La maladie de Parkinson (MP) se caractérise par une dégénérescence progressive et irréversible des neurones dopaminergiques de la substance noire induisant une perte de dopamine (DA) dans les structures cibles. Lorsque cette perte DA se situe entre 60 % et 80 %, les patients présentent des symptômes moteurs (rigidité, tremblement, akinésie) et non-moteurs très variés (dépression, anxiété, apathie). Ces derniers apparaissent avant et/ou en même temps que les symptômes moteurs. La dopathérapie permet de contrecarrer certains symptômes, mais tous ne sont pas sensibles à cette médication. Parallèlement à la dégénérescence DA, le système sérotoninergique (5-HT) serait aussi altéré de façon précoce dans la maladie. Cette dégénérescence est liée par l’expression de symptômes moteurs et non-moteurs. Néanmoins, aucun lien causal n’a été mis en évidence entre cette lésion 5-HT et la symptomatologie parkinsonienne. Ainsi, il était primordial de déterminer le rôle de la 5-HT dans 1) l’expression des troubles moteurs et non-moteurs 2) dans la réponse au traitement sérotoninergique et dopaminergique. Nous avons utilisé un nouveau modèle animal primate ayant une lésion 5-HT (via la MDMA) puis une lésion DA (via le MPTP). Ce modèle nous permet de mettre en évidence l’impact d’une lésion 5-HT précoce dans la symptomatologie. Des approches comportementales, pharmacologiques, d’imagerie et de neuroanatomie ont été utilisées. La lésion 5-HT a induit un trouble anxieux chez les animaux lésés à la MDMA, qui ne sont pas contrecarrer avec un traitement sérotoninergique (antidépresseur). Cette lésion a également induit une sévérité et une progression plus rapide des symptômes moteurs induits par la lésion DA / Parkinson’s disease (PD) is characterized by a progressive and irreversible degeneration of dopaminergic (DA) neurons localized in the substantia nigra, leading to a loss of dopamine within the target structures. When the loss of DA reaches 60 to 80 %, PD patients develop a wide range of motor (rigidity, tremor, akinesia fro example) and non-motor (depression, anxiety, apathy for example) symptoms. Dopatherapy allows the reduction of symptoms expression. But some motor and non-motor symptoms are not counteracted by those DA drugs. In addition to DA degeneration, patients present an early serotonergic (5-HT) lesion. This lesion is linked to the severity of some motor and non-motor symptoms. However, there is no causal link established between 5-HT lesion and parkinsonian symptoms. Therefore, it was essential to determine the role of 5-HT 1) in the expression of motor and non-motor symptoms 2) and in the response of DA and 5-HT treatments. For that, we used a new monkey model of PD, exhibiting a 5-HT lesion (with MDMA ‘”ecstasy”)) followed by a DA lesion (with MPTP). This model allowed us to evaluate the impact of an early 5-HT lesion on parkinsonian symptoms. We used different approaches: PET imaging, pharmacology, behavioral and neuroanatomy. The MDMA-driven early 5-HT lesion induced an anxious-like behavior on MDMA treatedmonkeys. This behavioral modification was not counteracted by 5-HT drugs (antidepressant). This MDMA lesion has also increased the severity and the progression of parkinsonian symptoms induced by DA lesion with MPTP

Bakgrund: Parkinsons sjukdom är en kronisk progredierande neurodegenerativ sjukdom och är den näst största i dess slag. Sjukdomen kan ge uttryck i både motoriska och icke-motoriska symtom. Genom sjukdomsförloppet genomgår personen olika faser som medför förlust av både mentala och kroppsliga funktioner. Förlusten av funktionerna ger en generellt sämre livskvalitet än hos andra personer. Syfte: Syftet med litteraturöversikten var att belysa symtomens påverkan på livskvaliteten hos personer med Parkinsons sjukdom. Metod: En allmän litteraturstudie baserad på tio kvalitativa studier. Resultat: Resultatet visar på att personer som lever med Parkinsons sjukdom har en komplex livssituation. De fysiska symtom som sjukdomen kännetecknas av ger svårigheter i vardagen. Resultatet visar också att den psykiska hälsan blir väsentligt påverkad i samband med detta. En följd av de fysiska och psykiska symtomen kan leda till social isolering, och tillsammans kan dessa skapa en kedjereaktion som leder till en försämrad livskvalitet. Slutsats och förslag på forskning: De motoriska symtomen är det mest påfrestande med att leva med Parkinsons sjukdom och bidrar starkt till en minskad livskvalitet. Därför behövs vidare omvårdnadsforskning för personer med Parkinsons sjukdom samt vilka omvårdnadsåtgärder som skulle kunna leda till förbättrad livskvalitet. / Background: Parkinson's disease is a chronic progressive neurodegenerative disease and is the second largest of its kind. The disease expresses both motor and non-motor symptoms. Through the course of the disease, the person undergoes different phases that cause loss of both mental and physical functions. The loss of functions gives a generally poorer quality of life than other people. Aim: The aim of the literature review was to highlight the effects of the symptoms on quality of life for people with Parkinson's disease. Method: A general literature study based on ten qualitative studies. Result: The result shows that people who are living with Parkinson's disease, lives in a complex life situation. The physical symptoms that the disease is characterized by creates difficulties in everyday life. The result also shows that mental health is significantly affected in this regard. A consequence of the physical and mental symptoms can lead to social isolation, and together they can create a chain reaction that leads to a deteriorating quality of life. Conclusion and Suggestions for Research: The motor symptoms are the most profound of living with Parkinson's disease and contribute significantly to a reduced quality of life. Therefore, nursing research is needed for people with Parkinson's disease as well as nursing measures that could lead to improved quality of life.

(in English): The aim of this diploma thesis is to analyse an availability of care for people mostly in productive age suffering from Parkinson's disease. In the first part, the author describes in a detail symptoms and medical treatment of the disease with an emphasis on the effects of these symptoms on life of patient and his/her surroundings. Following part pay attention to a specific group of so-called Young Onset, or younger patients. Finally, the thesis analyses the current state of the care in the Czech Republic with a comparison to a Dutch model. After exposing problematic spots in the Czech model, the author offers recommendations for viable changes in the institutional care system. The technique of analysing secondary literature was used in order to achieve the aim of this thesis.