Researchers urge better care for patients with cognitive impairment
Such patients have more severe symptoms, higher care needs: Study
People with Parkinson’s disease and cognitive impairment experience more severe symptoms and require more care but appear to use healthcare services less often, a European study has found, suggesting that new models of care are needed to better support these patients.
“Healthcare should be more targeted to help this group of people, given their higher care needs,” researchers wrote in the study “The Care Needs of Patients With Cognitive Impairment in Late-Stage Parkinson’s Disease,” which appeared in the Journal of Geriatric Psychiatry and Neurology.
Parkinson’s causes not only motor symptoms, but also nonmotor symptoms like problems with thinking and memory, which can range from mild cognitive impairment to severe dementia. This can impact the daily lives of both patients and their caregivers.
Cognitive impairment barrier to accessing healthcare
Cognitive impairment is also thought to be a barrier to accessing healthcare, but “how people with Parkinson’s who have cognitive impairment use healthcare and detail of their care needs is not well known,” the researchers wrote.
To know more, researchers drew on data from 675 adults with late-stage Parkinson’s from six countries across Europe, who took part in the Care of Late-Stage Parkinsonism project led by University College London in the U.K. There were 342 (51%) patients with cognitive impairment and 333 (49%) with normal cognition.
Of the 342 patients with cognitive impairment, 243 had a diagnosis of dementia and one a diagnosis of mild cognitive impairment. Despite having no diagnosis, the remaining 98 patients scored less than 24 points on the Mini Mental State Examination, indicating they had cognitive impairment.
On average, patients with cognitive impairment were 3.8 years older than those with normal cognition (77.8 vs. 74 years) and had fewer years of education (9.3 vs. 10.7 years). They also had more severe motor and nonmotor symptoms, including more severe symptoms of depression.
Patients with cognitive impairment were taking lower median doses of dopaminergic medications for Parkinson’s, but were more likely to take medications for dementia (40% vs. 9%) and psychosis, including clozapine (16% vs. 4%, brand names Clozaril, FazaClo, Versacloz, among others) and quetiapine (22% vs. 7%, brand name Seroquel, among others).
Care needs high especially for patients with cognitive impairment
Care needs were high for all patients but especially for those with cognitive impairment, who needed more help with tasks like dressing, looking after their personal hygiene, preparing and eating food or taking medication, and doing chores or moving. They also felt their health was worse, and their caregivers felt more burdened.
“We found that those with cognitive impairment had more severe Parkinson’s across a range of symptoms compared to those without cognitive impairment,” the researchers wrote. “They also had more care needs, reported their health status to be worse, and their caregivers experienced greater strain from caring.”
While patients with cognitive impairment were more likely to be in a care home (37% vs. 15%) or consult a nurse (13% vs. 19%), their use of other healthcare services, such as visits to a doctor or a therapist, was similar to that of patients with normal cognition.
“Further analysis showed an association between cognitive impairment and not having seen a Parkinson’s nurse or therapist recently, taking psychiatric symptoms, functional disability and care home residence into account,” the researchers wrote.
While patients with cognitive impairment have more severe symptoms and higher care needs, “this is not matched by healthcare use,” wrote the researchers, who noted that living in a care home appears to be a barrier to consultations with primary care doctors or specialists.
“This challenges current models of care, suggesting that healthcare needs to be targeted to those with most need. Furthermore, it highlights a need for improvement in diagnosis of cognitive impairment,” the researchers concluded.
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