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Motor Profile and Drug Treatment of Nursing Home Residents with Parkinson's Disease

Authors

  • Nico J. Weerkamp MD,

    Corresponding author
    1. Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen Center for Evidence Based Practice, Nijmegen, the Netherlands
    • Department of Neurology, Atrium Medical Center, Heerlen, the Netherlands
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  • Sytse U. Zuidema MD, PhD,

    1. Radboud University Nijmegen Medical Center, Nijmegen Center for Evidence Based Practice, Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Nijmegen, the Netherlands
    2. Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, the Netherlands
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  • Gerrit Tissingh MD, PhD,

    1. Department of Neurology, Atrium Medical Center, Heerlen, the Netherlands
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  • Petra J. E. Poels MD, PhD,

    1. Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen Center for Evidence Based Practice, Nijmegen, the Netherlands
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  • Marten Munneke PhD,

    1. Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen Center for Evidence Based Practice, Nijmegen, the Netherlands
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  • Raymond T. C. M. Koopmans MD, PhD,

    1. Radboud University Nijmegen Medical Center, Nijmegen Center for Evidence Based Practice, Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Nijmegen, the Netherlands
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  • Bastiaan R. Bloem MD, PhD

    1. Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen Center for Evidence Based Practice, Nijmegen, the Netherlands
    2. Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Address correspondence to Dr. Nico J. Weerkamp, Parkinson Center Nijmegen (ParC), Radboud University Nijmegen, Medical Centre, Department of Neurology (HP 935), PO Box 9101, 6500 HB Nijmegen, the Netherlands. E-mail: nicoweerkamp@hotmail.com

Abstract

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.

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