BackgroundParkinson's disease (PD) patients have an increased risk of under-nutrition, but we are unaware of any population based prevalence studies of under-nutrition in PD. The main objective of this study was to identify the prevalence, and nature, of under-nutrition in a representative population of people with PD.MethodsPeople diagnosed with idiopathic PD from within two PD prevalence study sites in North-East England were asked to participate in this study. Those who participated (n = 136) were assessed using a number of standard rating scales including Hoehn & Yahr stage and Unified Parkinson's Disease Rating Scale (UPDRS). Body mass index (BMI), mid-arm circumference (MAC), triceps skin fold thickness (TSF) and grip strength were recorded together with social and demographic information.ResultsBMI < 20 identified over 15% of the study group to have under-nutrition. The Malnutritional Universal Screening Tool (MUST) scoring system identified 23.5% of participants at medium or high risk of malnutrition. Low BMI, indicating under-nutrition, was associated with greater age and disease duration, lower MAC, TSF, mid-arm muscle circumference (MAMC), reduced grip strength and a report of unintentional weight loss. Problems increased with increasing age and disease duration and were greater in females.ConclusionsUnder-nutrition is a problem for around 15% of community dwelling people with PD. All PD patients should be screened for under-nutrition; the MUST score is a useful early screening tool.
Frailty as a concept has been around in medical practice for many years but has only relatively recently been established as a medical syndrome. Although frailty is not synonymous with chronological age, it is recognized to be more common as people get older. Frailty is independently associated with increasing dependency, hospital admissions and morbidity and mortality. As populations age, frailty will become more of a challenge to health care systems. It is important that health care professionals, especially geriatricians, are aware of this emerging syndrome and its potential adverse outcomes, as well as measures to reverse and slow its progress. The aim of this review is to discuss the definition, identification and potential treatment options for frailty, most relevant to the practising clinician.
A 64-year-old woman with a history of syncope when standing associated with urinary incontinence, prolonged recovery and subsequent exhaustion, was referred to our service for evaluation.She underwent a 20:15 glyceryl trinitrate head-up tilt test. This was unremarkable in the first 20 min but 90 s after the administration of glyceryl trinitrate her blood pressure fell from 125/82 mm Hg to unrecordable at 120 s associated with a short prodrome then syncope; whereby the test was terminated. with tilt testing reported in the literature. Despite the prolonged asystole the patient made a full recovery; emphasising that tilt testing is safe, 1 provided continuous heart rate and blood pressure monitoring are in situ and, as recommended by European Society of Cardiology guidance, 2 persons trained in cardiopulmonary resuscitation are immediately available.
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