1. Home
  2. Parkinson Disease

Parkinson Disease

Canadian guideline for Parkinson disease

Author/s: 
David Grimes, Megan Fitzpatrick, Joyce Gordon, Janis Miyasaki, Edward A Fon, Michael Schlossmacher, Oksana Suchowersky, Alexander Rajput, Anne Louise Lafontaine, Tiago Mestre, Silke Appel-Cresswell, Suneil K Kalia, Kerrie Schoffer, Mateusz Zurowski, Ronald B Postuma, Sean Udow, Susan Fox, Pauline Barbeau, Brian Hutton

KEY POINTS

This guideline update reflects substantial changes in the literature on diagnosis and treatment of Parkinson disease, and adds information on palliative care.

Impulse control disorders can develop in a person with Parkinson disease who is on any dopaminergic therapy at any stage in the disease course, especially for those taking dopamine agonists.

Advanced therapies like deep brain stimulation and intrajejunal levodopa-carbidopa gel infusion are now routinely used in Parkinson disease to manage motor symptoms and fluctuations.

Evidence exists to support early institution of exercise at the time of diagnosis of Parkinson disease, in addition to the clear benefit now shown in those with well-established disease.

Palliative care requirements of people with Parkinson disease should be considered throughout all phases of the disease, which includes an option of medical assistance in dying.

Parkinson disease is chronic and progressive in nature, decreasing the quality of life for both patients with the disease and their caregivers and placing an onerous economic burden on society.1

The first Canadian guideline on Parkinson disease was published in 2012.2 Since that guideline, there have been substantial advances in the literature on the disease, particularly with respect to diagnostic criteria and treatment options. Parkinson Canada undertook to update the existing guideline to reflect these advances, as well as to add information on palliative care.

With the aim of enhancing care for all Canadians with Parkinson disease, this guideline is based on the best published evidence, involves expert consensus when there is a lack of evidence, offers practical clinical advice, takes patient choice and informed decision-making into account and is relevant to the Canadian health care system. The guideline has been divided into 5 main sections to improve the ease of use: communication, diagnosis and progression, treatment, nonmotor features and palliative care. The full guideline is available in Appendix 1, at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.181504/-/DC1.

Keywords 
Disease Progression Dopamine Agonists exercise therapy palliative care Parkinson Disease quality of life

Parkinson's Disease

Author/s: 
Caroline M. Tanner, Jill L Ostrem

The global burden of Parkinson’s disease is projected to increase in future decades as the number and proportion of older adults increases. This review addresses research advances since 1998, when the disorder was last reviewed in the Journal, and includes recently introduced concepts relevant to clinical practice. For two centuries, Parkinson’s disease has been diagnosed clinically on the basis of the characteristic motor syndrome of bradykinesia accompanied by resting tremor, rigidity, and postural reflex impairment, all largely the result of dopaminergic dysfunction in the nigrostriatal system. Advances in our understanding of the disease suggest that a biologic definition may be possible, but many questions remain. In this review, we use the clinical definition of Parkinson’s disease.

Keywords 
Levodopa Parkinson Disease

Parkinson disease primer, part 2: management of motor and nonmotor symptoms

Author/s: 
Frank, C., Chiu, R., Lee, J.

Objective To provide family physicians with an approach to the management of
motor and nonmotor symptoms of Parkinson disease (PD).
Sources of information Published guidelines on the management of PD were
reviewed. Database searches were conducted to retrieve relevant research
articles published between 2011 and 2021. Evidence levels ranged from I to III.
Main message Family physicians can play an important role in identifying and
treating motor and nonmotor symptoms of PD. Family physicians should initiate
levodopa treatment for motor symptoms if they affect function and if specialist
wait times are long, and they should be aware of basic titration approaches
and possible side effects of dopaminergic therapies. Abrupt withdrawal of
dopaminergic agents should be avoided. Nonmotor symptoms are common and
underrecognized and are a major factor in disability, quality of life, and risk of
hospitalization and poor outcomes for patients. Family physicians can manage
common autonomic symptoms such as orthostatic hypotension and constipation.
Family physicians can treat common neuropsychiatric symptoms such as
depression and sleep disorders, and they can help recognize and treat psychosis
and PD dementia. Referrals to physiotherapy, occupational therapy, speech
language therapy, and exercise groups are recommended to help preserve function.
Conclusion Patients with PD present with complex combinations of motor
and nonmotor symptoms. Family physicians should have basic knowledge of
dopaminergic treatments and their side effects. Family physicians can play
important roles in management of motor symptoms and particularly nonmotor
symptoms and can have a positive impact on patients’ quality of life. An
interdisciplinary approach involving specialty clinics and allied health experts
is an important part of management.

Keywords 
Parkinson Disease Dopamine Agents Psychotic Disorders hospitalization dementia
Subscribe to Parkinson Disease