John is 63 years old and receives home care from an occupational

John is 63 years old and receives home care from an occupational therapist twice weekly. His therapist is currently working with John on maintaining joint flexibility and balance. John demonstrates resting tremors, so his therapist is also working on adaptive techniques so John can continue to use his hands to write, use the computer, and cook simple meals. John’s wife assists with his mobility and walks slowly beside him, holding his arm. Sometimes, she needs to help him open his prescription bottles so he can take his medicine, a combination of levodopa and carbidopa.

1. What motor disease does John demonstrate? One of his signs is a resting tremor. What is the difference between a resting tremor and an intentional tremor?

2. What is the advantage of combining levodopa with carbidopa? What is the benefit of anticholinergic drugs in the management of Parkinson disease?

3. Parkinson disease involves the destruction of the substantia nigra and the nigrostriatal pathway. Where are these structures anatomically?

4. The patient with Parkinson disease typically presents with a masklike facial expression. Why does he or she have a masklike facial expression? How are the eyes, mouth, and laryngopharynx affected by this disease?

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