Mark your calendar to attend a comprehensive 2 day course presented by the University of Toledo and University at Buffalo.

Our knowledge of the pathophysiology of PD continues to expand at a rapid rate – research is underway to help clinicians recognize patterns of early, non-motor symptoms as a possible prodrome that might give way to future neuroprotective therapies which, in turn, may decrease disease morbidity and reduce health care costs. Movement Disorder specialists recognize that PD is a heterogeneous disease, differing in presentation, progression, and response to treatment. This creates challenges for the health care provider trying to optimize management of the motor and non-motor symptoms of PD.

Treatment options include pharmacological, surgical, and non-pharmacological approaches. The involvement of an interdisciplinary team in the assessment and management of people with PD is vital as the problems people with PD face become more diverse and challenging. In addition, the identification and successful management of cognitive changes in PD may determine whether or not the person with PD can remain at home or will require nursing home placement.

This conference addresses all these challenges and provides a comprehensive review of PD, from issues of early diagnosis to end-of-life care. The target audience includes advanced practice nurses, physician assistants, as well as interested physicians and other health care professionals. The faculty includes leaders in Parkinson’s care from around the nation. We invite all health care providers involved in the care of people with PD to join us for this seminal educational event.

Following completion of this conference, learners will identify issues associated with early PD diagnosis and management through to end-of-life care. They will be able to describe and clinically determine the stages of PD progression, identifying pharmacological, non-pharmacological, and surgical treatment options for both motor and non-motor complications.

The learners will also be able to list and implement interdisciplinary strategies in the care of PD patients and their caregivers. Finally, the learners will distinguish and recognize issues related to common complications in PD, especially those involving disease progression and complications of PD therapy, and identify and treat medically related challenges to maximize quality of life in PD.

The University of Toledo is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The University of Toledo designates this live activity for a maximum of 18.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AAPA accepts certificates of participation for educational activities certified for Category I credit from AOACCME, Prescribed credit from AAFP, and AMA PRA Category 1 Credit from organizations accredited by ACCME or a recognized state medical society. Physician assistants may receive a maximum of 18.25 hours of Category I credit for completing this program.

This activity has been submitted to the New York State Nurses Association for approval to award contact hours. The New York State Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

University of Toledo College of Pharmacy and Pharmaceutical Sciences is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. The Care of Parkinson’s Disease and Related Disorders program will provide up to 16.25 contact hours (1.625 CEUs) of knowledge-based continuing education credit from the University of Toledo approved programming. To receive a statement of credit, participants must verify their attendance at the program and complete evaluations and post-test questions. ACPE statements of credit will be mailed to participants approximately 4 weeks following the program.

This activity has been submitted to the New York Physical Therapy Association for approval of 16.75 continuing education credits. The New York Physical Therapy Association is an approved sponsor of continuing education by the New York State Education Department, Office of the Professions.

This activity is pending approval from the National Association of Social Workers.

Occupational Therapists/Certified Occupational Therapy Assistants can receive credit for contact hours for this course. Documentation indicating attendance to this course may need to be submitted when applying for re-licensing.

Register for this event.

Posted: 4/21/2011 5:11:27 AM by Cathy Whitlock

By: Andrew Siderowf, MD
University of Pennsylvania Parkinson's Disease and Movement Disorders Center

The term “impulse control disorders” (ICDs) describes a group of behaviors that may affect Parkinson’s patients, particularly those patients receiving dopaminergic treatment.  The main ICDs are:  excessive or pathological gambling, binge eating, compulsive shopping and compulsive sexual behavior.  Patients may have more subtle ICDs including project-orientedness, which is compulsively working on projects (like home improvements) without necessarily finishing them, or compulsive internet searching.  These behaviors, which are sometimes called “hobbyism”, are less socially inappropriate, and may be mistaken for healthy industriousness by clinicians that are not familiar with ICDs.

Other behaviors that are related to ICDs include purposelessly taking apart gadgets like clocks or electronics, called “punding”, and aimlessly walking or driving around for long periods of time.  This latter behavior is sometimes termed “walkabout”.

ICDs were initially described in PD patients in 2003, but probably were under-recognized for a number of years prior to that time.  Treatment with dopaminergic medications is the main risk factor for ICDs.  In particular, treatment with dopamine agonists is a major risk factor for ICDs.  Approximately 15% of patients treated with a dopamine agonist could have an ICD problem, compared to about 5% who are not receiving a dopamine agonist.  All medications in this class – pergolide (now off market due to cardiac side effects), pramipexole and ropinirole – are about equally associated with ICDs.  Recently diagnosed PD patients who are not on any medication have a risk for ICDs that appears to be similar to the general population.  Patients receiving other treatments for PD including levodopa or deep brain stimulation have a somewhat increased risk, but not to the same extent as patients treated with dopamine agonists. 

It is important to note that dopamine agonist medications can still be used safely in PD patients and have been demonstrated to be effective in reducing motor symptoms like tremor, rigidity and bradykinesia.  ICD behaviors resolve almost immediately once the relevant medication has been discontinued.

Other risk factors for ICDs include younger age, smoking and a family history of gambling problems.  Neuropsychological factors associated with ICDs include greater depression and axiety, obsessive-compulsive symptoms, higher novelty seeking and impulsivity.  More severe motor impairment has also been linked to greater risk for ICDs.  In spite of these associations, one of the hallmarks of ICDs is that they often occur in people who have shown no inclination to impulsive or socially inappropriate behavior in the past, and reflect an unmistakable change from a patient’s normal personality.

ICDs can have substantial financial and social consequences.  Many patients act on their impulses in secret because they are aware that the behaviors are socially inappropriate.  Patients are also unlikely to connect behaviors to their medical treatment unless they have been made aware of the association. For these two reasons, patients are unlikely to spontaneously report their ICD behaviors to their doctor.  It is essential that clinicians are pro-active in educating PD patients about ICDs, particularly those who are about to begin treatment with dopamine agonist medications.  It is also essential to probe specifically for the presence of ICDs at follow-up clinic visits.  Patients should also report any unusual behaviors or urges to their physicians, because they could be linked to treatment.  By taking these relatively simple steps, the vast majority of potentially damaging ICDs can be avoided.

Andrew Siderowf, MD, is the Medical Director of the NPF Center of Excellence at the University of Pennsylvania Parkinson's Disease and Movement Disorders Center.

Posted: 4/4/2011 6:00:00 AM by Cathy Whitlock

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Each month, we will feature a new column with the latest updates and information for how to provide optimal care to your patients with Parkinson's disease.

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