Do's, Don'ts, and Dopa: A Primer on Palliative Care in Parkinson's Disease (TH152)

Outcomes 1. To identify the key features of Parkinson's disease (PD) at the time of diagnosis and in early-stage disease 2. To describe the progression of symptoms and disease experience in moderate- to advanced-stage PD 3. To recognize the unique aspects and challenges of care at the end of life in PD Parkinson's disease (PD) is a common chronic, progressive neurodegenerative condition, listed by the Centers for Disease Control and Prevention as the 14th leading cause of death in the United States. There are currently no curative or disease-modifying therapies, so the mainstay of treatment is palliation of distressing symptoms. Over time, the hallmark motor symptoms worsen and become harder to treat, and nonmotor symptoms such as pain, constipation, and sialorrhea accumulate to further impair quality of life. Several independent studies have found that the symptom burden for patients with advanced PD is comparable to that experienced by patients with advanced cancer. Neuropsychiatric symptoms such as depression, impulse control disorders, psychosis, and cognitive impairment can be particularly distressing for patients and caregivers, as they may lead to major shifts in personal identity or roles within a relationship while increasing caregiving needs. Over time, patients with PD need increasingly complex medication regimens and may undergo surgical interventions such as deep brain stimulation. Therefore, palliative care providers often face the daunting task of managing these treatments, potential drug-drug interactions, and side effects in later disease stages and at the end of life while also providing intensive psychosocial and spiritual support. Given that dysphagia, dementia, and recurrent hospitalizations are common in advanced disease, advance care planning is critical and should occur early. Expert management of PD requires an interdisciplinary approach with a strong understanding of the underlying physiology, related pharmacology, and unique challenges for patients and caregivers living with this progressive neurodegenerative disease. Our session will progress through an exemplary patient case, from the time of diagnosis to the end of life. For each disease stage, our panel will summarize the medical, psychosocial, and spiritual components of management. We will conclude by summarizing the importance of skilled and interdisciplinary palliative care in the management of PD and taking questions.