Parkinson

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Parkinsons Disease
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Incidence

• 21000
• 110 nursing home residents
• 1.7 lt50yrs of age

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Parkinsons 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

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Clinical features

• Slowness
• Stiffness
• Tremor
• Loss of balance

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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

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What not to do

• Dont prescribe delay until after care plan has
  been agreed by specialist

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Management

• Diagnosis
• Maintenance
• Complex
• palliative

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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
  Parkinsons disease, planning appropriate
  management, nurse specialist assessment

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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 Parkinsons Disease Society

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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

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Maintenance contd.

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

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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
  whats going on
• Referral increased role of secondary care
  support, good communication

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Palliative

• PCT priorities consider dopa reduction or
  withdrawal, watch out for complications, care for
  the carer
• Aims relief of symptoms, pain relief, ensure
  patients dignity
• Referral palliative care services may be
  required, social services, ?transfer to hospice
  etc