NR 603 Week 6 Assignment and Collaboration Cafe _ CEA Pre-Diagnostic Case Study Part 1 and Part 2

and details of conversations. There is no history of a sudden onset of these symptoms. He denies vision changes and headaches. Differential Diagnoses 1. Parkinson’s Disease (PD) o Pathophysiology: Parkinson's disease is found to be a progressive neurodegenerative disorder caused by the death of dopaminergic neurons in the substantia nigra, leading to motor symptoms such as tremor, rigidity, bradykinesia, and postural instability (Armstrong & Okun, 2020). o Rationale: The patient’s presentation of rest tremor, bradykinesia, shuffling gait, and cognitive changes is classic of Parkinson’s disease. 2. Essential Tremor o Pathophysiology: An essential tremor has a couple of theories surrounding the etiology; most recently, scientists believe it results from abnormal activity in the cerebellum, inferior olive nuclei (ION), thalamus, red nucleus, and cerebral cortex. Essential tremors are characterized by bilateral tremors, particularly in the hands, with no other neurological symptoms associated (Kosmowska & Wardas, 2021). o Rationale: The presence of tremors in the patient's right hand could initially suggest essential tremors, but it is usually bilateral and does not cause the additional motor and non-motor symptoms seen in PD. 3. Multiple System Atrophy (MSA) o Pathophysiology: Multiple System Atrophy is a very rare, progressive neurodegenerative disease. The pathology is not widely understood; however, it is believed that within oligodendrocytes and neurons, there is an accumulation of misfolded aSyn. Symptoms present similarly to Parkinson’s disease; however, beginning in early stages of the disease, it is associated with autonomic dysfunction (Jellinger, 2020). o Rationale: MSA should be considered when there are autonomic symptoms (which are not prominent in this case). Risk Factors: Parkinson's Disease (PD) • Age: Parkinson’s disease typically affects individuals over 50 years old. Which increases his risk. • Gender: Parkinson’s disease is more common in men than in women. o When comparing the differentials on this case, Parkinson’s disease is the only disorder where the pathology is more well-known. The destruction of dopaminergic neurons in the substantia nigra causes the classic symptoms associated with the disorder. Both essential tremors and MSA are poorly understood. Essential tremors, as mentioned before, are thought to be associated with abnormalities of the thalamus, red nucleus, cerebral cortex, inferior olive nuclei, and the cerebellum. MSA is associated with the accumulation of malformed aSyn on the neurons and oligodendrocytes (Balestrino & Schapira, 2020; Jellinger, 2020; Kosmowska & Wardas, 2021). • Presentation: o PD typically includes a combination of tremors, bradykinesia, rigidity, and postural instability. o Essential tremors are mostly limited to tremors and are usually symmetric. o MSA presents with more complex motor dysfunction, including ataxia and autonomic disturbances such as orthostatic hypotension, which are not seen in typical PD. (Balestrino & Schapira, 2020; Jellinger, 2020; Kosmowska & Wardas, 2021). Relevant Testing Required 1. Parkinson’s Disease: o PD is often a clinical diagnosis made by exclusion from severe pathologic or physiological conditions. o Dopamine transporter (DAT) scan may be used in unclear cases to show reduced dopamine uptake in the basal ganglia. 2. Essential Tremor: o Single photon emission computed tomography (SPECT) to differentiate between Parkinson’s