Grosset / Fernandez / Okun Parkinson's Disease

Clinican's Desk Reference
Erscheinungsjahr 2009
ISBN: 978-1-84076-517-5
Verlag: Manson Publishing
Format: PDF
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, 176 Seiten

The second title in the new series ‘Clinician’s Desk Reference’, designed as concise up-to-date volumes on key conditions for physicians in the hospital setting and in primary care, and for many professionals allied to medicine.

Coverage ranges from incidence, diagnosis, investigation, drug treatments, non-motor features of Parkinson’s Disease, assessment scales and surgical intervention, to the role of nurses, physio– and occupational therapists, speech/language pathologists, dieticians, and to the use of complementary medicine.

The book is illustrated by photos/imaging and by charts and tables.

Autoren/Hrsg.

Grosset, Donald

Fernandez, Hubert

Okun, Michael

Grosset, Katherine

Leseproben

WE HAVE TRIED, in writing this book, to take a unique
approach to Parkinson’s disease and one that we
hope will provide a concise, practical and useful
resource for the reader. The book adopts a ‘key facts’
method of explaining the disease, its diagnosis, differentiation
from other conditions, assessment, and
treatment. The chapters are laid out in an easy-to-read
style, with bulleted points throughout and a wealth of
helpful diagrams and photographs.
The management of motor symptoms in relation
to drug treatment, from initial presentation through
the period of fluctuating disease to complex
advanced stages, is reviewed, but there is also specific
attention paid to the non-motor aspects, which have
come under closer scrutiny in recent years. We have
also included a complete section on surgical
therapies. Moreover, the non-pharmacological management
of Parkinson’s disease is also specifically
addressed, with sections regarding the input from
multidisciplinary, allied team professionals, including
physiotherapy, occupational therapy, speech and
language, dietetics, and complementary therapy. We
also did not want to forget the important and influential
role of the Parkinson’s disease nurse specialist
who is often a key point of coordination of services
for patients, including the medical and allied professionals,
and wider aspects of social care and involvement
and informing of the patient’s carers and family.
We provide a detailed glossary of terms used in this
field, and a summary of key resources, in particular
the patient representative bodies and self-help organizations
which provide so much assistance to patients
and their carers, as well as support for research.
In Chapter 1, Parkinson’s disease facts and
figures, we offer a logical sequence moving from
incidence and prevalence figures and survival data,
through to the causes and risk factors associated with
the condition, and then on to the genetic and environmental
ones. In this chapter we also address rates of
progression of Parkinson’s disease, a frequent
question by patients and their carers. The reader will
find clear summary statements, essentially a ‘mini
evidence-based summary’ on this and many points.
And where data are controversial or contradictory, we
similarly highlight these key points. Lastly, the pathophysiology
and neuropathology of Parkinson’s are
considered, with a review of mitochondrial dysfunction
and oxidative stress.
In Chapter 2, Clinical diagnosis of parkinsonism
and tremor, we look at diagnostic issues, first by
examining the question of when symptoms develop,
then by describing the cardinal features of the disease
and their clinical tests, and finally the additional or
supporting features are reviewed. There is then a
consideration of problems relating to diagnosis,
measured against the various diagnostic clinical
criteria that have been proposed for PD. Conditions
which are sometimes confused in clinical practice
with Parkinson’s disease are outlined, together with a
summary of the ‘red flags’ – a key guide to recognizing
what is and is not PD.
In Chapter 3, Diagnostic testing and neuroimaging,
the role of these techniques is summarized.
While clinical diagnosis remains the main approach
for this condition, there are situations where diagnostic
tests need to be performed. The use of antiparkinson
therapy is itself sometimes an investigative
test (a ‘trial of therapy’) to support a possible PD
diagnosis. There are also the more recent developments;
testing the sense of smell – which is impaired
in Parkinson’s disease and is usually normal in other
movement disorders – and the use of functional
dopaminergic imaging. In this latter category the two
main types of imaging with PET and SPECT scans are
examined. While structural imaging does not have a
major role in the diagnosis of Parkinson’s disease, the
reasons why it should be used in some cases, and the
type of findings which may be seen, are also covered.
In Chapter 4, Drug treatment of Parkinson’s
disease, the treatment of both motor and non-motor
features is reviewed in detail, with consideration of
current anti-PD drugs under their respective classes.

The non-motor features are given their own section
(Chapter 5, Nonmotor features of Parkinson’s
disease). Here the reader will find the key areas of
depression, anxiety, cognitive impairment, and
dementia, amongst others. The chapter describes the
clinical features of these complications and considers
the drug treatments which have been tested in clinical
trials and which can now be applied in clinical care.
Although much of the severity scoring for
Parkinson’s disease is applied in the clinical trial
setting, an understanding of the assessment scales is
important in the interpretation of the clinical research
literature. In addition, selective application of scores
and scales can be helpful in obtaining a comprehensive
clinical picture. For example the identification of
non-motor features such as depression, and other
aspects of PD, can be made more objective with a
scoring system. Where a short version of such a
scoring scheme is available, we guide the reader to
this alternative, to help save time in the busy clinic.
We also cover the schemes that patients can administer
primarily themselves, which mainly relate to functional
ability and quality of life. There are therefore
many reasons for including Chapter 6, Motor and
nonmotor assessment scales, which takes a step-bystep
approach and comments on the limitations and
benefits of each instrument.
Chapter 6 concludes with one of the assessment
tools used when considering a patient for surgery –
which nowadays is mainly deep brain stimulation
(DBS) surgery. DBS is the focus for Chapter 7,
Surgical therapy for Parkinson’s disease, and details
of the evaluation criteria to select appropriate patients
for surgical intervention are presented. Issues of
cognitive screening, psychiatric co-morbidity, and
any previous antiparkinson medication effects the
patient has experienced are reviewed. The chapter
moves on to the practical issues of the type of surgery,
then onto DBS techniques such as the localization of
the surgical target and the application of microelectrode
recording.
The work of allied team professionals is looked
at in the following chapters. The role of the nurse
practitioner/physician assistant (Chapter 8) emphasizes
the coordination of care and communication
with patient, family and other caregivers. The role of
the physical and occupational therapist (Chapter 9)
again looks beyond the simple physical limitations of
the condition. The wider aspects of perceptual ability,
the impact of cognitive impairments, the effect of
antiparkinson medication on the patient’s physical
condition are all addressed, as well as different
approaches to the management of a range of movements,
posture, balance, and gait. The individual
functions on which all this has impact are then considered
from the occupational therapy point of view.
In Chapter 10, The role of the speech–language
pathologist/therapist, the Parkinson patient’s specific
problems with communication and swallowing are
addressed. This is set against a wider background of
communication and swallowing disorders and the
impact of cognitive slowing and impairment, together
with referral and evaluation considerations and
potential treatment techniques.
In Chapter 11, Malnutrition and related
disorders, the dietician’s role is defined, with discussion
of both the risk factors and identification of malnutrition,
and also the management of bowel status,
vitamin status, interaction with other disease features
like depression, loss of sense of smell, and concerns
relating to the nutritional effects of antiparkinson
medication. Finally, Complementary medicine and
Parkinson’s disease, Chapter 12, examines the usefulness
of complementary approaches in the management
of Parkinson’s, with a point-by-point review of
popular therapies such as acupuncture and dietary
supplementation.
A list of resources for the patient and family, as
well as caregivers, is provided at the end of the book,
and also a list of further reading, a glossary explaining
many of the specialized terms used in the text, a list of
abbreviations, and an index.
DONALD GROSSET, KATHERINE GROSSET,
HUBERT FERNANDEZ, MICHAEL OKUN