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Parkinson’s Disease

@ HEFT

Parkinson’s disease (PD) affects 1 in every 500 people in the UK. It is more common over the age of 50, but younger people can develop the disease. PD affects both sexes but is slightly more common in men. Many people think Parkinson’s is just a tremor, but it is much more than this —Parkinson’s is a complex neurodegenerative condition. It is still not completely understood, but the pathophysiology is related to the progressive loss of dopamine-producing neurons within the brain.

The triad of symptoms and signs that commonly characterize PD are tremor, rigidity and bradykinesia (slowness of movement). However, Parkinson’s has many different symptoms and signs affecting a range of systems —PD can affect patient’s lives in many different ways:

Motor Symptoms

  • tremor
  • rigidity
  • bradykinesia (slowness of movement)
  • dyskinesia (abnormal movement)
  • dystonia
  • difficulty initiating movement
  • postural instability
  • end-of-dose deterioration (motor deterioration before next tablet is due)
  • freezing (periods of being unable to move)
  • motor fluctutations (alternating between dyskinesia / moving too much and bradykinesa / freezing)

Non-motor Symptoms

Autonomic

  • postural hypotension
  • urinary urgency
  • erectile dysfuntion

Gastrointestinal

  • nausea
  • constipation (can be severe) / ileus
  • recurrent volvulus

Neuropsychiatric

  • apathy / depression / anxiety
  • hallucinations
  • REM sleep disorder
  • cognitive impairment (including PD dementia)
  • impulse control disorders (e.g. gambling, hypersexuality, risk taking behaviour)
  • increased risk of delirium

Speech & Swallowing

  • apathy / depression / anxiety
  • drooling of saliva
  • slow quiet monotonous speech
  • impaired swallow (neuromuscular dysphagia)
  • risk of aspiration pneumonia

Patients with PD rarely come into hospital because of the disease itself. However, patients often present to hospital with complications of their PD (e.g. falls, delirium, severe constipation, aspiration pneumonia). Patients may also present to hospital for any other reason and then suffer additional complications as a result of their PD.

Parkinson’s medication is time critical —if Parkinson’s medications are delayed or omitted, patients can deteriorate very quickly in terms of their ability to move, speak and swallow safely. Each patient will have a different regimen of PD medication —the timing of medication administration is critical but will often fall outside of traditional drug-round times. In addition to the distress to patients and their families caused by deterioration in motor symptoms, the consequences of delayed or missed PD medications include prolonged length of hospital stay, falls, pressure ulcers, rapidly deteriorating swallow, physical de-conditioning, aspiration pneumonia and neuroleptic malignant-like syndrome (NMLS) —this can be life threatening.

It can sometimes be difficult to know what to do when a Parkinson’s patient has swallowing difficulties, is made ‘nil by mouth’ or has surgery planned. The links on this website provide resources to assist the clinician in such situations when caring for patients with PD.

obtaining emergency medicationsnew


swallowing problems / nbm


pd on surgical wards


apomorphine flowchart


apomorphine guideline


our team


contact us

Watch Our Training Video —Parkinson’s: Reducing Omissions and Delays

Please note —there may be a small delay after clicking play on some computers as the video file loads

A few missed doses of PD medication can be fatal —a patient with Parkinson’s who is ‘Nil By Mouth’ is no less of an emergency than someone with severe sepsis…

To see how your ward is performing with respect to administering PD medications on time, log in to Concerto® and under the DASHBOARD tab on the left, select Medications > Ward-Daily Parkinson’s Drugs Administered Within 1/2 Hour then filter reports by site and ward.

acute | MEDICINE BHH