Parkinson’s Disease

Incidence

2:1000 1:10 nursing home residents 1.7 <50yrs of age

Parkinson’s disease is ….

Progressive, disabling and distressing Appropriate management and planning right

from the start can prevent some of the most distressing features

Teamwork can address and solve most of the issues and help the GP to deliver better care

Clinical features

Slowness Stiffness Tremor Loss of balance

What to do

Tell patient your suspicion of Parkinsonism and need for confirmation by referral

Obtain patients perspective… What do they understand and what would

they like to ask? Check for drugs with extra-pyramidal side

effects e.g. prochlorperazine

What not to do

Don’t prescribe… delay until after care plan has been agreed by specialist

Management

Diagnosis Maintenance Complex palliative

Diagnosis

Primary care team priorities: management of co-moribities, nursing assessment to address queries, carer support

Patient concerns: driving (must inform DVLA and insurers), ?genetic predisposition

Referral for confirmation of diagnosis to an physician with a special intererest in Parkinson’s disease, planning appropriate management, nurse specialist assessment

Diagnosis contd

Nurse specialist to act as liaison between primary and secondary care and as point of contact for the patient and carer

Refer to Parkinson’s Disease Society

Maintenance

PCT priorities: watch out for complications, establish relationship with nurse specialist, care for the carer, define follow up arrangements

Aims: morbidity relief and maintenance of good health

Patient concerns: finance, work, benefits, sexual and personal relationships

Maintenance contd.

Referrals e.g. to OT, physio, psychologist, social services etc.

Complex

PCT priorities: support for patients and carers, look out for complications, several drugs may have to be co-prescribed

Aims: maintenance of good health, management of drugs, ensure patients and carers understand what’s going on

Referral: increased role of secondary care support, good communication

Palliative

PCT priorities: consider dopa reduction or withdrawal, watch out for complications, care for the carer

Aims: relief of symptoms, pain relief, ensure patient’s dignity

Referral: palliative care services may be required, social services, ?transfer to hospice etc