Resumen de Motor Profile and Drug Treatment of Nursing Home Residents with Parkinson's Disease
Nico J. Weerkamp, Sytse U. Zuidema, Gerrit Tissingh, Petra J. E. Poels, Marten Munneke, Raymond T. C. M. Koopmans, Bastiaan R. Bloem
Objectives: To examine the clinical characteristics, motor impairments, and drug treatments of nursing home residents with Parkinson's disease (PD).
Design: Cross-sectional study.
Setting: Nursing homes in the southeast of the Netherlands.
Participants: Nursing home residents with PD and a Mini-Mental State Examination score of 18 or greater seen by a physician with experience in movement disorders.
Measurements: Participant characteristics, motor function, and dopaminergic medications were assessed. The Short Parkinson's Evaluation Scale/SCales for Outcomes in Parkinson's disease (SPES-SCOPA) was used to assess motor impairments and disabilities.
Results: Seventy-three nursing home residents with PD (mean age 78.7; 45% male; mean disease duration 10.1 years; Hoehn and Yahr 4 (38%) and 5 (49%)) were included. Most residents were severely disabled, 49% being wheelchair bound. According to the SPES-SCOPA, 44% of residents were �off� (in a motor state in which they are slow and stiff) most of the time. Dyskinesias were encountered infrequently. Most residents were mainly treated with levodopa monotherapy, and daily doses varied widely (20�1,600 mg, mean 673 mg); 25% of residents were treated with less than 400 mg levodopa daily, and 8% received no levodopa at all. The movement disorders specialist considered 32 residents to be possibly undertreated.
Conclusion: 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.
