa) for three years and, most recently amantadine hasbeen added to his regime.
Pathology results

tae_636717952510397205_121004_1.docx

Anju Lata · Accepted Answer

Running Head: Case Study 2- Parkinson’s Disease
Case Study 2: Parkinson’s Disease                                                                                                                   5
HSNS262 ASSESSMENT PART-B
Case Study 2: Mr. Patrick Drew
(Parkinson’s disease)
Student Name:
Student ID:
Professor Name:
University:
	Introduction
Parkinson’s disease is a fatal neurodegenerative disease of Central Nervous System which mainly restricts the body movements, a condition known as Bradykinesia in medical terms (Muller, 2012) and also affects the mental ability of the patient. The report refers to a case study of Mr. Patrick Drew, a 74-year old man who is a patient of Parkinson’s disease. The work elaborates the Pathophysiology and Pharmacology of his symptoms.
Pathophysiology 
The physiological symptoms of Parkinson’s disease occur due to consistent reduction in a number of neurotransmitters like Dopamine (Lo Monaco et al, 2018). With time, as more of the affected cells are lost, it leads to worsening of symptoms. The disease progresses sequentially and gradually initially affecting the dorsal motor nuclei of olfactory bulbs and vagus nerve, after that progressing towards locus coeruleus, the disease consequently affects the substantia nigra region (Stagg & Grice, 2011). The disease reaches the cortical areas of the brain at last. Damaging all these neuronal systems, the disease impairs the motor system, neurophysiologic and cognitive mechanism of the body. The motor impairment reduces the speed and amplitude of limb movement, as evident in the symptoms of Mr. Patrick.
Dopamine and its Role
Just like other neurotransmitters, the dopamine transfers the action potential from one neuron to another through synapse. After traveling along the axon, as the action potential reaches the pre-synaptic area of neuron, it triggers the release of neurotransmitter molecules which travel through the synapse and binds to the membrane of postsynaptic neuron.
The comparison of mechanism of healthy neuron with that of a Parkinson affected neuron shows that the dopamine progressively reduces with age in Parkinson’s patients. When the motor symptoms start appearing first time in the patient, by that time there is a tremendous loss of dopamine in the neurons. As the production of dopamine consistently reduces in the pre-synaptic neurons, very less amount of dopamine is there to travel through the synapse to bind the receptors at postsynaptic membrane. This loss of dopamine gives rise to Tremors, postural instability, trembling in extremities, shuffling gait and gaze limitations. Similar symptoms are evident in case study of Mr. Patrick.
 The loss of Dopaminergic neurons is relatively different in the process of normal ageing, in idiopathic Parkinson’s disease, in Parkinson’s disease caused by genetic and environmental factors, and during the early symptoms of Parkinson’s disease. 
During the normal process of aging the dopamine loss takes place at a very marginal level without affecting the motor functions of the brain. In idiopathic Parkinson’s disease, the degeneration of dopaminergic neurons occurs at slow rate and the motor symptoms appear at old age (Konno et al, 2018). Mr. Patrick seems to suffer from Idiopathic PD, because he has progressive degeneration at old age. When the Parkinson’s disease occurs due to genetic and repeated exposure to environmental agents, the motor symptoms appear during later stage in life. In early onset of disease, the mutation of PARKIN gene leads to the decline of dopaminergic neurons and appearance of symptoms at a very early stage in life (Konno et al, 2018). Sometimes when the intoxicants affect the in utero development, it lowers the number of dopaminergic neurons at birth,

Written Assessment: B (Science) (30%) ON Weight: 30% Length: 1,500 words Case Study 2 - Mr Patrick Drew is a 74 year old man (UR number XXXXXXXXXXHe was referred by his GP to the neurology team for...

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