Parkinson’s disease – Key priorities for implementation – 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 PD should be referred quickly[2] 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[3] 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 Parkinson’s disease 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.


[2] The Guideline Development Group considered that people with suspected mild PD should be seen within 6 weeks but new referrals in later disease with more complex problems require an appointment within 2 weeks.

[3] The Guideline Development Group considered that people diagnosed with PD should be seen at regular intervals of 6–12 months to review their diagnosis.

Issued: June 2006

© National Institute for Health and Clinical Excellence, 2006. All rights reserved. This material may be freely reproduced for educational and not-for-profit purposes. No reproduction by or for commercial organisations, or for commercial purposes, is allowed without the express written permission of the Institute.

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