A 67-year-old man presents to the HCP with chief complaint of tremors in his arms. He also has noticed some tremors in his leg as well. The patient is accompanied by his son, who says that his father has become “stiff” and it takes him much longer to perform simple tasks.

A 67-year old man is accompanies by his son with complains of tremors in his arms and legs. The son also reports that he has noticed that his father has become stiff and takes him much longer to execute tasks such as rising from his chair. On physical examination, the patient has at rest tremors in the hands and fingers exhibit pin rolling movement.  His face is immobile and exhibits mask like appearance. He has an uneven and he shuffles when he walks and his head/neck, hips and knees are flexed forward. He exhibits jerky or cog wheeling movement. The patient reports of extreme incidents of flushing and sweating not associated with activity. The laboratory findings were unremarkable and a diagnosis of Parkinson’s disease was made. Advanced Pathophysiology Module 5 Assignment Paper

Neurological and musculoskeletal pathophysiologic processes

Parkinson’s disease is a complex progressive neurodegenerative disorder that manifests with symptoms of movement disorders such as; tremors at rest, rigidity, bradykinesia, and postural imbalance arising at a later stage.  Parkinson’s involves the extrapyramidal structures which consist motor components of the basal ganglia and is characterized by loss of dopaminergic function resulting in loss of motor function causing the clinical manifestation of the disease (Kouli et al., 2018). Dopamine is a neurotransmitter that is responsible for movement and coordination.

Various clinical researchers have pointed out striatal dopamine deficiency as a leading causative agent of the motor clinical manifestation, even though; the clinical presentation of non-motor symptoms supports the involvement of other neurotransmitters of the cholinergic, adrenergic, glutamatergic, and serotonergic systems. Researchers also propose that the disease origin may arise from the glossopharyngeal and vagal nerves dorsal motor nucleus and in the anterior olfactory nucleus proposing that the disease begins in the brain stem ascending to the higher cortical system (Zafar & Yaddanapudi, 2021). Clinical studies have continuously shown that Parkinson’s comprises of a disseminated global network dysfunction at varying levels in the nervous system.

Racial/ethnic variables that may impact physiologic functioning

There is an unclear understanding of the specific ethnic variables that impact Parkinson’s disease.  Contributors to ethnic variables are classified as biological and non-biological (Ben-Joseph et al., 2020).  Biological factors include; vascular diseases, comorbidities, and genetics. On the other hand non-biological factors are; health inequalities and under-reporting symptoms. Advanced Pathophysiology Module 5 Assignment Paper

How the processes interact to affect the patient

The most common monogenic forms of PD are as a result of gene mutation such as SNCA, PARK2, LRRK2 and DJ-1. They are associated with varying phenotypes and their predominance differs in different ethnic groups. Comorbidities such as type 2 diabetes which is prevalent among south Asians and Asia has been shown to have a close association with Parkinson’s disease. African-Americans have an increased risk of cerebral vascular burden than white Americans (Ben-Joseph et al., 2020).  The cerebral small vessel disease is closely associated with gait disturbance, postural instability, freezing gait and worsening cognitive impairment. Therefore, ethnic variation in cerebral vascular disease is likely to be an influence and also a causative agent of Parkinson’s disease.

Studies have shown that the prevalence is increased in sub-Saharan Africa compared to European countries. This is because in low-middle income areas, there is less access to Parkinson’s disease medication and neurology services.   Also Chinese-Americans and African Americans have an increased likelihood of perceiving Parkinson’s symptoms as the normal part of ageing as compared to white Americans.

References

Ben-Joseph, A., Marshall, C. R., Lees, A. J., & Noyce, A. J. (2020). Ethnic Variation in the Manifestation of Parkinson’s Disease: A Narrative Review. Journal of Parkinson’s Disease, 10(1), 31–45. https://doi.org/10.3233/jpd-191763

Kouli, A., Torsney, K. M., & Kuan, W.-L. (2018). Parkinson’s Disease: Etiology, Neuropathology, and Pathogenesis. Parkinson’s Disease: Pathogenesis and Clinical Aspects, 3–26. https://doi.org/10.15586/codonpublications.parkinsonsdisease.2018.ch1

Zafar, S., & Yaddanapudi, S. S. (2021, August 11). Parkinson Disease. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470193/