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Palliative Management of Parkinson Disease: Focus on Nonmotor, Distressing Symptoms

Schools of Medicine and Pharmacy, Movement Disorders Center, Loma Linda University, California, jjchen{at}llu.edu

Dominick P. Trombetta, PharmD, BCPS, CGP

Geriatrics/Internal Medicine, College of Pharmacy and Nursing, Wilkes University, Wilkes-Barre, Pennsylvania

Hubert H. Fernandez, MD

Department of Neurology, McKnight Brain Institute/University of Florida, Gainesville, Florida, Movement Disorders Center

Parkinson disease is a progressive neurodegenerative disease that commonly affects elderly persons. In the absence of neuroprotective or curative therapies, currently available therapies only provide symptomatic benefit. Progression to advanced Parkinson disease is often accompanied by functional dependence with increased risk of admission to a long-term care facility. The prevalence of Parkinson disease in long-term care facilities, within the United States, has been estimated to be between 5.2% and 10%. Patients with advanced Parkinson disease also experience other distressing motor and nonmotor conditions, such as motor complications, dementia, depression, gastrointestinal distress, orthostatic hypotension, pain, and psychosis, which can be a challenge for clinicians to manage. The presence of distressing symptoms along with the fact that Parkinson disease remains incurable necessitate discussion on a palliative care approach to this disorder. This article discusses the symptomatic management of distressing symptoms encountered in the long-term care resident with Parkinson disease, including motor complications and nonmotor features.

Key Words: Dementia • depression • palliative • Parkinson disease • psychosis

Journal of Pharmacy Practice, Vol. 21, No. 4, 262-272 (2008)
DOI: 10.1177/0897190008318370


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