Nonmotor symptoms were highly prevalent in NH residents with PD. Quality of life was poor, largely because of NMS. Because many NMS are potentially treatable, diagnosis and treatment of these severely affected individuals deserve more attention.
Considering the observed positive subjective effects, it seems reasonable to recommend headache patients to try this non-invasive intervention for a short period of time to see whether they experience improvement.
These findings show that PD in nursing home residents is characterized by severe motor impairment and a high proportion of daily "off" time, which underscores the need for better management of PD in nursing homes, for example within specialized institutions or with periodic consultations by a movement disorders expert.
One half of institutionalized PD patients had OH, of whom half were probably symptomatic. OH was rarely noted in the medical records, suggesting underdiagnosis. Finally, OH was rarely treated, suggesting undertreatment.
Background Treatment of patients with late-stage parkinsonism is often sub-optimal. Objective To test the effectiveness of recommendations by a movement disorder specialist with expertise in late-stage parkinsonism. Methods Ninety-one patients with late-stage parkinsonism considered undertreated were included in a pragmatic multi-center randomizedcontrolled trial with six-month follow-up. The intervention group received a letter with treatment recommendations to their primary clinician based on an extensive clinical assessment. Controls received care as usual. The primary outcome was the Unified Parkinson Disease Rating Scale (UPDRS) part-II-Activities of Daily Living. Other outcomes were quality-of-life (PDQ-8), mental health (UPDRS-I), motor function (UPDRS-III), treatment complications (UPDRS-IV), cognition (Mini-mental-state-examination), non-motor symptoms (Non-Motor-Symptoms-scale), health status (EQ-5D-5L) and levodopa-equivalent-daily-dose (LEDD). We also assessed adherence to specialist recommendations. In addition to intention-to-treat analyses, a per-protocol analysis was conducted only including those in whom recommendations were at least partially followed. Results Sample size calculation required 288 patients, but only 91 patients could be included. Treating physicians followed recommendations at least partially in 37 (64%) patients. The intention-to-treat analysis showed no difference in primary outcome (between-group difference =-1.2, p = 0.45), but there was greater improvement for PDQ-8 in the intervention group (between-group difference =-3.7, p=0.02). The per-protocol analysis confirmed these findings, and also showed less deterioration in UPDRS-part I, greater improvement on UPDRS-total score and greater increase in LEDD in the intervention group. Conclusions There was no improvement on the UPDRS-ADL part in this study, which was limited by underrecruitment and limited implementation of recommendations, but there was a positive change in quality of life. These findings suggest that therapeutic gains may be reached even in this vulnerable group of patients with late-stage parkinsonism, but also emphasize the need for better strategies to implement specialist recommendations to further improve outcomes.
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