You are on page 1of 1

Visual summary

Managing symptoms of Parkinson’s disease (PD)


Ongoing care and support

Specialist nursing Physiotherapy Occupational therapy Speech and language Palliative care

People with PD should Offer PD-specific Offer PD-specific Offer speech and language therapy for Consider referring
have regular access physiotherapy for people occupational therapy for people with PD who are experiencing: people at any stage of
to the services who are experiencing: people who are having: PD to the palliative
provided by a PD Communication problems care team to discuss
Balance problems
nurse specialist Difficulties with their priorities for care
daily living activities Problems with
Motor function problems swallowing or saliva at the end of life

Managing non-motor symptoms Managing motor symptoms More improvement /


fewer adverse events
While the non-pharmacological
management strategies listed above are If symptoms If symptoms do
first line treatments for non-motor affect daily life, not affect daily life, Intermediate
symptoms, consider treating refractory offer levodopa offer a choice
problems with the following drugs: Consider whether new
symptoms might Less improvement /
be caused by side more adverse events
Excessive daytime sleepiness effects of other
medications
Modafinil
Dopamine MAO-B
Levodopa agonists inhibitors

REM* sleep Nocturnal akinesia Symptoms Symptoms Symptoms


behaviour disorder Activities Activities Activities
Levodopa Oral dopamine agonists
Motor comp. Motor comp. Motor comp.
Clonazepam Melatonin if neither Rotigotine
is effective Adv. Evts. Adv. Evts. Adv. Evts.

Adjuvant therapy
Orthostatic hypotension Hallucinations and delusions
If dyskinesia or motor fluctuations develop, adjuvant therapy
may be added to a Levodopa regimen, under specialist advice.
Midodrine Do not treat if well tolerated
Quetiapine Dopamine MAO-B COMT
If contraindicated, not
tolerated or not effective If not effective
For people
without + agonists + inhibitors + inhibitors
cognitive
Fludrocortisone Clozapine impairment Symptoms Symptoms Symptoms

Lower doses needed for people Activities Activities Activities


with PD than in other indications Off-time Off-time Off-time
Drooling
Do not offer Adv. Evts. Adv. Evts. Adv. Evts.
Olanzapine
Glycopyrronium bromide olanzapine Hallucinat. Hallucinat. Hallucinat.

If contraindicated, not If dyskinesia is not adequately managed by the above, consider amantadine.
tolerated or not effective Dementia
Specialist referral for Mild–moderate Severe + Amantadine (no evidence of benefit or harms)
Botulinum toxin A
Cholinesterase
If person’s risk of cognitive Offer inhibitor Consider Impulse Ensure patients Managing ICDs
adverse effects is minimal control and carers are
If not tolerated
aware of ICD types Adjust
Other anticholinergic or contraindicated disorders (ICDs)
medicines dopaminergic
Memantine ICDs are common Compulsive gambling therapy gradually,
adverse effects of Hypersexuality to balance motor
dopaminergic therapy. symptoms and
They are a group of Binge eating ICDs
psychiatric conditions
Advanced Parkinson’s disease linked by a failure to Obsessive shopping If not
resist the temptation effective
to perform an act Also inform them
Offer best medical Intermittent Continuous who to contact if Offer specialist CBT
and/ harmful to either
therapy, which apomorphine subcutaneous ICDs develop targeted at ICDs
or oneself or others
may include: injection apomorphine infusion

if symptoms are not


Consider deep brain stimulation Read the full
adequately controlled http://bmj.co/parkNG
article online
Disclaimer: This infographic is not a validated clinical decision aid. This information is provided without any representations,
conditions or warranties that it is accurate or up to date. BMJ and its licensors assume no responsibility for any aspect of treatment administered with the aid of this information. Any
reliance placed on this information is strictly at the user's own risk. For the full disclaimer wording see BMJ's terms and conditions: http://www.bmj.com/company/legal-information/ © 2017 BMJ Publishing group Ltd.

You might also like