Palliative approach to Parkinson disease and parkinsonian disorders
- David Oliver, BSc FRCP FRCGP
David Oliver, BSc FRCP FRCGP
- Honorary Professor
- University of Kent
- Simon Veronese, MD, MSc, PhD
Simon Veronese, MD, MSc, PhD
- Fondazione Faro Onlus, Palliative Care Department
- Turin, Italy
- Section Editors
- R Sean Morrison, MD
R Sean Morrison, MD
- Section Editor — Selected End Stage Conditions
- Hermann Merkin Professor of Palliative Care
- Mount Sinai School of Medicine
- Howard I Hurtig, MD
Howard I Hurtig, MD
- Section Editor — Movement Disorders
- Professor of Neurology
- University of Pennsylvania School of Medicine
Parkinson disease 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 disease progression, and particularly in the later stages as death approaches.
This topic will review the palliative care aspects of Parkinson disease and related neurodegenerative disorders. Other clinical aspects of these disorders are reviewed elsewhere. (See "Clinical manifestations of Parkinson disease" and "Progressive supranuclear palsy (PSP)" and "Multiple system atrophy: Clinical features and diagnosis" and "Corticobasal degeneration" and "Clinical features and diagnosis 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 Parkinson disease, 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 — 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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- PARKINSON DISEASE AND PARKINSONISM
- Parkinson disease
- Atypical parkinsonian disorders
- ROLE OF PALLIATIVE CARE
- Initiating palliative care
- Advance care planning
- Monitoring progression
- MANAGEMENT OF PARKINSON DISEASE
- Nonmotor symptoms
- Autonomic dysfunction
- MANAGEMENT OF ATYPICAL PARKINSONIAN DISORDERS
- CAREGIVER BURDEN
- CAREGIVER SUPPORT
- FINAL STAGES OF DISEASE
- HOSPICE CARE
- Pain management
- Dyspnea and secretions
- Hydration and nutrition
- Place of death
- SUMMARY AND RECOMMENDATIONS