In 2017, the United Kingdom’s National Institute for Health and Care Excellence (NICE) published its latest guidelines on how adult patients and their caregivers should manage Parkinson’s disease (PD).
In a new commentary, four experts discuss the implications of some of these recommendations for both patients and healthcare professionals, highlighting the importance of clear communication between both parties to ensure the best management for this chronic disease.
The article, “Highlighting the goals for Parkinson’s care: commentary on NICE Guidelines for Parkinson’s in Adults (NG71),” was published in Age and Ageing.
Parkinson’s disease, the second most prevalent neurodegenerative disease in the elderly after Alzheimer’s disease, is a complex, multifactorial disorder characterized by the gradual loss of muscle control, sometimes accompanied by cognitive deficits.
So far, several models of care provision have attempted to summarize recommendations for both Parkinson’s patients and clinicians.
In this article, the authors discussed the implications of five different aspects of Parkinson’s disease highlighted in the Parkinson’s disease NICE quality standard, derived from the full NICE guidelines published previously.
First, the quality standard recommends that patients always remain in contact with a healthcare specialist to ensure continuous disease monitoring and to help with informed decision-making.
“Ensuring that a point of contact with specialist services is available for people with PD is vital for maintaining continuity of care and providing access to information, advice, care and support when people with PD, their families and carers need it,” the authors wrote.
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Second, patients on dopaminergic medications should be aware of the risks of developing impulse control disorders (ICDs) — a type of personality disorder characterized by the inability to resist impulses to engage in excessive or harmful behaviors — that have been associated with levodopa and dopaminergic agonists used in the treatment of Parkinson’s.
“A better understanding of the risk of ICDs can ensure they are detected earlier and help patients understand the need to reduce their dopamine therapy and engage with cognitive behavioral therapy,” the authors wrote.
Third, patients with balance issues, severe motor symptoms, and difficulties with daily life activities, including problems with communication, swallowing, or saliva, should be referred to supportive therapies, such as physiotherapy, occupational therapy, or speech and language therapy.
“The broader impact that these symptoms have on activities of daily living requires a multi-disciplinary team approach to treatment. For clinicians this means having an awareness of the multi-system nature of the condition and the impact it can have on lifestyle. Discussing this with people with PD should prompt referral to the appropriate multi-disciplinary team member,” the authors wrote.
Fourth, patients admitted to a hospital or care home should take levodopa within 30 minutes of their usual prescribed administration time to avoid the occurrence of acute akinesia, or the inability to move voluntary muscles, and neuroleptic malignant syndrome, which is a life-threatening adverse reaction to certain anti-psychotic medications.
“The goal of current clinicians should be to take steps to … [ensure] staff training and understanding of the importance of prompt administration of levodopa,” the authors said.
Finally, healthcare professionals should provide clozapine to patients who are experiencing hallucinations and delusions that could occur as a side effect of treatment.
“The guidance advises considering quetiapine as a first line treatment as there is evidence to support that it is effective in treating hallucinations and delusions in people with PD … [and] recommends that clozapine is offered if quetiapine proves ineffective but highlights the need for services to provide access to the drug and a monitoring mechanism,” the authors said.
These different aspects highlight the importance of communication between Parkinson’s patients and clinicians and of working closely with multidisciplinary teams of healthcare professionals and services to ensure patients’ needs are being met.
“With the variety of symptoms, complex treatments and the potential for significant side effects of medications associated with PD, ensuring patients are well informed requires a point of contact and specialist clinicians to ensure that the information they give is of high quality and understandable,” the researchers concluded.
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