Updated Parkinson Disease Guidelines Available in Canada

David Grimes, MD

For the first time since 2012, researchers in Canada have updated their guidelines for physicians, allied health professionals, patients, and families in managing Parkinson disease.

Since the first guideline was published, there has been significant advancements in Parkinson disease in diagnosis, treatment, and symptom management.

Included in the guideline are sections on communication, diagnosis and progression, treatment, nonmotor features, and palliative care.

In the communications section, the investigators suggest encouraging people with the disease to participate in choices about their own care. Communication with the patient should be both verbal and written and discussions should aim for a balance between providing realistic information about the person’s prognosis and promoting optimism.

Families and caregivers should also be informed about the patient’s condition and what support services are available.

In the diagnosis and progression section, the authors suggest suspecting Parkinson disease in anyone with a tremor, stiffness, slowness, balance problems, or gait disorders.

However, they do not suggest routinely using tools like MRI’s and cat scans to diagnose the disease. They also said there are no effective therapies for slowing or stopping brain degeneration in the disease.

The investigators suggest a regular exercise regimen early in the diagnosis in the treatment section. Patients with the possible diagnosis of Parkinson disease could also benefit from a trial of dopamine replacement therapy to aid with the diagnosis.

Another treatment option is deep brain stimulation and gel infusion to manage motor symptoms.

Rehabilitation therapists experienced with Parkinson disease can also benefit patients through all stages of the disease.

In the nonmotor features sections, the authors said botulinum toxin A could be useful to control drooling. They also said the management of depression should be tailored to the individual and their current therapy.

Dementia should also not exclude a diagnosis, even if it presents early.

Rapid eye movement sleep behavior disorder can predate the diagnosis.

New to the guidelines is a section on palliative care, which the authors suggest should be considered throughout all phases of the disease with medical assistance in dying discussed should the patient ask.

The guidelines were formed by experts from various health disciplines from across Canada.

"We hope this guideline will help physicians and other health care professionals improve the care of people with Parkinson disease," David Grimes, MD, a neurologist at The Ottawa Hospital and the University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, said in a statement.

Along with health care professionals, the guideline is also beneficial for policy-makers, charities, and funders, as well as patients and family members.

"A limitation to implementing the guideline is the lack of access to health care providers experienced in caring for people with Parkinson disease," Grimes said. "In addition to specialist physicians, we need more nurses, and speech, occupational and physical therapists with training in this area, as well as adequate palliative care for Parkinson patients."

While it draws on recommendations from other countries, including Scotland, the UK, the European Union, and the US, the guidelines are specifically designed for the Canadian health care system.