Parkinson’s disease guidelines for pharmacists

Parkinson’s disease (PD) is a chronic, progressive, neurodegenerative disorder, characterized by the loss of dopaminergic neurons from the substantia nigra that subsequently results in the loss of control of voluntary movement over time.1-3 An estimated 100,000 Canadians have PD, and the incidence rate is between 10 to 20 per 100,000.4 Although younger people are diagnosed with PD, it is often thought of as a disease of the elderly, and indeed, the mean age of onset is 60 years, with 85% of individuals diagnosed with PD being older than 65 years.1,2,4 Over the course of 6 years, between 1993 and 1999, the prevalence of PD increased by 26% in Ontario, related in part to the increase in the population of those aged 65 years and over.5 A review by Health Canada in 1998 indicated that PD is associated with substantial direct ($87.8 million) and indirect ($470.3 million) costs.4 Although 70% of the cost is associated with long-term disability, life expectancy is also significantly shorter, with premature mortality accounting for 14.1% of the cost of the disease.2,4 Although the clinical presentation can vary from one individual to another, patients will typically present with complaints of asymmetrical (i.e., more on one side of the body than the other) tremors at rest in one extremity, whether it be the arm or the leg, and stiffness or rigidity and/or slowness in movement (bradykinesia). Over time, individuals will develop a shuffling gait and postural instability (see Table 1 for a complete list of the motor features of PD).1,2 Motor symptoms are thought to result when 60% to 70% of dopaminergic neurons have been lost.2 The loss of dopaminergic neurons results in a deficiency of dopamine, the primary neurotransmitter involved in the coordination of movement. Currently, the pharmacotherapy of PD is primarily related to replacing dopamine or mimicking the activity of dopamine. As the disease progresses, patients struggle to maintain the balance between the positive and negative effects of pharmacotherapy, often requiring multiple adjustments of drug doses and dosing regimens as well as the addition and removal of adjuvant drugs.1,3 Table 1 Clinical presentation of motor features of PD

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