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Parkinson's disease Contents
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 14
Implementation 15
Further information 15
National Institute for
Health and Clinical Excellence
MidCity Place © National Institute for Health and Clinical
71 High Holborn Excellence, June 2006. All rights reserved.…read more

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Parkinson's disease Introduction
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 history and examination.
People with PD classically present with the symptoms and signs associated with parkinsonism, namely
bradykinesia, rigidity and rest tremor.…read more

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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.
Diagnosis and expert review
G The diagnosis of PD should be reviewed regularly2 and reconsidered if atypical clinical features
develop.…read more

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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 and mobility
­ improvement of personal self-care activities, such as eating, drinking, washing and dressing
­ environmental issues to improve safety and motor function
­ cognitive assessment and appropriate intervention.…read more

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Interventions for people with PD
Disease
progression Diagnosis and early disease Throughout disease Later disease
Interventions
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 for people
and reviews diagnosis: G depression G dementia with later PD.…read more

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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 and
promoting optimism.…read more

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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 based on the UK Parkinson's Disease Society Brain Bank Criteria.
G Consider discussing with patients the possibility of tissue donation to a brain bank for diagnostic
confirmation and research.…read more

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Parkinson's disease Neuroprotection
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
It is not possible to identify a universal first-choice drug therapy for either early PD or for adjuvant drug
therapy for later PD.…read more

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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 of motor
complications.
©
Dopamine ++ · If side effects prevent titration to
©
agonists clinically efficacious dose, replace
with another dopamine agonist or
another drug class.…read more

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