Nonpharmacologic management of Parkinson disease
- Daniel Tarsy, MD
Daniel Tarsy, MD
- Professor of Neurology
- Harvard Medical School
Parkinson disease (PD) is a chronic disorder that requires broad-based management including patient and family education, support group services, general wellness maintenance, exercise, and nutrition. Treatment of PD can be divided into nonpharmacologic, pharmacologic, and surgical therapy. A useful algorithm for the management of PD has been published by the American Academy of Neurology (AAN) .
This topic will review the nonpharmacologic management of PD. The pharmacologic treatment of PD and the treatment of comorbid problems associated with it are discussed separately. (See "Pharmacologic treatment of Parkinson disease" and "Management of nonmotor symptoms in Parkinson disease".)
The prospect of having a chronic and progressive neurologic disease is frightening. Many individuals are familiar with Parkinson disease (PD) and may even have had first-hand acquaintance with its disabling effects in an affected family member or friend. Education is essential in order to provide the patient and family with some understanding and control over the disorder.
However, caution should be exercised in newly diagnosed patients with mild symptoms and an uncertain future with regard to progression; early overexposure to potentially disturbing material may be counterproductive. Focused education surrounding particular symptoms may be more effective and is available through books and other materials (see 'Information for patients' below) written for the lay audience, through national and regional Parkinson disease organizations (table 1), which publish educational pamphlets and organize symposia for patients and families, and through the internet.
The emotional and psychologic needs of the patient with PD and family should be addressed. Normal reactions of anger, depression, anxiety, and social and economic concerns often begin with the onset of the disease and evolve as it progresses. Support for the caregiver is particularly important as he or she learns to cope with the increasing needs of the spouse or parent, or more rarely, a son or daughter . Support groups are especially valuable for allowing interactions with other patients or families with similar experiences and for providing access to useful educational information .
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