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Feature Article

Assessing and managing Parkinson’s disease

Neil Mahant, Victor SC Fung, John GL Morris

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Abstract

Parkinson’s disease is relatively common: the prevalence is over 1% in those older than 55 years, rising with age to nearly 5% in people over 85. Antiparkinsonian treatment improves quality of life. Management involves collaboration between the patient, carers, GP, allied health professionals and neurologist.

Key Points

  • The diagnosis of Parkinson’s disease depends on a careful history and examination. Investigations are done to exclude other disorders.
  • It is useful to divide the syndrome of parkinsonism into two groups: idiopathic (Lewy body) Parkinson’s disease, where the response to levodopa is good, and atypical parkinsonism, where the response to levodopa is usually poor.
  • Levodopa remains the most effective treatment for Parkinson’s disease; however, long term complications are common.
  • Dopamine agonists and catechol-O-methyl transferase (COMT) inhibitors are useful in the management of levodopa-related dyskinesia and fluctuations.

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