Key priorities for implementation
- Referral to expert for accurate diagnosis
- Diagnosis and expert review
- Regular access to specialist nursing care
- Access to physiotherapy
- Access to occupational therapy
- Access to speech and language therapy
- Palliative care
The following recommendations have been identified as priorities for implementation.
People with suspected PD should be referred quickly and untreated to a specialist with expertise in the differential diagnosis of this condition.
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.
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.
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.
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.
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 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.
 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.
 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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