National Secondary Schools use Malay as the main medium of instruction because Malay language is the National language of Malaysia while English is a compulsory subject in all schools. SinceScience and Mathematics had been taught in English, however in the government decided to revert to use Malay starting in year In addition, foreign languages such as Arabic or Japanese may be taught at certain schools.
Several neurodegenerative disorders also may present with parkinsonism and are sometimes referred to as "atypical parkinsonism" or "Parkinson plus" syndromes illnesses Formal letter essay pmr parkinsonism plus some other features distinguishing them from PD. They include multiple system atrophyprogressive supranuclear palsycorticobasal degenerationand dementia with Lewy bodies DLB.
In contrast to Parkinson's disease, Alzheimer's disease presents most commonly with memory loss, and the cardinal signs of Parkinson's disease Formal letter essay pmr, tremor, stiffness, and postural instability are not normal features of Alzheimer's.
Dementia with Lewy bodies is another synucleinopathy and it has close pathological similarities with PD, especially with the subset of PD cases with dementia known as Parkinson's disease dementia.
Signs and symptoms of Parkinson's disease The most recognizable symptoms in Parkinson's disease are movement "motor" related. Some of these non-motor symptoms may be present at the time of diagnosis. Parkinsonian gait Four motor symptoms are considered cardinal in PD: A feature of tremor is pill-rolling, the tendency of the index finger and thumb to touch and perform together a circular movement.
Performance of sequential and simultaneous movement is impaired.
It leads to particular difficulty in carrying out two independent motor activities at the same time and can be made worse by emotional stress or concurrent illnesses. Paradoxically patients with Parkinson's disease can often ride a bicycle or climb stairs more easily than walk on a level.
While most physicians may readily notice bradykinesia, formal assessment requires a patient to do repetitive movements with their fingers and feet. Postural instability is typical in the later stages of the disease, leading to impaired balance and frequent falls,  and secondarily to bone fracturesloss of confidence, and reduced mobility.
Freezing of gait brief arrests when the feet seem to get stuck to the floor, especially on turning or changing directiona slurred monotonous quiet voice, mask-like facial expression, and handwriting that gets smaller and smaller are other common signs.
This includes disorders of cognition, mood, behavior, and thought. The dopamine dysregulation syndrome — with wanting of medication leading to overusage — is a rare complication of levodopa use Giovannoni, et al.
Behavior and mood alterations are more common in PD without cognitive impairment than in the general population, and are usually present in PD with dementia.
The most frequent mood difficulties are depressionapathyand anxiety. Punding in which complicated repetitive aimless stereotyped behaviors occur for many hours is another disturbance caused by anti-Parkinson medication.
Auditory hallucinations are uncommon in PD, and are rarely described as voices. It is now believed that psychosis is an integral part of the disease. A psychosis with delusions and associated delirium is a recognized complication of anti-Parkinson drug treatment and may also be caused by urinary tract infections as frequently occurs in the fragile elderlybut drugs and infection are not the only factors, and underlying brain pathology or changes in neurotransmitters or their receptors e.
Sleep problems are a feature of the disease and can be worsened by medications. Causes of Parkinson's disease Environmental factors Exposure to pesticides and a history of head injury have each been linked with Parkinson disease PDbut the risks are modest.
Never having smoked cigarettes, and never drinking caffeinated beverages, are also associated with small increases in risk of developing PD. It has been suggested that some cases of PD may be caused by lysosome dysfunctions that reduce the ability of cells to break down alpha-synuclein.
The brown colour is positive immunohistochemistry staining for alpha-synuclein.
This loss of neurons is accompanied by the death of astrocytes star-shaped glial cells and a significant increase in the number of microglia another type of glial cell in the substantia nigra. These are known as the motoroculo-motorassociativelimbic and orbitofrontal circuits, with names indicating the main projection area of each circuit.
When a decision is made to perform a particular action, inhibition is reduced for the required motor system, thereby releasing it for activation. Dopamine acts to facilitate this release of inhibition, so high levels of dopamine function tend to promote motor activity, while low levels of dopamine function, such as occur in PD, demand greater exertions of effort for any given movement.
Thus, the net effect of dopamine depletion is to produce hypokinesiaan overall reduction in motor output. This insoluble protein accumulates inside neurones forming inclusions called Lewy bodies. As the disease progresses, Lewy bodies develop in the substantia nigra, areas of the midbrain and basal forebrain and, finally, the neocortex.
Other forms of alpha-synuclein e. Neurofibrillary tangles and senile plaquescharacteristic of Alzheimer's diseaseare not common unless the person is demented. It may be related to oxidative stressprotein aggregation and neuronal death, but the mechanisms are not fully understood.
The finding of Lewy bodies in the midbrain on autopsy is usually considered final proof that the person had PD.(Click here for bottom) P p p, P Momentum. Utility of the concept of momentum, and the fact of its conservation (in toto for a closed system) were discovered by .
English Essay Pmr Formal Letter Format Spm Best Of Essay Help Line And Assignment Writing 24 7 is one of the images that are related with the image in the post that published as ideas for your document and template. The Scarlet Letter, Critical Essay Nathaniel Hawthorne’s novel, The Scarlet Letter was the greatest writing of American Literature of his time and even to this day.
His beliefs in this book are based on the ideas of the Romantics. Sep 16, · Sunday, September 16, PMR Tips, Writing - Informal Letter Writing an Informal Letter * A hardworking student from across the .
Oct 07, · Look at the model answer below to revise the format of a formal letter and see how the points are elaborated. Guidelines for Writing a Formal Letter: · Your address should appear on the · left-hand corner.
2. A horizontal line across the page separates your address from the recipient’s address. 3. Address of the person to whom you are writing.