Sore throat, dysphagia, and headache with Parkinson’s disease
Assignment Details: Sore throat, dysphagia, and headache with Parkinson’s disease
Parkinson’s disease is a neurodegenerative disorder; the typical clinical movement disorder Parkinsons disease consists of bradykinesia, resting tremor and rigidity (Kouli et al., 2018). Loss of the dopaminergic neurons in the substantia nigra is the cause of the movement disorder. Genetic risk factors might be the grounds for the development of Parkinson’s disease as well as different environmental factors such as smoking, caffeine consumption and exposure to pesticides (Kouli et al., 2018).
Levodopa is a precursor to dopamine, it serves as a replacement therapy to treat Parkinson’s disease (Gandhi & Saaddabadi, 2023). Levodopa is co-administered with decarboxylase inhibitors such carbidopa to increase its bioavailability by allowing more Levodopa to cross the blood brain barrier. (Gandhi & Saaddabadi, 2023).
Headache, nausea, dizziness, and somnolence are the common side effects when taking levodopa (Gandhi & Saaddabadi, 2023). Incidence of headache is very common when taking Sinemet; up to 17 % experience headaches when taking this medication (Drugs.com, n.d.).
Sore throat or pharyngitis is defined as throat pain especially when swallowing (Dunphy et al., 2019). Most common causes of sore throat are due to streptococcal or viral infections. Diagnosis of pharyngitis may be due to infectious and inflammatory, neurologic, traumatic, or neoplastic origin (Dunphy et al., 2019). Oro-pharyngeal dysphagia is common in neuro-degenerative disorders such as Parkinson’s disease as the disease progresses dysphagia increases rapidly (Kwon & Lee, 2019).
Managing symptoms
The rule of thumb in levodopa treatment is to administer the lowest dosage to control symptoms (Dunphy et al., 2019). After 2 to 5 years of treatment with Levodopa, more than 50% of patients experience fluctuations in response to dyskinesia as the medication wears off (Dunphy et al., 2019). COMT inhibitors can be used as adjunct treatment with levodopa to increase its bioavailability (Dunphy et al., 2019).
Rating scales are used to assess the effectiveness of treatment. Unified Parkinsons Disease Rating Scale (UPDRS) is one of the tools that determines effectiveness by assessing the “mental, historical, and motor features and the complications of dopaminergic therapy (Dunphy et al., 2019, p. 129).
Frequency and follow up visits will depend on the response of the patient to the treatment, adverse effects of medication, and disease progression (Dunphy et al., 2019, p. 129). Referral to a specialist is warranted and should be based on the knowledge and comfort level in treating Parkinson’s disease (Dunphy et al., 2019). Speech therapy is essential to assist with dysphagia and drooling; nutrition is affected if dysphagia occurs (Dunphy et al., 2019).
The Beer’s criteria are an explicit list of potentially inappropriate list of medications used by older adults in the treatment of disease, which serves as a guide for clinicians (American Geriatric Society, 2023). Anyone 65 years old and above in all ambulatory, acute and institutionalized settings except in hospice and end of life care are subject to the Beer’s criteria (American Geriatric Society, 2023).
References:
American Geriatrics Society. (2023). American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7). https://doi.org/10.1111/jgs.18372
Drugs.com. (n.d). Sinemet Side Effects: Common, Severe, Long Term. https://www.drugs.com/sfx/sinemet-side-effects.html
? Dunphy, L., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2019). Primary care: The art and science of advanced practice nursing – an interprofessional approach (5th ed.). F.A. Davis Company.
Kouli, A., Torsney, K. M., & Kuan, W.-L. (2018). Parkinson’s Disease: Etiology, Neuropathology, and Pathogenesis. Parkinson’s Disease: Pathogenesis and Clinical Aspects, 1, 3–26. https://doi.org/10.15586/codonpublications.parkinsonsdisease.2018.ch1
Kwon, M., & Lee, J. H. (2019). Oro-Pharyngeal Dysphagia in Parkinson’s Disease and Related Movement Disorders. Journal of movement disorders, 12(3), 152–160. https://doi.org/10.14802/jmd.19048
Gandhi, K. R., & Saadabadi, A. (2022, May 2). Levodopa (L-Dopa). Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482140/
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