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
...Key Terms/Abbreviations DefinedHaving...
Recognition
...ognition...
...h motor and non-motor symptoms, which can be prese...
...le 1. Motor and Non-Motor Features o...
...fferential Diagnosis – Parkinsonism...
...ture - Possible Alternate DiagnosisHaving trouble...
...d Flags: Other Symptoms Not Consistent with the D...
...Requires the presence of parkinsoni...
Assessment
...ssessment...
...le 3. Symptoms and SignsHaving trouble viewing...
...omorbidities Motor and non-motor...
...resentations Sudden decreased functions and de...
Treatment
...atment...
...nt of Non-Motor Symptoms (in alphabetical o...
...Physical, Occupational, and Speech Therapy...
Table 6. Some Factors that Increase Risk...
...etary Considerations Refer residen...
...onal ConsiderationsDental health...
...arijuana Marijuana contains hundreds...
...oach to Pharmacotherapy The goal of pharm...
...ABOUT DYSKINESIAS:Dyskinesias are slower, writhi...
...ure 2. Optimal Levodopa Dosing and Blood...
...ceptions and Common Questions from People wi...
...otor Pharmacotherapy Options Carb...
...Pharmacotherapy Options Carbidop...
...Treatment Amantadine (Symmetrel)...
Side Effects Carbidopa-levodopa: Nausea...
...Options There are three major su...
Monitoring
...nitoring
...uality Measures with Proposed Frequen...
...s/Palliative Care/End-Of-Life IssuesPr...
Table 8. Medicare Hospice Eligibility Criteri...
Parkinson's Disease Dementia and Psychosis
...s Disease Dementia and Psychosis...
...Dementia is a common feature of PD. The...
...Dementia with Lewy Bodies vs. Park...
.... Differential Diagnosis of Parkinson’s Di...
...hen assessing for PD psychosis, most ess...
...eople with Parkinson’s Disease...
...e 4. Stepwise Process for Treating...
...ntia in PD - Most but not all studies of c...
Appendices
...endices
...Long-Term Care Interval History: Parkinson'...
...endix 1: LTC Interval History: Parkinson’s Disea...