Parkinson's Disease: Clinican's Desk Reference PDF
Preview Parkinson's Disease: Clinican's Desk Reference
CLINICIAN’S DESK REFERENCE Parkinson’s Disease Michael S Okun Hubert H Fernandez Movement Disorders Center, McKnight Brain Institute, University of Florida, Gainesville, Florida, USA Donald G Grosset Katherine A Grosset Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK MANSON PUBLISHING CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2009 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 20141208 International Standard Book Number-13: 978-1-84076-517-5 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. 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Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com Contents Contributors 5 CHAPTER 3 Introduction 6 Diagnostic testing and neuroimaging 45 Dopaminergic challenge tests 45 CHAPTER 1 Olfactory testing 46 Parkinson’s disease facts and figures 9 Structural neuroimaging 46 Functional neuroimaging 50 History 9 Mechanisms in functional neuroimaging 50 Epidemiology 9 Presynaptic dopamine imaging as a diagnostic and Survival 10 research tool in PD 52 Causes 11 Postsynaptic dopamine imaging in parkinsonism 54 Risk factors 11 Other types of functional neuroimaging in PD 55 Genetic factors 12 Functional neuroimaging in clinical drug trials 55 Environmental factors 15 Vascular parkinsonism and functional neuroimaging Protective factors 17 56 Disease progression 18 Clinical applications of functional neuroimaging 56 Pathophysiology 20 Transcranial ultrasound 57 Neuropathology 22 Cardiac sympathetic nerve imaging 57 Causes of neurone death 23 Tremor recording 57 CHAPTER 2 CHAPTER 4 Clinical diagnosis of parkinsonism Drug treatment of Parkinson’s disease 59 and tremor 25 Management principles 59 Symptom development 25 When to increase or add in therapy 59 Clinical features 25 Signs of overtreatment 59 Bradykinesia 28 Levodopa 60 Asymmetry 28 COMT inhibitors 62 Rigidity 31 Dopamine agonists 63 Tremor 32 Monoamine oxidase inhibitors 66 Postural instability 33 Anticholinergics 67 Frontal lobe reflexes 34 Amantadine 67 Subtypes of idiopathic PD 34 Continuous dopaminergic stimulation 68 Problems in diagnosis 35 Other similar presentations 36 CHAPTER 5 Red flags (alerts) 43 Nonmotor features of Parkinson’s Misdiagnosis 44 disease 69 Cognitive impairment 69 Psychiatric complications 74 Behavioural dysfunction 77 Sleep disturbances 82 Autonomic dysfunction 84 CHAPTER 6 CHAPTER 10 Motor and nonmotor assessment scales 89 The role of the speech–language pathologist/therapist 141 Motor scales 89 Nonmotor scales 98 Introduction 141 Communication disorders in PD 141 CHAPTER 7 Causes of communication disorders 142 Surgical therapy for Parkinson’s disease 115 Evaluation and treatment of communication disorders 143 Surgical options for PD 115 Swallowing disorders in PD 144 Selecting candidates for DBS or lesion surgery 116 Causes of dysphagia in PD 145 Factors which may improve the success of PD surgery Evaluation and treatment of swallowing problems 118 145 Choosing a type of surgery and target site 119 DBS targeting and lead placement 120 CHAPTER 11 Mapping the GPi 122 Malnutrition and related disorders 147 Microelectrode localization of the subthalamus 122 DBS lead implantation 122 Nutritional health and the role of the registered dietician 147 DBS programming: general concepts 123 Nutritional disorders related to autonomic effects of Programming DBS devices 123 PD 147 Postoperative care 124 Nutritional disorders related to mental aspects of PD Risks of DBS 124 149 Other effects of PD on nutritional health 151 CHAPTER 8 Effects of PD medication 152 The role of the nurse practitioner/ physician assistant 125 CHAPTER 12 Complementary medicine and Introduction 125 Examining the PD patient 125 Parkinson’s disease 155 Coordinating care 127 Introduction 155 Specialized services 129 Acupuncture 155 Care of DBS patients 132 Massage therapy 156 Tai chi 157 CHAPTER 9 Dietary supplements 157 The role of the physical and Chelation therapy 159 occupational therapist 133 Enhanced external counterpulsation 159 Movement and functional deficits in the PD patient 133 Resources 160 Referral to a therapist 134 Further reading 162 Limitations of therapy 134 Glossary 166 Role of the physical therapist 135 Index 170 Effects of medication on movment dysfunction 137 Effects of surgical intervention on movement Abbreviations176 dysfunction 138 Role of the occupational therapist 138 Social/emotional concerns and carer support 140 5 Contributors Chapters 1, 2, 3, 4 Chapter 8 Donald G.Grosset,BSc MBChB MD FRCP Janet Romrell,PA-C Consultant Neurologist Physician Assistant Katherine A.Grosset,MBChB MRCGP(1989) MD Movement Disorders Center, Hospital Practitioner University of Florida, Institute of Neurological Sciences, Gainesville, Florida, USA Southern General Hospital, Glasgow, UK Chapter 9 Keith J.Myers,MBA,PT Chapters 4, 5, 7 Portia Gardner-Smith,OTR/L,CHT Hubert H.Fernandez,MD Shands Healthcare, Michael S.Okun,MD Department of Rehabilitation Services, University of Co-Directors Florida Movement Disorders Center, Gainesville, Florida, USA McKnight Brain Institute, University of Florida, Gainesville, Florida, USA Chapter 10 John C.Rosenbek,PhD Chapter 6 Harrison N.Jones,MA Maria L.Moro-de-Casillas,MD Department of Communicative Disorders, University of Movement Disorders Fellow Florida Joseph H.Friedman,MD Gainesville, Florida, USA Clinical Professor Kelvin L.Chou,MD Chapter 11 Clinical Assistant Professor Kathrynne Holden,MS,RD Department of Clinical Neurosciences, Brown Medical President School, NeuroHealth Parkinson’s Disease and Movement Five Star Living, Inc. Disorders Center, Springfield, Missouri, USA Warwick, Rhode Island, USA Chapter 12 Melissa Amick,PhD Theresa A.McClain,MSN,ARNP Research Associate Robert A.Hauser,MD,MBA Department of Psychiatry and Human Behavior, Brown Medical School, Department of Neurology Staff Neuropsychologist, Department of Rehabilitation Parkinson’s Disease and Movement Disorders Center Medicine, University of South Florida, Memorial Hospital of Rhode Island, Tampa, Florida, USA Pawtucket, Rhode Island, USA Acknowledgements The authors would like to gratefully acknowledge the illustrations – Angela O’Donnell, Dr Edward Newman, following people for their kind and expert assistance in Dr Jim Patterson, Atchar Sudhyadhom, Elaine Tyrrell, the preparation of this book: the authors of the individ- Dr Jerry Vitek, Dr Benjamin Walter, Dr Ludvic Zrinzo, ual chapters; the University of Florida’s Greg Crucian for and for secretarial assistance – Margaret Crawford and his assistance with Chapter 10; those who assisted with Elizabeth Jackson. 6 Introduction WE HAVE TRIED, in writing this book, to take a unique find clear summary statements, essentially a ‘mini approach to Parkinson’s disease and one that we evidence-based summary’ on this and many points. hope will provide a concise, practical and useful And where data are controversial or contradictory, we resource for the reader. The book adopts a ‘key facts’ similarly highlight these key points. Lastly, the patho- method of explaining the disease, its diagnosis, differ- physiology and neuropathology of Parkinson’s are entiation from other conditions, assessment, and considered, with a review of mitochondrial dysfunc- treatment. The chapters are laid out in an easy-to-read tion and oxidative stress. style, with bulleted points throughout and a wealth of In Chapter 2, Clinical diagnosis of parkinsonism helpful diagrams and photographs. and tremor, we look at diagnostic issues, first by The management of motor symptoms in relation examining the question of when symptoms develop, to drug treatment, from initial presentation through then by describing the cardinal features of the disease the period of fluctuating disease to complex and their clinical tests, and finally the additional or advanced stages, is reviewed, but there is also specific supporting features are reviewed. There is then a attention paid to the non-motor aspects, which have consideration of problems relating to diagnosis, come under closer scrutiny in recent years. We have measured against the various diagnostic clinical also included a complete section on surgical criteria that have been proposed for PD. Conditions therapies. Moreover, the non-pharmacological man- which are sometimes confused in clinical practice agement of Parkinson’s disease is also specifically with Parkinson’s disease are outlined, together with a addressed, with sections regarding the input from summary of the ‘red flags’ – a key guide to recogniz- multidisciplinary, allied team professionals, including ing what is and is not PD. physiotherapy, occupational therapy, speech and In Chapter 3, Diagnostic testing and neuro- language, dietetics, and complementary therapy. We imaging, the role of these techniques is summarized. also did not want to forget the important and influen- While clinical diagnosis remains the main approach tial role of the Parkinson’s disease nurse specialist for this condition, there are situations where diagnos- who is often a key point of coordination of services tic tests need to be performed. The use of anti- for patients, including the medical and allied profes- parkinson therapy is itself sometimes an investigative sionals, and wider aspects of social care and involve- test (a ‘trial of therapy’) to support a possible PD ment and informing of the patient’s carers and family. diagnosis. There are also the more recent develop- We provide a detailed glossary of terms used in this ments; testing the sense of smell – which is impaired field, and a summary of key resources, in particular in Parkinson’s disease and is usually normal in other the patient representative bodies and self-help organi- movement disorders – and the use of functional zations which provide so much assistance to patients dopaminergic imaging. In this latter category the two and their carers, as well as support for research. main types of imaging with PET and SPECT scans are In Chapter 1, Parkinson’s disease facts and examined. While structural imaging does not have a figures, we offer a logical sequence moving from major role in the diagnosis of Parkinson’s disease, the incidence and prevalence figures and survival data, reasons why it should be used in some cases, and the through to the causes and risk factors associated with type of findings which may be seen, are also covered. the condition, and then on to the genetic and environ- In Chapter 4, Drug treatment of Parkinson’s mental ones. In this chapter we also address rates of disease, the treatment of both motor and non-motor progression of Parkinson’s disease, a frequent features is reviewed in detail, with consideration of question by patients and their carers. The reader will current anti-PD drugs under their respective classes. 7 The non-motor features are given their own section The work of allied team professionals is looked (Chapter 5, Nonmotor features of Parkinson’s at in the following chapters. The role of the nurse disease). Here the reader will find the key areas of practitioner/physician assistant(Chapter 8) empha- depression, anxiety, cognitive impairment, and sizes the coordination of care and communication dementia, amongst others. The chapter describes the with patient, family and other caregivers. The role of clinical features of these complications and considers the physical and occupational therapist(Chapter 9) the drug treatments which have been tested in clinical again looks beyond the simple physical limitations of trials and which can now be applied in clinical care. the condition. The wider aspects of perceptual ability, Although much of the severity scoring for the impact of cognitive impairments, the effect of Parkinson’s disease is applied in the clinical trial antiparkinson medication on the patient’s physical setting, an understanding of the assessment scales is condition are all addressed, as well as different important in the interpretation of the clinical research approaches to the management of a range of move- literature. In addition, selective application of scores ments, posture, balance, and gait. The individual and scales can be helpful in obtaining a comprehen- functions on which all this has impact are then con- sive clinical picture. For example the identification of sidered from the occupational therapy point of view. non-motor features such as depression, and other In Chapter 10, The role of the speech–language aspects of PD, can be made more objective with a pathologist/therapist, the Parkinson patient’s specific scoring system. Where a short version of such a problems with communication and swallowing are scoring scheme is available, we guide the reader to addressed. This is set against a wider background of this alternative, to help save time in the busy clinic. communication and swallowing disorders and the We also cover the schemes that patients can adminis- impact of cognitive slowing and impairment, together ter primarily themselves, which mainly relate to func- with referral and evaluation considerations and tional ability and quality of life. There are therefore potential treatment techniques. many reasons for including Chapter 6, Motor and In Chapter 11, Malnutrition and related nonmotor assessment scales,which takes a step-by- disorders, the dietician’s role is defined, with discus- step approach and comments on the limitations and sion of both the risk factors and identification of mal- benefits of each instrument. nutrition, and also the management of bowel status, Chapter 6 concludes with one of the assessment vitamin status, interaction with other disease features tools used when considering a patient for surgery – like depression, loss of sense of smell, and concerns which nowadays is mainly deep brain stimulation relating to the nutritional effects of antiparkinson (DBS) surgery. DBS is the focus for Chapter 7, medication. Finally, Complementary medicine and Surgical therapy for Parkinson’s disease, and details Parkinson’s disease, Chapter 12, examines the useful- of the evaluation criteria to select appropriate patients ness of complementary approaches in the manage- for surgical intervention are presented. Issues of ment of Parkinson’s, with a point-by-point review of cognitive screening, psychiatric co-morbidity, and popular therapies such as acupuncture and dietary any previous antiparkinson medication effects the supplementation. patient has experienced are reviewed. The chapter A list of resources for the patient and family, as moves on to the practical issues of the type of surgery, well as caregivers, is provided at the end of the book, then onto DBS techniques such as the localization of and also a list of further reading, a glossary explaining the surgical target and the application of micro- many of the specialized terms used in the text, a list of electrode recording. abbreviations, and an index. DONALDGROSSET, KATHERINEGROSSET, HUBERTFERNANDEZ, MICHAELOKUN This page intentionally left blank
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