1) Discuss the demographics and etiology of idiopathic Parkinson’s (PD) and Huntington’s diseases (HD)
2) Compare and contrast the pathological features and pathogenesis of idiopathic PD, PD plus syndromes, and HD
3) Differentiate between the diagnosis of idiopathic PD and HD
4) Compare and contrast typical signs and symptoms of idiopathic PD and HD
5) Describe the clinical course, prognosis, and medical and surgical treatment of idiopathic PD and HD
6) Discuss evidence-based examination of the client with PD and HD
7) Discuss evidence-based management of the client with PD and HD
8) Compare and contrast examination and management of early, middle, and late-stage PD and HD
WHAT ARE PARKINSON’S AND HUNTINGTON’S DISEASES?
Parkinson’s disease and Huntington’s disease are progressive neurodegenerative disorders of the basal ganglia and its connections that profoundly impact motor, cognitive, and psychiatric functions of affected individuals. Parkinson’s disease was named for James Parkinson, an English physician, whose work “An Essay on the Shaking Palsy” published in 1817 described six individuals with symptoms of the disease. Huntington’s disease was named for George Huntington, an American physician, who published an article entitled “On Chorea” in 1872 that described the disease.
Parkinson’s disease (PD) is the second most common neurodegenerative disorder, after Alzheimer’s disease, with an estimated 1 million Americans and 7 to 10 million people worldwide affected by the disease. There are approximately 60,000 new cases annually of PD in the United States.1 The average age of onset is 60, and prevalence and incidence rates are very low in individuals under 40 years, increasing with age and peaking by age 80.2 The disease is approximately 1.5 times more common in men than women. A large study of US Medicare beneficiaries aged 65 and older from the years 1995 and 2000-2005 found that the incidence of PD was highest among Hispanics, followed by non-Hispanic whites, Blacks, and Asians.3 However, the prevalence of PD was highest among non-Hispanic whites, followed by Hispanics, Asians, and Blacks. Geographically, the incidence and prevalence of Parkinson’s disease were 2 to 10 times greater in the Midwest and Northeast regions of the United States than Western and Southern regions.3
ETIOLOGY AND RISK FACTORS FOR PARKINSON’S DISEASE
Parkinsonism refers to a group of disorders with a variety of different underlying pathologies that can cause Parkinson’s-like symptoms, including slowing movement (bradykinesia), tremor, rigidity or stiffness, and balance problems. PD, or idiopathic parkinsonism, is the most common disorder, affecting about 78% of individuals. Secondary parkinsonism results from identifiable causes such as toxins, trauma, multiple strokes, infections, metabolic disorders, and drugs. There are also conditions such as parkinson-plus syndromes that mimic PD in some ways but are caused by other neurodegenerative disorders.
IDIOPATHIC PARKINSON’S DISEASE
The exact cause of Parkinson’s disease remains ...