Beyond Motor Symptoms: A Brain, Bone and Balance Clinic for Holistic Parkinson’s Care

Introduction: Parkinson’s disease (PD) is a complex, multisystem neurodegenerative disorder extending beyond its cardinal motor features. Progressive cognitive decline, osteoporosis, falls and fragility fractures substantially affect quality of life, independence, caregiver burden, morbidity and mortality. Within routine movement disorder clinics, comprehensive bone health assessment and the safe initiation and monitoring of cognitive treatment can be challenging and often delayed. We therefore established integrated, specialist nurse led Brain and Bone clinic pathways to support holistic Parkinson’s review and reduce missed opportunities for assessment, treatment and follow-up.

Method: We established parallel, protocol driven, specialist nurse led Brain and Bone clinic pathways alongside routine Parkinson’s clinics to complete focused assessment and monitoring under consultant oversight. Prospectively maintained registers from 14 January to 17 June 2026 were evaluated. The Brain clinic included cognitive review, blood screening, neuroimaging and ECG-based treatment monitoring. The Bone clinic included falls assessment, FRAX/NOGG categorization, relevant blood testing, treatment review and osteoporosis referral. Records were deduplicated, future appointments excluded, and attendance, clinical outcomes and treatment gaps assessed.

Results: The Brain clinic had 146 referrals and the Bone clinic 131, with 32 patients appearing in both pathways. In the Brain clinic, 45/47 appointments were completed (95.7%), representing 44 patients; 40/44 (90.9%) had cognitive testing documented. Potentially reversible blood abnormalities were identified in 15/44 (34.1%). Cardiac or conduction concerns relevant to cognitive treatment were identified in 10/44 (22.7%), contributing to acetylcholinesterase inhibitors being withheld, stopped or avoided in 9/44 (20.5%). Further investigation was arranged in 11/44 (25.0%). Among 57 Bone clinic reviews, 25/57 (43.9%) were high or very high fracture risk; 16/25 (64.0%) had no antiresorptive treatment documented. Vitamin D was below 50 nmol/L in 18/33 tested patients (54.5%).

Conclusions: Integrated, specialist nurse led Brain and Bone clinic pathways replaced intermittent, fragmented assessment with a structured and transparent system for tracking patients, investigations, treatment decisions and follow-up. The pathways identified reversible abnormalities, treatment safety concerns and unmet fracture prevention needs, supporting more consistent and holistic Parkinson’s care under consultant oversight.