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
...lossary/Key Terms/Abbreviations DefinedHaving...
Recognition
...ecognition...
Include both motor and non-motor symptom...
...Motor and Non-Motor Features of Parkinson’s D...
...rential Diagnosis – Parkinsonism...
...le: Feature - Possible Alternate DiagnosisH...
...ed Flags: Other Symptoms Not Consistent...
...nosis Requires the presence of parkinsonis...
Assessment
Assessment
...le 3. Symptoms and SignsHaving trouble...
...morbidities Motor and non-motor sym...
...DeclinePresentations Sudden decrea...
Treatment
...atment
Table 4. Treatment of Non-Motor Symptoms...
...le 5. Physical, Occupational, and Speech Therapy...
...ome Factors that Increase Risk of Falls in Pe...
Dietary Considerations Refer resident t...
...al ConsiderationsDental health P...
...ug TherapiesMarijuana Marijuana contains hun...
Approach to Pharmacotherapy The goal of pha...
...BOUT DYSKINESIAS:Dyskinesias are slower, wri...
...igure 2. Optimal Levodopa Dosing and Bl...
...eptions and Common Questions from People w...
...r Pharmacotherapy Options Carb...
...d Motor Pharmacotherapy Options Carbidopa-lev...
...reatment Amantadine (Symmetrel) Ren...
...arbidopa-levodopa: Nausea, upset...
...ons There are three major surgical...
Monitoring
...onitoring...
...ested Quality Measures with Proposed...
...nosis/Palliative Care/End-Of-Life IssuesP...
...able 8. Medicare Hospice Eligibility CriteriaHa...
Parkinson's Disease Dementia and Psychosis
...son's Disease Dementia and Psychosis...
...Dementia is a common feature of PD. T...
...Dementia with Lewy Bodies vs. Parkinson’...
...ential Diagnosis of Parkinson’s Disease...
...t When assessing for PD psychosis, mo...
...People with Parkinson’s Disease...
...ise Process for Treating Parkinsonâ...
...tment Dementia in PD - Most but not a...
Appendices
...pendice...
...re Interval History: Parkinson's Dise...
...Interval History: Parkinson’s Dise...