Best practices in Parkinson's disease care
Richard Rosenbaum, M.D.
Medical director, Providence Center for Parkinson’s Disease
Neurologist, The Oregon Clinic
Published April 2012
Parkinson’s disease causes gradual deterioration of multiple facets of neurological function. It is second only to Alzheimer’s disease as a cause of progressive brain degeneration with an age-adjusted incidence of about 0.5 percent, affecting men a bit more frequently than women.
Providence Center for
A team of neurologists and therapists coordinates a complete package of care for each of our patients. This includes highly advanced diagnostics and therapies, rehabilitation and referral to community resources.
To refer a patient:
For patients older than 66, the diagnosis of Parkinson’s disease indicates a risk of mortality greater than other ominous diagnoses such as Alzheimer’s disease, myocardial infarction, stroke or COPD.
Fortunately, Parkinson’s is the neurodegenerative disease that is most amenable to symptomatic treatment, not only of its characteristic motor complications of tremor, bradykinesia, rigidity and postural instability, but also of its myriad and more distressing effects on non-motor aspects of daily living.
The American Academy of Neurology recommends 10 quality care measures for treating Parkinson’s disease. The physician should:
- Review the diagnosis annually
- Review treatment options
- Query medication-related motor complications
- Query falls
- Consider rehab
- Assess psychiatric issues
- Assess cognition
- Assess autonomic symptoms
- Assess sleep
- Counsel the patient and caregiver about safety
Providence Center for Parkinson’s Disease received a grant from the Portland IPA to surveyed quality of care of Parkinson’s disease both by neurologists at The Oregon Clinic and by primary care providers in the Providence Medical Group. We are proud that our specialist and primary care meets or exceeds nationally published experience.
More important, we want to consider what we have learned about improving care of patients with Parkinson’s disease.
Some of our providers perfectly met all quality measures. We were more interested in those aspects of care that were overlooked or undocumented. In our continuing education, we are stressing:
The diagnosis of Parkinson’s is best confirmed by regular expert review of the clinical course and medication response.
Throughout the course of the disease, physical, occupational and speech therapies can help in ways that medication cannot. We want to reassess rehabilitation plans at least once a year, and we constantly encourage our patients to exercise.
Motor complications, such as medication-induced dyskinesia and wearing-off of medication effect, often appear a few years after onset of the disease. We ask our patients at each visit if they are having these fluctuations, which are amenable to medication adjustments and, in selected patients, to deep brain stimulation surgery.
A number of treatable sleep disorders can complicate Parkinson’s, but if the physician does not take a sleep history, these therapeutic opportunities are often missed.
Patients with Parkinson’s disease usually are safe drivers early in their illness, but many eventually need to stop driving. Physicians and caregivers must monitor driving safety regularly.
Educating patients about their illness is part of every patient visit. Advocacy and support groups, like Parkinson’s Resources of Oregon, are key allies. We encourage providers to document this education and any referrals to outside resources.
Dementia, depression, hallucinations, and other psychiatric and behavioral problems can add to patient distress and caregiver stress. As Parkinson’s disease progresses, we routinely reassess these issues. We should watch for caregiver stress or even abuse by caregivers.
Patients, their caregivers, primary providers and neurologists can work together to meet the diverse challenges of Parkinson’s disease. In our quality assessment, we examined many other aspects of care. I have emphasized areas of care that we are continuing to improve.
Clinical articles by Richard Rosenbaum, M.D.