Parkinson’s disease - ED considerations (Frailty pathway)
Overview
Parkinson’s disease (PD) is a common progressive neurodegenerative condition in older people combining motor and important non‑motor problems. In the emergency department (ED) the priorities are to prevent avoidable deterioration, maintain functional status and treat reversible precipitants.
The single highest‑value action is to continue the patient’s usual dopaminergic therapy on time. Other practical priorities are early assessment of swallow, avoidance of dopamine‑blocking drugs, and timely involvement of specialist and allied‑health teams (PD nurse, neurology, SALT, physiotherapy). (NICE NG71; RCEM)
Recognising PD in the ED - salient features
Motor (core)
- Bradykinesia/hypokinesia (required for diagnosis).
- Rest tremor (classically 4-6 Hz, often unilateral at onset).
- Rigidity (often cogwheel quality).
- Shuffling gait, reduced arm swing and freezing episodes.
- Later postural instability.
- Hypomimia, micrographia and soft/monotonous speech are common.
Non‑motor
- Cognitive impairment progressing to dementia in some patients.
- Depression and anxiety.
- Hallucinations and psychosis (often medication‑related).
- Autonomic features including orthostatic hypotension, constipation and urinary symptoms.