Parkinson’s Disease (PD) is a progressive neurodegenerative disorder that can result in motor and non-motor symptoms, following motor and non-motor basal ganglia circuitry degeneration. Motor features include rigidity and bradykinesia, as well as gait and balance difficulties, patients may also develop tremors. Pharmacological treatment is focused around replacing dopamine, and carbidopa/levodopa is the most used medication. In more advanced PD stages, motor symptoms become more challenging to manage. At 5 years, approximately ½ of patients will develop motor fluctuations (or ON/OFF phenomenon). This phenomenon is defined as fluctuating between improved symptoms (ON dopaminergic state) and worsened symptoms (OFF dopaminergic) state, multiple times during a 24-hour period. Complicating the management is the potential of developing dyskinesias, which are involuntary choreiform movements that occur because of a combination of medications and disease progression. Management of PD patients with motor fluctuations frequently requires multiple outpatient or telehealth visits to the movement disorders specialist (a neurologist with additional training in Parkinson’s disease and other similar disorders). Much of the approach is expert ‘empiricism’ as there is a search for a medication regimen to minimize motor fluctuations and reduce dyskinesia. Conventional medication management requires complicated regimens with multiple medications, requiring frequent dosing as often as every three or even every two hours. Delays as little as 15 or 30 minutes can adversely affect outcome and some patients are sensitive to micro-doses of the medications; so called brittle dyskinesia.
Parkinson’s disease (PD) patients are admitted to the hospital more frequently and have worse outcomes. Our Research Topic with Frontiers will focus on collecting all articles relevant to advancing our knowledge on hospitalization related issues and Parkinson’s disease.
People with PD are more likely to present to the emergency room and be hospitalized, and present an increased risk for adverse events compared to those without PD. One factor that may account for poorer outcomes is the importance of timing and frequency of antiparkinsonian medications not matching hospital policies. Commonly used medications may be contraindicated for patients with PD and may lead to morbidity and mortality. Adding to the challenges, many antiparkinsonian agents are not on in-patient formulary and potentially harmful alternatives may be recommended. The resulting missed, omitted, delayed, or substituted medications, and the administration of contraindicated medications have all been demonstrated to result in significant harm for admitted PD patients. Suboptimal medication management can lead to increases in confusion, falls, dysphagia, and length of stay, adding financial costs to the health system as well. Annually ~300,000 patients with PD are admitted to US hospitals with an associated cost of $7.19 billion. One PD advocacy group, The Parkinson’s Foundation has recommended better approaches for improving safety of PD patients in the hospital and has even developed an Aware in Care Kit.
Studies documenting safety gaps have been increasing in the literature, and more recently there have been publications demonstrating implementation and treatment strategies. This Research Topic will help advance the field, identify issues, and provide novel implementation and outcome approaches for PD hospitalization. We are interested in any articles on hospitalization in PD. We would encourage submission on tools and strategies used in single and multiple institutions to overcome gaps in care and to address safety. Articles on falls, fractures, infections and sepsis in PD are also welcome. Finally, we encourage articles on original science, hypothesis driven studies, outcomes research, review articles, meta analyses and case series relevant to PD hospitalization.
Parkinson’s Disease (PD) is a progressive neurodegenerative disorder that can result in motor and non-motor symptoms, following motor and non-motor basal ganglia circuitry degeneration. Motor features include rigidity and bradykinesia, as well as gait and balance difficulties, patients may also develop tremors. Pharmacological treatment is focused around replacing dopamine, and carbidopa/levodopa is the most used medication. In more advanced PD stages, motor symptoms become more challenging to manage. At 5 years, approximately ½ of patients will develop motor fluctuations (or ON/OFF phenomenon). This phenomenon is defined as fluctuating between improved symptoms (ON dopaminergic state) and worsened symptoms (OFF dopaminergic) state, multiple times during a 24-hour period. Complicating the management is the potential of developing dyskinesias, which are involuntary choreiform movements that occur because of a combination of medications and disease progression. Management of PD patients with motor fluctuations frequently requires multiple outpatient or telehealth visits to the movement disorders specialist (a neurologist with additional training in Parkinson’s disease and other similar disorders). Much of the approach is expert ‘empiricism’ as there is a search for a medication regimen to minimize motor fluctuations and reduce dyskinesia. Conventional medication management requires complicated regimens with multiple medications, requiring frequent dosing as often as every three or even every two hours. Delays as little as 15 or 30 minutes can adversely affect outcome and some patients are sensitive to micro-doses of the medications; so called brittle dyskinesia.
Parkinson’s disease (PD) patients are admitted to the hospital more frequently and have worse outcomes. Our Research Topic with Frontiers will focus on collecting all articles relevant to advancing our knowledge on hospitalization related issues and Parkinson’s disease.
People with PD are more likely to present to the emergency room and be hospitalized, and present an increased risk for adverse events compared to those without PD. One factor that may account for poorer outcomes is the importance of timing and frequency of antiparkinsonian medications not matching hospital policies. Commonly used medications may be contraindicated for patients with PD and may lead to morbidity and mortality. Adding to the challenges, many antiparkinsonian agents are not on in-patient formulary and potentially harmful alternatives may be recommended. The resulting missed, omitted, delayed, or substituted medications, and the administration of contraindicated medications have all been demonstrated to result in significant harm for admitted PD patients. Suboptimal medication management can lead to increases in confusion, falls, dysphagia, and length of stay, adding financial costs to the health system as well. Annually ~300,000 patients with PD are admitted to US hospitals with an associated cost of $7.19 billion. One PD advocacy group, The Parkinson’s Foundation has recommended better approaches for improving safety of PD patients in the hospital and has even developed an Aware in Care Kit.
Studies documenting safety gaps have been increasing in the literature, and more recently there have been publications demonstrating implementation and treatment strategies. This Research Topic will help advance the field, identify issues, and provide novel implementation and outcome approaches for PD hospitalization. We are interested in any articles on hospitalization in PD. We would encourage submission on tools and strategies used in single and multiple institutions to overcome gaps in care and to address safety. Articles on falls, fractures, infections and sepsis in PD are also welcome. Finally, we encourage articles on original science, hypothesis driven studies, outcomes research, review articles, meta analyses and case series relevant to PD hospitalization.