Introduction

Parkinson’s disease (PD) is a progressive neurological disorder associated with a loss of dopamine-generating cells in the brain that results in a complex array of symptoms, but is primarily associated with progressive loss of motor control. 

Parkinson’s disease is a major cause of disability among the elderly. Parkinson’s disease is currently the second most common neurological degenerative disorder after Alzheimer’s disease, affecting an estimated 1.5% of the US population over the age of 65, and more than 4 million individuals over the age of 50 worldwide, a number expected to double by the year 2030. Parkinson’s disease is more common in males and is twice as likely to affect whites and Hispanics as blacks and Asians. Individuals under 40 years of age may develop PD, this is called young-onset Parkinson's disease. Healthcare professionals are encourage to consider PD in every patient, regardless the age, presenting with motor and non motor symptoms of the disease. 

Parkinson’s disease is difficult to diagnose. Common diagnostic criteria generally require the initiation of antiparkinsonian medication before the diagnosis can be confirmed. This ambiguity can be confusing for primary care physicians, especially when the disease presents without the characteristic tremor. Parkinson’s disease without tremor is commonly mistaken for a musculoskeletal condition (frozen shoulderi or osteoarthritis leading to gait problems) and patients have been recommended for surgery without realizing that the underlying condition is neurological.

Medications for PD are effective, but determining the optimal dose is difficult. Further, there are 10 classes of commonly used antiparkinsonian medications making treatment a complex matter. In addition, symptoms such as constipation, cognitive impairment, sleep disturbance, and sexual dysfunction can have quite an impact on patient quality of life but may be overlooked by a nonspecialist who focuses on the motor symptoms.

Despite these challenges, PD is often manageable in primary care. This allows patients— either early in their disease when therapies are simple or late in their disease when patients and caregivers may opt for palliative care—to be managed in their community.