Addressing Comorbidities in People with Parkinson's Disease: Considerations From An Expert Panel

Overview

Journal J Parkinsons Dis

Publisher Sage Publications

Specialty Neurology

Date 2024 Jan 13

PMID 38217610

Authors

Camille Carroll

Carl E Clarke

Donald Grosset

Arshad Rather

Biju Mohamed

Miriam Parry

Prashanth Reddy

Robin Fackrell

Kallol Ray Chaudhuri

Affiliations

Soon will be listed here.

Abstract

In the UK, guidance exists to aid clinicians and patients deciding when treatment for Parkinson's disease (PD) should be initiated and which therapies to consider. National Institute for Health and Care Excellence (NICE) guidance recommends that before starting PD treatment clinicians should discuss the following: the patient's individual clinical circumstances; lifestyle; preferences; needs and goals; as well as the potential benefits and harms of the different drug classes. Individualization of medicines and management in PD significantly improves patients' outcomes and quality of life. This article aims to provide simple and practical guidance to help clinicians address common, but often overlooked, co-morbidities. A multi-disciplinary group of PD experts discussed areas where clinical care can be improved by addressing commonly found co-morbidities in people with Parkinson's (PwP) based on clinical experience and existing literature, in a roundtable meeting organized and funded by Bial Pharma UK Ltd. The experts identified four core areas (bone health, cardiovascular risk, anticholinergic burden, and sleep quality) that, if further standardized may improve treatment outcomes for PwP patients. Focusing on anticholinergic burden, cardiac risk, sleep, and bone health could offer a significant contribution to personalizing regimes for PwP and improving overall patient outcomes. Within this opinion-based paper, the experts offer a list of guiding factors to help practitioners in the management of PwP.

References

Sherrington C, Tiedemann A . Physiotherapy in the prevention of falls in older people. J Physiother. 2015; 61(2):54-60. DOI: 10.1016/j.jphys.2015.02.011. View

Amara A, Chahine L, Videnovic A . Treatment of Sleep Dysfunction in Parkinson's Disease. Curr Treat Options Neurol. 2017; 19(7):26. PMC: 6371969. DOI: 10.1007/s11940-017-0461-6. View

Rudolph J, Salow M, Angelini M, McGlinchey R . The anticholinergic risk scale and anticholinergic adverse effects in older persons. Arch Intern Med. 2008; 168(5):508-13. DOI: 10.1001/archinternmed.2007.106. View

Ehrt U, Broich K, Larsen J, Ballard C, Aarsland D . Use of drugs with anticholinergic effect and impact on cognition in Parkinson's disease: a cohort study. J Neurol Neurosurg Psychiatry. 2009; 81(2):160-5. DOI: 10.1136/jnnp.2009.186239. View

Menza M, Dobkin R, Marin H, Bienfait K . Sleep disturbances in Parkinson's disease. Mov Disord. 2010; 25 Suppl 1:S117-22. PMC: 2840057. DOI: 10.1002/mds.22788. View

Fistarol M, Rezende C, Figueiredo Campos A, Kakehasi A, Geber S . Time since menopause, but not age, is associated with increased risk of osteoporosis. Climacteric. 2019; 22(5):523-526. DOI: 10.1080/13697137.2019.1634046. View

Crispo J, Willis A, Thibault D, Fortin Y, Hays H, McNair D . Associations between Anticholinergic Burden and Adverse Health Outcomes in Parkinson Disease. PLoS One. 2016; 11(3):e0150621. PMC: 4777375. DOI: 10.1371/journal.pone.0150621. View

Loddo G, Calandra-Buonaura G, Sambati L, Giannini G, Cecere A, Cortelli P . The Treatment of Sleep Disorders in Parkinson's Disease: From Research to Clinical Practice. Front Neurol. 2017; 8:42. PMC: 5311042. DOI: 10.3389/fneur.2017.00042. View

Fackrell R, Carroll C, Grosset D, Mohamed B, Reddy P, Parry M . Noninvasive options for 'wearing-off' in Parkinson's disease: a clinical consensus from a panel of UK Parkinson's disease specialists. Neurodegener Dis Manag. 2018; 8(5):349-360. DOI: 10.2217/nmt-2018-0020. View

10.

Ancelin M, Artero S, Portet F, Dupuy A, Touchon J, Ritchie K . Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: longitudinal cohort study. BMJ. 2006; 332(7539):455-9. PMC: 1382539. DOI: 10.1136/bmj.38740.439664.DE. View

11.

Wade R, Pachana N, Dissanayaka N . Management of Sleep Disturbances in Parkinson's Disease Patients, Carers and the Patient and Carer Dyadic Relationship: A Scoping Review. Clin Gerontol. 2018; 43(5):499-507. DOI: 10.1080/07317115.2018.1539424. View

12.

Stacy M . Sleep disorders in Parkinson's disease: epidemiology and management. Drugs Aging. 2002; 19(10):733-9. DOI: 10.2165/00002512-200219100-00002. View

13.

Sachdev P . Homocysteine and brain atrophy. Prog Neuropsychopharmacol Biol Psychiatry. 2005; 29(7):1152-61. DOI: 10.1016/j.pnpbp.2005.06.026. View

14.

Bateman D, Levett K, Marsden C . Sleep benefit in Parkinson's disease. J Neurol Neurosurg Psychiatry. 1999; 67(3):384-5. PMC: 1736545. DOI: 10.1136/jnnp.67.3.384. View

15.

Knie B, Mitra M, Logishetty K, Chaudhuri K . Excessive daytime sleepiness in patients with Parkinson's disease. CNS Drugs. 2011; 25(3):203-12. DOI: 10.2165/11539720-000000000-00000. View

16.

Litwin H, Erlich B, Dunsky A . The Complex Association Between Fear of Falling and Mobility Limitation in Relation to Late-Life Falls: A SHARE-Based Analysis. J Aging Health. 2017; 30(6):987-1008. PMC: 6655432. DOI: 10.1177/0898264317704096. View

17.

Salahudeen M, Duffull S, Nishtala P . Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review. BMC Geriatr. 2015; 15:31. PMC: 4377853. DOI: 10.1186/s12877-015-0029-9. View

18.

Cai X, Campbell N, Khan B, Callahan C, Boustani M . Long-term anticholinergic use and the aging brain. Alzheimers Dement. 2012; 9(4):377-85. PMC: 3674201. DOI: 10.1016/j.jalz.2012.02.005. View

19.

Trenkwalder C, Kohnen R, Hogl B, Metta V, Sixel-Doring F, Frauscher B . Parkinson's disease sleep scale--validation of the revised version PDSS-2. Mov Disord. 2011; 26(4):644-52. DOI: 10.1002/mds.23476. View

20.

Madamanchi N, Runge M . Mitochondrial dysfunction in atherosclerosis. Circ Res. 2007; 100(4):460-73. DOI: 10.1161/01.RES.0000258450.44413.96. View