Abstract
INTRODUCTION The Cardiff and Vale Parkinson's service is an integrated, multidisciplinary service providing support and input from initial diagnosis to end of life care, undertaking comprehensive, specialist assessments for patients. Traditional care models have focused on physical disease, with neuropsychiatric symptoms often requiring input from other (e.g. Mental Health) teams to manage even the less- complex symptoms of dementia. Our service aims to manage both physical and neuropsychiatric symptoms via non-pharmacologic and pharmacologic means.
METHODOLOGY From our total clinic population, a cohort of 425 people with established idiopathic Parkinson's who were subsequently diagnosed with Parkinson's dementia (PDD)in the decade 2013-2023 was identified. From this cohort we assessed a sample of 50 people (56% male, 44% female, mean age 75 years) for advanced demographics, disease duration, presenting dementia features and the diagnostic method.
RESULT From our database of 3668 clinic patients, 425 people with PDD were identified. 76% people with PDD (n=325) were prescribed acetylcholinesterase inhibitors. Subgroup analysis (n=50) demonstrated that cognition was assessed by a range of tests: ACE (60%), MoCA (22%), clinical opinion alone (16%) or RUDAS (2%). Neuroimaging was undertaken in 50% patients, predominantly to exclude other pathologies. The mean time from PD diagnosis to PDD diagnosis was 6.5 years, and survival from PDD was a mean of 3 years.
CONCLUSION When cognitive impairment or dementia develops in Parkinson's, care provision by the same team ensures continuity for People with Parkinson's (PwP) and their families or carers. PwP live for an average of 3 years post-dementia diagnosis and so joint training in both 'traditional' Parkinson's care and diagnosis and management of dementia allows for a truly holistic approach in managing the complex interplay between motor, non-motor and neuropsychiatric features that manifests later in this condition.