Parkinson's Disease

Scope

Parkinson's disease is a progressive neurodegenerative disease resulting in motor and non-motor dysfunction. The main motor features are tremor, rigidity and bradykinesia, as well as postural instability. Non-motor symptoms are common and include constipation, bladder dysfunction, postural hypotension, sleep disturbance, depression, psychosis and dementia. Non-motor symptoms contribute significantly to poor quality of life and are often the precipitant of non-elective admissions.

People with suspected Parkinson's disease (PD) should be managed by a specialist Parkinson's team to ensure pro-active management of motor and non-motor complications.

Please refer suspected Parkinson's Disease (PD) untreated to a neurologist

Assessment

History and Examination

History:
  • Progressive slowness
  • Progressive stiffness
  • Rest tremor
  • Impaired dexterity (smaller handwriting, difficulty with brushing teeth etc)
  • Walking slower or with shuffling
Examination:
  • Rest tremor
  • Cogwheel rigidity
  • Reduced arm swing

More suspicious of Parkinson's if any of the above is unilateral.

Investigations

Where symptoms are not attributable to other causes,no investigations are required.

Management

Follow-up care post-diagnosis will be tailored to the needs of the individual patient.

Post-diagnosis: patients will enter the new patient pathway, receiving follow-up and support from the hospital-based PDNS, with consultant and multi-disciplinary input as required; medications will be optimised.

Community maintenance: during the first year post-diagnosis, the patient will be referred to the community PDNS. We expect most patients to be seen by the consultant at least annually and by the PDNS at least 6-monthly. Care will be provided with multi-disciplinary input co-ordinated by the specialist clinic in liaison with local services including PDNS, physiotherapy, occupational therapy, speech and language therapy and Parkinson's UK advisers.

Complex management: patients with high non-motor symptom burden, or with significant motor complications will be referred to the complex disease pathway. This will take the form of targeted follow-ups with the hospital PDNS to address specific issues and/or evaluation for advanced therapies.

Palliative management: patients too frail to attend specialist clinics will be managed primarily in the community by their PDNS, who will liaise with the consultant and GP regarding management decisions where appropriate.

Formulary chapter 4 - Parkinson's disease management

Referral

Referral Criteria

  • Refer a patient if they have any of the history and examination findings listed above which are not attributable to another cause (e.g. musculoskeletal problem etc.)
  • Known Parkinson's (PD) (new to area or lost to follow-up)

Please refer (untreated) as soon as Parkinson's is suspected.

Referral Instructions

Please refer (untreated) as soon as Parkinson's is suspected.

e-Referral Service

  • Specialty: Neurology
  • Clinic Type: Parkinsons/Movements Disorders
  • Service: DRSS-South Devon & Torbay-Neurology- Devon CCG - 15N

Referral Form

DRSS referral form

Torbay and South Devon seeking advice form

Supporting Information

GP Information

NICE Guidance: Parkinson's disease: Diagnosis and management in primary and secondary care

Patient Information

Parkinson's UK

Parkinson's (NHS Choices)

Evidence

Meara J, Bhowmick BK, Hobson P. Accuracy of diagnosis in patients with presumed Parkinson's disease. Age Ageing 1999:28;99-102

Happe S, Shrodi B,Falti M, Muller C, Auff E and Zeitlhofer J (2001) Sleep disorders and depression in patients with Parkinson's Disease. Acta Neurologica Scandinavica 104:275-280.

Parkinson's Disease in the older patient 2008 ed Playfer J and Hindle Radcliffe Publishing Oxford

Pathway Group

This guideline has been signed off by Dr Alex Rowe - GP and Clinical Lead for Planned Care South Devon and Torbay CCG.

Author: Dr C Carroll, Consultant Neurologist PHNT / Gary Lenden DRSS Clinical Lead Western

Publication date: January 2017

 

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