Parkinson’s Disease & Psychosis in the Post-Acute and Long-Term Care Setting
Key Points
Key Points
- Parkinson’s disease (PD) is a progressive, neurodegenerative movement disorder. Currently there are an estimated 9.4 million people living with PD around the world, which is significantly higher than the previously reported 6 million cases in 2016. As the population ages, so does the increase in prevalence of PD. As a result, a growing number of residents living in long-term care settings are also living with PD. Both motor and neuropsychiatric symptoms contribute to institutionalization, but the presence of dementia is its strongest predictor. Ultimately, 20% to 40% of people with PD are admitted to a nursing home or assisted living facility. Of nursing home residents with PD, only one-third are followed by a neurologist, leaving the majority of care for these residents to long-term care providers. This pocket guide is intended to provide guidance on the management and treatment of Parkinson’s disease for clinicians in the post-acute and long-term care settings.
- PD typically presents in people who are in their 50s and 60s. Clinically, the four well known cardinal motor features are rigidity, bradykinesia, asymmetric rest tremor, and gait instability. These motor symptoms are due to the loss of dopaminergic neurons deep in the midbrain, which cause the majority of dysfunction in the motor circuitry of the basal ganglia. Additionally, there are many non-motor features of PD (discussed later in the pocket guide).
- There is no known treatment to slow or halt the progression of PD. However, good symptomatic control is possible with dopaminergic and non-dopaminergic medications; exercise; physical, occupational, speech, and music therapy; and in select cases, brain surgery.
- Research into disease modifying treatment, new medications, and better medical devices is advancing at a rapid pace. In this pocket guide, you will learn the basics of diagnosis and management of PD.
Glossary/Key Terms/Abbreviations Defined
...ssary/Key Terms/Abbreviations Define...
Recognition
...ognition
...oth motor and non-motor symptoms,...
...and Non-Motor Features of Parkins...
.... Differential Diagnosis – Parkinsonism...
...Feature - Possible Alternate DiagnosisHavin...
...gs: Other Symptoms Not Consistent with the...
...s Requires the presence of parkinsoni...
Assessment
...sessmen...
...3. Symptoms and SignsHaving trouble v...
Comorbidities Motor and non-motor sym...
...den DeclinePresentations Sudden decreased f...
Treatment
...atment...
...e 4. Treatment of Non-Motor Symptoms (in alpha...
...ysical, Occupational, and Speech TherapyHaving tro...
...Some Factors that Increase Risk of Falls in P...
...iderations Refer resident to a dietitian...
...nal ConsiderationsDental health PD pati...
...TherapiesMarijuana Marijuana contains hundre...
...proach to Pharmacotherapy The goal of ph...
...WORD ABOUT DYSKINESIAS:Dyskinesias...
...al Levodopa Dosing and Blood Levels...
...onceptions and Common Questions fr...
...otor Pharmacotherapy Options Carbid...
...nd Motor Pharmacotherapy Options Carbidop...
Dyskinesia Treatment Amantadine (Symmetrel)...
...fects Carbidopa-levodopa: Naus...
Surgical Options There are three major surgica...
Monitoring
...onitorin...
...sted Quality Measures with Proposed FrequencyNote:...
...iative Care/End-Of-Life IssuesPrognosis Pe...
...Medicare Hospice Eligibility CriteriaHaving...
Parkinson's Disease Dementia and Psychosis
...nson's Disease Dementia and Psych...
...tia is a common feature of PD. The mean preval...
.... Dementia with Lewy Bodies vs. Par...
Figure 3. Differential Diagnosis of Parkinson’s...
Assessment When assessing for PD...
...in People with Parkinson’s Diseas...
...tepwise Process for Treating Parkinson’s...
...eatment Dementia in PD - Most but...
Appendices
Appendice...
...he Long-Term Care Interval History...
Appendix 1: LTC Interval History: Parkins...