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Quick reference guide

Issue date: June 2006

Parkinson's disease
Diagnosis and management in primary and
secondary care

NICE clinical guideline 35
Developed by the National Collaborating Centre for Chronic Conditions

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Parkinson's disease Contents

Introduction 3
Patient-centred care 3
Key priorities for implementation 4
Interventions for people with PD 6
Communicating with people with PD
and their carers 7
Diagnosing PD 8
Neuroprotection 9
Pharmacological interventions 9
Surgery 12
Non-motor features of PD 12
Other key interventions 14
Palliative care…

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Parkinson's disease Introduction

Parkinson's disease (PD) is a progressive neurodegenerative condition resulting from the death of the
dopamine-containing cells of the substantia nigra. There is no consistently reliable test that can
distinguish PD from other conditions that have similar clinical presentations. The diagnosis is primarily
clinical, based on a…

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Parkinson's disease Key priorities for implementation

Key priorities for implementation

The following recommendations have been identified as priorities for implementation.

Referral to expert for accurate diagnosis
G People with suspected PD should be referred quickly1 and untreated to a specialist with expertise
in the differential diagnosis of this condition.


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Parkinson's disease Key priorities for implementation

Key priorities for implementation continued

Access to occupational therapy
G Occupational therapy should be available for people with PD. Particular consideration should
be given to:
­ maintenance of work and family roles, employment, home care and leisure activities
­ improvement and maintenance of transfers…

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Interventions for people with PD

progression Diagnosis and early disease Throughout disease Later disease

Parkinson's disease

Refer untreated to a Consider management of non-motor It is not possible to identify a universal first

NICE clinical guideline 35
specialist who makes symptoms, in particular: choice adjuvant drug therapy…

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Communicating with people with
Parkinson's disease PD and their carers

Communicating with people with PD and their carers
G Aim to empower people with PD to participate in judgements and choices about their own care.
G Aim to achieve a balance between provision of honest, realistic information about the condition…

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Parkinson's disease Diagnosing PD

Diagnosing PD
G PD should be suspected in people presenting with tremor, stiffness, slowness, balance problems
and/or gait disorders.
G Refer people with suspected PD quickly3 and untreated to a specialist in the differential diagnosis
of PD.

Diagnosis and regular review
G Diagnose PD clinically and…

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Parkinson's disease Neuroprotection

G Do not use vitamin E as a neuroprotective therapy in PD.
G Do not use the following as neuroprotective therapies in PD, except in clinical trials:
­ co-enzyme Q10
­ dopamine agonists
­ MAO-B inhibitors.

Pharmacological interventions
Treatment options for early and later PD

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Parkinson's disease Pharmacological interventions

Table 1 Options for initial pharmacotherapy in early PD
Initial therapy First-choice Symptom Risk of side effects Notes
for early PD option control
Motor Other adverse
complications events
Levodopa +++ · Use lowest dose possible to


maintain good function in order to
reduce development…


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