Parkinson’s Disease & Psychosis in the Post-Acute and Long-Term Care Setting

Publication Date: June 1, 2021

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

...ey Terms/Abbreviations Defined...

Recognition

...Recognition...

...h motor and non-motor symptoms, which...


...otor and Non-Motor Features of Parkinson...


...re 1. Differential Diagnosis – Parkinson...

...e - Possible Alternate Diagnosis...


...: Other Symptoms Not Consistent with the Diagnosis...


...Requires the presence of parkinsonism, which is d...


Assessment

...Assess...

...ms and Signs Motor (TRAP)...


...ies Motor and non-motor symptoms (e.g...


Sudden DeclinePresentations Sudden d...


Treatment

...Treatment...

...tment of Non-Motor Symptoms (in alphabe...


...sical, Occupational, and Speech Therapy...


...Some Factors that Increase Risk of Fall...


...tary Considerations Refer resident to a dietiti...


...nal ConsiderationsDental health...


...g TherapiesMarijuana Marijuana cont...


...rmacotherapy The goal of pharmacother...

...DYSKINESIAS:Dyskinesias are slower, writhing, dan...

...igure 2. Optimal Levodopa Dosing and Blood Level...

...ptions and Common Questions from People...

...able 7. Motor Pharmacotherapy Options...

...-Demand Motor Pharmacotherapy Options Carbi...

...Treatment Amantadine (Symmetrel) Renally...

...Carbidopa-levodopa: Nausea, upset stomach...

...ical Options There are three majo...


Monitoring

...Mon...

...y Measures with Proposed FrequencyNote: See “LT...


...ognosis/Palliative Care/End-Of-Life...


...dicare Hospice Eligibility Criteria...


Parkinson's Disease Dementia and Psychosis

...Parkinson's Diseas...

...Dementia is a common feature of PD....


...able 9. Dementia with Lewy Bodies vs....


...gure 3. Differential Diagnosis of Park...


...n assessing for PD psychosis, most ess...


...eople with Parkinson’s Disease Parkinson...


...wise Process for Treating Parkinson’s Di...


...reatment Dementia in PD - Most but not all...


Appendices

...Appendices...

...Care Interval History: Parkinson's Disease M...


...Interval History: Parkinson’s Di...