Advertisement
Feature Article

Advanced management of Parkinson’s disease – beyond the ‘shaking palsy’

CHRISTINE WOOLS, ANDREW EVANS

Figures

Abstract

Good management of Parkinson’s disease requires a patient-centric approach understanding the broad involvement of the disease and its impact on the patient and carer. The motor features of tremor, bradykinesia and rigidity are central to diagnosis and respond best to dopaminergic therapies. Extradopaminergic involvement relates to a range of important nonmotor symptoms that connect to sleep, neuropsychiatric disturbances, dementia, dysautonomia and sensory symptoms. They are often under-recognised, but if identified and managed they can offer an opportunity for treatment that may impact positively on the quality of life of both patients and carers.

Key Points

  • The features of tremor, bradykinesia and rigidity form the core diagnostic features of Parkinson’s disease and respond best to dopaminergic therapies and advanced therapies.
  • Motor fluctuations in advanced disease can be approached by fractionating levodopa, adding on other pharmacotherapies and considering advanced therapies.
  • Nonmotor symptoms in Parkinson’s disease are ubiquitous and diverse, frequently relating to degeneration outside the dopaminergic system, and are often challenging to treat. However, they offer an opportunity to address features that impact heavily on quality of life.
  • Common nonmotor symptoms include those relating to sleep, neuropsychiatric disturbances, dementia, autonomic dysfunction and sensory symptoms. 


    Picture credit: © Bryson Biomedical Illustrations Inc

Figures