Parkinsonism and Parkinson’s disease progress, that is, the situation of the patients deteriorate, in relation to the quality of health care and to general health of the patient. A study of 328 patients confirmed this hypothesis in Veteran Affairs units in Nevada and California. A coordinated patient-centered management program was applied to half of the patients, and the others were controls. Evaluations at 6, 12, 18 months with quality of care measurements showed the coordinated care to be superior.

Connor et al. Neurology 2019, 92:e1831-e1842

This result confirms the clinical observation that when patients with parkinsonism and Parkinson’s disease lead a dedicated life, directing some of their time and energy to health care, there is improvement in various aspects of the disease, including medication side-effects, motor and non-motor complications.

Another study confirmed another clinical observation, that is, general health is directly related to progress and prognosis of parkinsonism and Parkinson’s disease. This was observed in 2 separate evaluations at autopsy of 1430 people originated in 3 separate study populations in the USA.

Buchman et al 2019, 92:e1821-e1830

The burden of Alzheimer’s disease pathology, of Parkinson’s pathology and of cerebrovascular disease was shown to be related to the rate of progress of parkinsonism in people with and without the diagnosis of Parkinson’s disease.  In summary, the mixed burden of cerebral pathology determines the rate of progress of parkinsonism in the elderly.

Palliative care focuses more on multimodal patient-oriented quality of life than on the diagnosis and therapy of one specific disease. It is related with advance care planning, a highly individualized subject, dependente of health literacy, interfamily dynamics and trust in the medical world.

Tuck and Tarolli. Neurology 2019, 92:1039-1040

Lum et al. Neurology 2019, 92:e2571-e2579

This approach is obviously what is best for patients with Parkinson’s disease and parkinsonism, but in the USA and in Brazil these procedures may not be reimbursed by the health providers.

Dr Paulo Bittencourt

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