Excerpt

This guideline covers diagnosing and managing Parkinson’s disease in people aged 18 and over. It aims to improve care from the time of diagnosis, including monitoring and managing symptoms, providing information and support, and palliative care.

Contents

• 1. GDG membership and ICG technical team
  • 1.1. GDG
  • 1.2. Internal Clinical Guidelines team
  • 1.3. Strength of recommendation
  • Interventions that must (or must not) be used
  • Interventions that could be used
• 2. Methods
  • 2.1. Additional methods used in this guideline
• Evidence reviews and recommendations
  • 3. Communication with people with Parkinson’s disease and their carers
    • 3.1.1. Introduction
    • 3.1.2. Methodology
    • 3.1.3. Evidence statements
    • 3.1.4. From evidence to recommendation
    • 3.1.5. Recommendations
  • 4. Information needs of people with Parkinson’s disease and their families and carers
    • 4.1. Impulse control disorders
    • 4.2. Women of childbearing age
  • 5. Parkinson’s disease diagnosis
    • 5.1. Definition and differential diagnosis
    • 5.2. Expert versus non-expert diagnosis
    • 5.3. Single photon emission computed tomography
    • 5.4. Positron emission tomography
    • 5.5. Magnetic resonance volumetry
    • 5.6. Magnetic resonance spectroscopy
    • 5.7. Acute levodopa and apomorphine challenge tests
    • 5.8. Objective smell testing
  • 6. Pharmacological management of motor symptoms
    • 6.1. First-line treatment of motor symptoms
  • 7. Pharmacological management of non-motor symptoms
    • 7.1. Daytime hypersomnolence
    • 7.2. Nocturnal akinesia
    • 7.3. Orthostatic hypotension
    • 7.4. Depression
    • 7.5. Psychotic symptoms (hallucinations and delusions)
    • 7.6. REM sleep behaviour disorder
    • 7.7. Thermoregulatory dysfunction
    • 7.8. Saliva management
  • 8. Pharmacological management of dementia associated with Parkinson’s disease
    • 8.1. Pharmacological management of Parkinson’s disease dementia
  • 9. Non-pharmacological management of motor and non-motor symptoms
    • 9.1. Parkinson’s disease nurse specialist interventions
    • 9.2. Physiotherapy and physical activity
    • 9.3. Occupational therapy
    • 9.4. Speech and language therapy
    • 9.5. Nutrition
    • 9.6. Neuroprotection
  • 10. Advanced therapies: deep brain stimulation and levodopa–carbidopa intestinal gel
    • 10.1. Call for evidence
    • 10.2. Expert witnesses
    • 10.3. Deep brain stimulation, levodopa–carbidopa intestinal gel and best medical treatment for advanced Parkinson’s disease
    • 10.4. Deep brain stimulation compared with best medical treatment for earlier Parkinson’s disease
  • 11. Managing and monitoring impulse control disorder as an adverse effect of dopaminergic treatment
    • 11.1. Predictors for the development of impulse control disorders
    • 11.2. Managing dopaminergic treatment in people who have developed impulse control disorder
  • 12. Palliative care
    • 12.1.1. Introduction
    • 12.1.2. Evidence review
    • 12.1.3. Description of included studies
    • 12.1.4. Evidence statements
    • 12.1.5. Health economic evidence
    • 12.1.6. Evidence to recommendations
    • 12.1.7. Recommendations
• Appendix A. Committee membership list – Parkinson’s disease guideline committee
• Appendix B. National Institute for Health and Care Excellence
• Appendix C. Review protocols
• Appendix D. Evidence tables
• Appendix E. GRADE Profiles
• Appendix F. Full health economics report
• Appendix G. Excluded studies
• Appendix H. deleted text from NICE clinical guideline 35 (CG35)
• Appendix I. Search Strategies
• Appendix J. Old guideline references
• Appendix K. Parkinson’s Disease Society Communication Table
• Appendix L. Economic modelling for Parkinson’s disease nurse specialist care
• Appendix M. Call for evidence
• Appendix N. Research recommendations

Final Version

Developed by the National Institute for Health and Care Excellence

Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.