Parkinson's Disease (eBook)

Excellent diagrams, charts and tables presented in easily readable pastels... There are only two UK contributors but the content is relevant to the UK reader; particularly the well-summarised facts and figures chapter but also those dealing with clinical aspects and drug treatments... Notwithstanding the international dimensions to this book, it is indeed a concise, practical and useful resource.

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