A service evaluation of the methods and efficacy of the South Manchester Parkinson’s service in diagnosing and managing Parkinson's Disease Dementia

Introduction

Parkinson’s disease dementia (PDD) is characterised by years of motor symptoms preceding cognitive decline, particularly presenting with declining executive function, attention, visuospatial abilities, and psychiatric symptoms. The motor symptoms of Parkinson’s disease are managed under a Parkinson’s and movement disorder service led by geriatricians or neurologists and should involve a multidisciplinary team. When dementia symptoms develop, patients are generally referred to a memory service led by old age psychiatrists with dementia support advisors and admiral nurses available.

Method

This service evaluation surveyed the MDT staff of a geriatrician-led Parkinson’s service to determine what is currently done and if the practices are as effective as a memory service in diagnosing and managing PDD. This was based on the Manchester Memory Assessment and Treatment Service Standard Operational Procedures and the standards from the Memory Services National Accreditation Programme of the Royal College of Psychiatrists. The qualitative data was reviewed using grounded theory and analysis of themes.

Results

It was found that the diagnostic side was strong with adequate cognitive evaluation, holistic review, and risk assessment performed. With respect to management, close follow up is performed and medications offered, however, improvement in signposting patients and caregivers to the appropriate supports is necessary. It is also recommended that a checklist for diagnosing and managing PDD is developed so that clinic staff are aware of the process and options available and to enable consistency between clinicians. Further investigation into whether a joint Parkinson’s and memory service MDT is feasible would be beneficial as it would allow for input from both teams while streamlining patient experience.

Conclusions

There is proficiency in diagnosing PDD and, with some adaptations, the Parkinson’s service would also be capable of managing majority of PDD patients. This would allow for more consistent and comprehensive care of those living with the condition.