Parkinson Disease Concept Map | Pathophysiology | Differential Diagnosis | Antiparkinson Drugs | L-dopa therapy

Parkinson Disease Concept Map: An Overview

Parkinson Disease Concept Map Parkinson Disease
Parkinson Disease Concept Map
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What is Parkinson Disease (PD)?

The map starts with disease's definition, epidemiology, etiology, and signs and symptoms.
Parkinson disease is an idiopathic, slowly progressive, degenerative disorder that is characterized by resting tremor, stiffness (rigidity), slow and decreased movement (bradykinesia), and gait and/or postural instability. The etiology of Idiopathic Parkinson Disease (IPD) is unknown, but most likely IPD is a result of interactions between ageing, genetic predisposition, and environmental factors.

Part of Parkinson Disease (PD) Concept Map - definition, epidemiology, etiology, and signs and symptoms
Part of Parkinson Disease (PD) Concept Map - definition, epidemiology, etiology, and signs and symptoms
Common motor signs of Parkinson disease include tremor, regidity, bradykinesia, and postural instability. Each of these sings is stated in the map with corresponding features in the form of table. For example, features of bradykinesia include:
  1. Smaller handwriting (micrographia)
  2. Infrequent blink
  3. Excessive drooling (sialorrhea) may contribute to disability
  4. Soft voice trails off
  5. Speech becomes hypophonic, ... etc.

Parkinson Disease Differential Diagnosis

Parkinson disease must be differentiated from other conditions presenting tremors, especially "Atypical Parkinsonism". As shown in the map, atypical parkinsonism refers to a set of symptoms typically seen in PD, but caused by other disorders.  It is caused not only by cell loss in the substantia nigra pars compacta (SNc), but also by additional degeneration of cells in the parts of the nervous system that normally contain DA receptors (striatum). Also mentioned in the map:
  • Common features of atypical parkinsonism that differentiate it from PD.
  • Forms of atypical parkinsonism and associated conditions.
Parkinson disease vs atypical parkinsonism - PD differential diagnosis - Zoom out - Pharmacotherapy
Parkinson disease vs atypical parkinsonism - PD differential diagnosis Zoom-out-pharmacotherapy

Parkinson's Pathophysiology

At this part of the map, there is an inter-link between disease's pathophysiology and treatment. Starting from disease's pathophysiology, the main pathological feature of PD is the death of dopaminergic neurons in
the substantia nigra pars compacta (SNc), causing the motor manifestations of PD. This point leads you to understand first the role of dopamine and dopamine metabolism in disease's pathophysiology and treatment.
Part of Parkinson Disease Concept Map - Pathophysiology and Treatment of Parkinson Disease
Part of Parkinson Disease Concept Map - Pathophysiology and Treatment of Parkinson Disease

Parkinson's Treatment

Dopamine metabolism and Antiparkinson drugs mechanisms of actions - Zoom out - Pharmacotherapy
Dopamine metabolism and Antiparkinson drugs mechanisms of actions
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This part of the map links between dopamine metabolism in presynaptic neurons and antiparkinson drugs mechanisms of actions. Pharmacological treatment of PD aims to restore dopaminergic function in the brain using one or more of the following:
  • Carbidopa/L-Dopa
  • COMT Inhibitors
  • MAO-B Inhibitors
  • DA Agonists
  • Anticholinergic Medications
  • Amantadine
For each drug or drug class, its mechanism of action, efficacy against PD symptoms, adverse effects, precautions or drug interactions if present are explained.
It is important to state that treatment of PD doesn't prevent progression of the disease and drug choice is based on symptoms. For example, Levodopa is most effective at relieving bradykinesia and rigidity, although it often substantially reduces tremor. On the other hand, anticholinergic medications are effective against IPD tremor in about 50% of patients; not bradykinesia or rigidity.

Antiparkinson Drugs Table Comparisons

Beside using the way of concept mapping to build information upon each other (information about drugs mechanisms of action and indications are built upon dopamine metabolism), there are also table comparisons for antiparkinson drugs. There are three tables that compares:
  1. Catechol-O-methyl transferase inhibitors (COMT inhibitors): Tolcapone and Entacapone.
  2. Monoamine oxidase B inhibitors (MAO-B inhibitors): Selegiline and Rasagiline
  3. Nonergot dopamine agonists: Apomorphine, Pramipexole, Ropinirole, and Rotigotine transdermal.
Antiparkinson drugs table comparisons-zoom-out-pharmacotherapy
Antiparkinson drugs table comparisons

L-dopa motor complications

Despite its efficacy as a symptomatic treatment of Parkinson disease, long-term L-dopa therapy is associated with disabling motor complications. These complications includes:
  1. End-of-dose wearing off (motor fluctuation)
  2. "Delayed-on" and "no-on" response
  3. Freezing
  4. Dyskinesias
  5. "Off-period" dystonia
These complications are represented in the map through a table that contains clinical features, mechanism, and management approach for each of l-dopa motor complications.
Levodopa motor complications table - clinical features, mechanism, and management - Zoom out - Pharmacotherapy
Levodopa motor complications table - clinical features, mechanism, and management

Surgical Management of Parkinson Disease

Surgical Management of Parkinson Disease - Zoom out - Pharmacotherapy
Surgical Management of Parkinson Disease
Surgery should be considered as an adjunct to pharmacotherapy in case that PD symptoms not adequately controlled with optimized medical therapy. The map briefly states surgical procedures for the treatment of PD, including the most common procedure which is Deep brain stimulation (Thalamic Stimulation) and its patient selection criteria.

Management of Special Situations

Hallucination and  cognitive disorders associated with PD - Zoom out - Pharmacotherapy
Hallucination and  cognitive disorders associated with PD
Parkinson disease is associated with nonmotor symptoms that may be caused by either the disease itself or the anti-parkinson drugs. These nonmotor symptoms can be hallucinations/psychosis, cognitive disorders, sleep disorders, depression, agitation, anxiety, constipation, orthostatic hypotension, seborrhea, and blepharitis. The goal in the management of Parkinson disease is to improve motor and nonmotor symptoms
in order to improve quality of life. This part of the map gives and overview about medications that can be used in the management of nonmotor complications and those that should be avoided in order not to worsen Parkinson symptoms.

We hope you find Parkinson Disease (PD) Concept Map helpful.  And if you've any inquiries or suggestions, please don't hesitate to contact us or comment below. This map is available in the following formats:


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Folded Poster

The maps is printed out on ordinary A1 size paper and it is folded to be nearly sized as A4 paper.

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To be sent to your address through the Egyptian Registered Postal Mail.

Delivery in Egypt takes few days,

Other countries: 2-3 weeks; you can upgrade to express mail. Please contact us for details.

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Whole Map

It's the map's soft copy. You will have the map as a whole on your computer screen.



Electornic; Download link.

A .pdf file for the whole map will be available for download immediately after payment received.

Printing the .pdf file of the map is not allowed.
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Printable Version

The map is split into pages to be printed on nine A4 papers. After printing them, you have to tape the edges together to make a folded poster.

Electornic; Download link.

A .pdf file for the printable version of the map will be available for download immediately after payment received.

Printing is allowed. The map is to be printed out on several pages.
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Parkinson Disease (PD) Concept Map by Maha Atef, B Pharm, PGDip (ClinPharm), PGDip (TQM).
Last updated on:  26 October 2014
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Who are "Zooming out"?

We are a team of pharmacists who are interested in the science of pharmacotherapy, which is represented through this site. At this site we are trying to help whoever experiences difficulty understanding and memorizing diseases and their corresponding treatment approaches. We are convinced with the idea of connecting information together and making links between it, to prevent its escape from minds, so we are presenting diseases using the concept mapping and the mind mapping methods to help in dealing with “information explosion!” in the field of pharmacotherapy. We really hope that you find this site helpful. Know more about those who are Zooming out!