Parkinson's disease: the follow-up consultation

Parkinson's disease (PD) is a complex condition and the requirements for managing both motor and non-motor symptoms evolve during the disease course. General neurologists following up people with PD should provide information, support and lifestyle advice, such as on exercise, with support from a multidisciplinary team. Levodopa remains the most effective and well-tolerated symptomatic treatment, but dose adjustments and adjunctive dopaminergic therapies can help with motor fluctuations. Clinicians should pay close attention to non-motor symptoms, including neuropsychiatric complications such as impulse-control disorders. The evidence base for managing non-motor symptoms is evolving. Involving the patient in the multidisciplinary follow-up of PD can help in managing symptoms unlikely to respond simply to dopamine replacement, including gait problems, falls and swallowing impairment. Clinicians should be open-minded about the diagnosis during follow-up and consider referring appropriate patients to specialists for device-aided therapies.