[Medical management and social status of elderly Parkinson patients]

Seventy-four in- and out-patients (mean age 71.9 years) with Parkinsonian syndromes (summarized as "PS": idiopathic Parkinson's disease, vascular pseudo Parkinsonian syndrome (VPS), and Parkinson-dementia (PDK)) were prospectively evaluated as to present clinical state according to usual rating scales, as to clinical syndrome and physician's diagnosis and treatment at the start of the illness, and as to current medical and social care. 54% of the patients had history and findings of tremor, 14% had visual hallucinations, 19% had depression. Ratings on part II of the "Unified Parkinson's Disease Rating Scale" (UPDRS) describing "activities of daily living" correlated highly with the ratings of part III ("motor evaluation") and with another activity of daily living scale according to Schwab and England. The mean difference between time of diagnosis and start symptoms (the "diagnostic delay") was nearly 21 months. Initial symptoms did not show an impact on this difference. 68% of patients were presently treated by general physicians and were significantly older than those treated by neurologists. 59% were in-patients during the study and were more likely to carry a diagnosis of VPS or PDK. 75% of those patients who were ever in-patients during their illness had the disease for up to six years before they were first hospitalized. 77% of the patients had drug treatment; 88% of these took L-Dopa preparations. 23% of patients with drug treatment had L-Dopa-associated motor complications. 15% of patients lived alone, 66% with their family, and 19% in a nursing home. 24% of patients had assistance in their household by a professional caretaker. 16% of patients retired early from work. The long-term care of older Parkinsonian patients is a task for general medicine based on neurogeriatric expertise.