Parkinson's disease: diagnosis and management in primary and secondary care

National Institute for Health and Clinical Excellence

Key priorities for implementation

The following recommendations have been identified as priorities for implementation

Referral to expert for accurate diagnosis

• People with suspected Parkinson's disease (PD) should be referred quickly and untreated to a specialist with expertise in the differential diagnosis of this condition

Diagnosis and expert review

• The diagnosis of PD should be reviewed regularly and reconsidered if atypical clinical features develop
• Acute levodopa and apomorphine challenge tests should not be used in the differential diagnosis of parkinsonian syndromes

Regular access to specialist nursing care

• People with PD should have regular access to the following:
  • clinical monitoring and medication adjustment
  • a continuing point of contact for support, including home visits, when appropriate
  • a reliable source of information about clinical and social matters of concern to people with PD and their carers which may be provided by a PD nurse specialist

Access to physiotherapy

• Physiotherapy should be available for people with PD. Particular consideration should be given to:
  • gait re-education, improvement of balance and flexibility
  • enhancement of aerobic capacity
  • improvement of movement initiation
  • improvement of functional independence, including mobility and activities of daily living
  • provision of advice regarding safety in the home environment

Access to occupational therapy

• Occupational therapy should be available for people with PD. Particular consideration should be given to:
  • maintenance of work and family roles, employment, home care and leisure activities
  • improvement and maintenance of transfers and mobility
  • improvement of personal self-care activities, such as eating, drinking, washing and dressing
  • environmental issues to improve safety and motor function
  • cognitive assessment and appropriate intervention

Access to speech and language therapy

• Speech and language therapy should be available for people with PD. Particular consideration should be given to:
  • improvement of vocal loudness and pitch range, including speech therapy programmes such as Lee Silverman Voice Treatment (LSVT)
  • teaching strategies to optimise speech intelligibility
  • ensuring an effective means of communication is maintained throughout the course of the disease, including use of assistive technologies
  • review and management to support the safety and efficiency of swallowing and to minimise the risk of aspiration

Palliative care

• Palliative care requirements of people with PD should be considered throughout all phases of the disease
• People with PD and their carers should be given the opportunity to discuss end-of-life issues with appropriate healthcare professionals