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

...Terms/Abbreviations DefinedHaving trouble view...

Recognition

Recognit...

...motor and non-motor symptoms, which can be presen...


...Motor and Non-Motor Features of P...


...ential Diagnosis – Parkinsonism...

...re - Possible Alternate DiagnosisHav...


...ther Symptoms Not Consistent with the Diagnosi...


...nosis Requires the presence of park...


Assessment

...sessmen...

.... Symptoms and SignsHaving trouble v...


...Motor and non-motor symptoms (e.g., fat...


...eclinePresentations Sudden decreased funct...


Treatment

...eatment...

...reatment of Non-Motor Symptoms (in alphabeti...


.... Physical, Occupational, and Spee...


...ble 6. Some Factors that Increase Risk...


...erations Refer resident to a dietitian if t...


...nsiderationsDental health PD patients...


Drug TherapiesMarijuana Marijuana contains...


...roach to Pharmacotherapy The goal of pharmacot...

...ORD ABOUT DYSKINESIAS:Dyskinesias are slower,...

...re 2. Optimal Levodopa Dosing and Blood...

...isconceptions and Common Questions from Pe...

...or Pharmacotherapy Options Carb...

...Pharmacotherapy Options Carbidopa-levodopa IR...

Dyskinesia Treatment Amantadine (S...

...Effects Carbidopa-levodopa: Nausea,...

...gical Options There are three major s...


Monitoring

Monitoring

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


...ative Care/End-Of-Life IssuesPrognosis...


...Medicare Hospice Eligibility Criteria...


Parkinson's Disease Dementia and Psychosis

...arkinson's Disease Dementia and Psy...

...a common feature of PD. The mean prevalence of...


...ementia with Lewy Bodies vs. Parkinson’s Disease...


...rential Diagnosis of Parkinson’s D...


...ssessment When assessing for PD psychosis, mos...


...osis in People with Parkinson’s Disease Pa...


...re 4. Stepwise Process for Treating Parkinson’...


...atment Dementia in PD - Most but not a...


Appendices

Appendice...

...e Long-Term Care Interval History: Parkinson'...


...pendix 1: LTC Interval History: Parkinson’s Dise...