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Palliative approach to Parkinson disease and parkinsonian disorders

Authors
David Oliver, BSc FRCP FRCGP
Simon Veronese, MD, MSc, PhD
Section Editors
R Sean Morrison, MD
Howard I Hurtig, MD
Deputy Editor
John F Dashe, MD, PhD

INTRODUCTION

Parkinson disease (PD) and the parkinsonian neurodegenerative disorders typically develop relatively slowly over several years. Affected patients and their families face increasing physical, psychosocial, and spiritual issues over this period of time. Palliative care has an important role in these conditions throughout the progression of disease, and particularly in the later stages as death approaches.

This topic will review the palliative care aspects of PD and related neurodegenerative disorders. Other clinical aspects of these disorders are reviewed elsewhere. (See "Clinical manifestations of Parkinson disease" and "Diagnosis and differential diagnosis of Parkinson disease" and "Pharmacologic treatment of Parkinson disease" and "Management of nonmotor symptoms in Parkinson disease" and "Nonpharmacologic management of Parkinson disease" and "Motor fluctuations and dyskinesia in Parkinson disease" and "Device-assisted and surgical treatments for Parkinson disease" and "Progressive supranuclear palsy (PSP): Clinical features and diagnosis" and "Progressive supranuclear palsy (PSP): Management and prognosis" and "Multiple system atrophy: Clinical features and diagnosis" and "Multiple system atrophy: Prognosis and treatment" and "Corticobasal degeneration" and "Clinical features and diagnosis of dementia with Lewy bodies" and "Prognosis and treatment of dementia with Lewy bodies".)

PARKINSON DISEASE AND PARKINSONISM

Symptoms and signs of parkinsonism (ie, bradykinesia, rest tremor, and rigidity) can be prominent in several neurodegenerative disorders, including PD, dementia with Lewy bodies, progressive supranuclear palsy, multiple system atrophy, and corticobasal degeneration. The average lifespan of patients diagnosed with these disorders is reduced.

Parkinson disease — PD is one of the more common progressive neurodegenerative diseases. The prevalence of PD increases with age. The cardinal features of PD are tremor, bradykinesia, and rigidity. Postural instability generally occurs late in the course of the disease. Other motor features of PD include craniofacial (eg, masked facial expression, hypophonia), visual (eg, hypometric saccades, eyelid opening apraxia), musculoskeletal (eg, micrographia, stooped posture), and gait (eg, shuffling, short-stepped gait, freezing) abnormalities (table 1). In addition to motor involvement, PD is a complex disorder with diverse clinical features that include neuropsychiatric and nonmotor manifestations (table 2). (See "Clinical manifestations of Parkinson disease".)

The nonmotor manifestations of PD include the following:

                    
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Literature review current through: Nov 2017. | This topic last updated: Sep 24, 2017.
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References
Top
  1. Hirschbichler ST, Erro R, Ganos C, et al. "Atypical" atypical parkinsonism: Critical appraisal of a cohort. Parkinsonism Relat Disord 2017; 37:36.
  2. Poewe W. The natural history of Parkinson's disease. J Neurol 2006; 253 Suppl 7:VII2.
  3. WHO definition of palliative care. www.who.int/cancer/palliative/definition/en/ (Accessed on March 31, 2017).
  4. Kluger BM, Fox S, Timmons S, et al. Palliative care and Parkinson's disease: Meeting summary and recommendations for clinical research. Parkinsonism Relat Disord 2017; 37:19.
  5. Miyasaki JM. Palliative care in Parkinson's disease. Curr Neurol Neurosci Rep 2013; 13:367.
  6. Oliver D, Watson S. Multidisciplinary care. In: End of Life Care in Neurological Disease, Oliver D (Ed), Springer, London 2012. p.113.
  7. Oliver DJ, Borasio GD, Caraceni A, et al. A consensus review on the development of palliative care for patients with chronic and progressive neurological disease. Eur J Neurol 2016; 23:30.
  8. Payne S, Seymour J, Ingleton C. Introduction. In: Palliative Care Nursing: Principles and Evidence for Practice, 2nd ed, Payne S, Seymour J, Ingleton C (Eds), Open University Press, Maidenhead 2008. p.6.
  9. Richfield EW, Jones EJ, Alty JE. Palliative care for Parkinson's disease: a summary of the evidence and future directions. Palliat Med 2013; 27:805.
  10. Tuck KK, Brod L, Nutt J, Fromme EK. Preferences of patients with Parkinson's disease for communication about advanced care planning. Am J Hosp Palliat Care 2015; 32:68.
  11. Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology 1967; 17:427.
  12. Goetz CG, Poewe W, Rascol O, et al. Movement Disorder Society Task Force report on the Hoehn and Yahr staging scale: status and recommendations. Mov Disord 2004; 19:1020.
  13. Müller J, Wenning GK, Jellinger K, et al. Progression of Hoehn and Yahr stages in Parkinsonian disorders: a clinicopathologic study. Neurology 2000; 55:888.
  14. MacMahon DG, Thomas S. Practical approach to quality of life in Parkinson's disease: the nurse's role. J Neurol 1998; 245 Suppl 1:S19.
  15. Thomas S, MacMahon D. Parkinson's disease, palliative care and older people: Part 1. Nurs Older People 2004; 16:22.
  16. Ha AD, Jankovic J. Pain in Parkinson's disease. Mov Disord 2012; 27:485.
  17. Cury RG, Galhardoni R, Fonoff ET, et al. Effects of deep brain stimulation on pain and other nonmotor symptoms in Parkinson disease. Neurology 2014; 83:1403.
  18. Gibbons CH, Schmidt P, Biaggioni I, et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol 2017.
  19. Zesiewicz TA, Sullivan KL, Arnulf I, et al. Practice Parameter: treatment of nonmotor symptoms of Parkinson disease: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2010; 74:924.
  20. Michael A, Wallis P, Crome P. Urinary catheterisation in hospitalised patients with Parkinsonism. Mov Disord 2006; 21:S655.
  21. Boersma I, Jones J, Coughlan C, et al. Palliative Care and Parkinson's Disease: Caregiver Perspectives. J Palliat Med 2017; 20:930.
  22. Campbell CW, Chandler BJ, Smith S. Holistic care: Psychosocial and spiritual aspects. In: End of Life Care in Neurological Disease, Oliver D (Ed), Springer, London 2012. p.91.
  23. Hasson F, Kernohan WG, McLaughlin M, et al. An exploration into the palliative and end-of-life experiences of carers of people with Parkinson's disease. Palliat Med 2010; 24:731.
  24. Goy ER, Carter JH, Ganzini L. Needs and experiences of caregivers for family members dying with Parkinson disease. J Palliat Care 2008; 24:69.
  25. Giles S, Miyasaki J. Palliative stage Parkinson's disease: patient and family experiences of health-care services. Palliat Med 2009; 23:120.
  26. McLaughlin D, Hasson F, Kernohan WG, et al. Living and coping with Parkinson's disease: perceptions of informal carers. Palliat Med 2011; 25:177.
  27. Gouveia Melo C, Oliver D. Assessing burnout in Portuguese health care workers who care for the dying: Validity and reliability of a burnout scale using exploratory factor analysis. Psychol Community Health 2012; 1:257.
  28. National End of Life Care Programme. End of life care in long term neurological conditions: A framework for implementation. Jan 2010. https://www.mssociety.org.uk/sites/default/files/Documents/Professionals/End%20life%20care%20long%20term%20neuro%20conditions.pdf (Accessed on April 04, 2017).
  29. Hussain J, Adams D, Allgar V, Campbell C. Triggers in advanced neurological conditions: prediction and management of the terminal phase. BMJ Support Palliat Care 2014; 4:30.
  30. Clough CG, Blockley A. Parkinson’s disease and related disorders. In: Palliative Care in Neurology, Voltz R, Borasio GD, Bernat J, et al (Eds), Oxford University Press, Oxford 2004. p.8.
  31. National Institute for Health and Care Excellence. Care of dying adults in the last days of life. Dec 2015. https://www.nice.org.uk/guidance/ng31/chapter/context# (Accessed on April 05, 2017).
  32. Gomes B, Calanzani N, Gysels M, et al. Heterogeneity and changes in preferences for dying at home: a systematic review. BMC Palliat Care 2013; 12:7.
  33. Sleeman KE, Ho YK, Verne J, et al. Place of death, and its relation with underlying cause of death, in Parkinson's disease, motor neurone disease, and multiple sclerosis: a population-based study. Palliat Med 2013; 27:840.
  34. Moens K, Houttekier D, Van den Block L, et al. Place of death of people living with Parkinson's disease: a population-level study in 11 countries. BMC Palliat Care 2015; 14:28.
  35. Walker RW, Churm D, Dewhurst F, et al. Palliative care in people with idiopathic Parkinson's disease who die in hospital. BMJ Support Palliat Care 2014; 4:64.