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Parkinson's disease - Management
What is the role of primary care in the management of people with confirmed Parkinson's disease?
- To be aware of local services for people with Parkinson's disease and to enable appropriate access to them. Services may include:
- A Parkinson's disease physician specialist.
- A Parkinson's disease nurse specialist (PDNS), if available.
- Speech and language therapy, physiotherapy, occupational therapy, social services, community nursing, continence and urology specialists, palliative care specialists, and psychology and mental health services.
- The Parkinson's Disease Society local branch, regional support, and free UK helpline (0808 800 0303).
- To liaise with the person's Parkinson's disease physician specialist and PDNS (if available), particularly in relation to changes in medication:
- Only start or alter anti-parkinsonian medication on the advice of a specialist.
- Ensure that changes to repeat medication are made promptly.
- Titrate therapy between specialist review appointments according to recommendations from secondary care.
- Do not suddenly stop any anti-parkinsonian medication as this can precipitate acute akinesia or neuroleptic malignant syndrome.
- To identify worsening motor symptoms and motor complications (which may be caused by the disease itself or by anti-parkinsonian medication), and manage these appropriately.
- This will usually require the advice of a specialist or an interim referral.
- To identify and appropriately manage non-motor symptoms and complications, which may be caused by the disease itself or by anti-parkinsonian medication.
- To manage comorbidities: avoid or use with caution any drugs that could exacerbate parkinsonism or interact with anti-parkinsonian medication — see Drugs to avoid.
- To advise care staff in nursing or residential homes of the need for the correct timing of anti-parkinsonian medication.
- To offer a regular medication review, including adherence and adverse effects.
- To offer support to family and carers.
- To ensure that palliative care requirements are met throughout all phases of the disease, particularly at the end of life.
In depth
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