Parkinson's Disease - Onehealth.ca

Parkinson’s Disease
Handout Package

Learning Objectives
1. State the prevalence and main causes of
Parkinson’s disease (PD).
2. Give examples of possible risk factors for PD.
3. Identify signs and symptoms that may indicate
PD.
4. Explain common therapies and treatments.
5. Describe the role of the health care worker in
caring for clients living with Parkinson’s disease.
Main Causes of Parkinsonism
in the Elderly
• Idiopathic Parkinson’s Disease
• Atypical Parkinsonian Syndromes
• Other Neurodegenerative Disorders
• Drug-Induced
• Cerebrovascular Disease
1

What is Parkinson’s s Disease
• Illness of the brain
• Nerve cells that normally control
the body’s muscles and motion
stop working properly
• Results in movements that are
difficult, unpredictable, or
impossible for a person to control
http://health.allrefer.com
History of Parkinson’s s Disease
James Parkinson
• First described in 1817 by Dr. James
Parkinson in An Essay on the Shaking
Palsy
• Mainly focused on tremor and gait
disturbance
2

Signs and Symptoms
Four Main Neurological Features:
1. Paucity of Movement
• Bradykinesia
• Hypokinesia
• Akinesia
2. Rigidity
• ‘Lead pipe’
• ‘Cogwheeling’
3. Tremor
4. Postural Instability and Gait Disturbance
Less Obvious Signs
• Clumsiness
• Changes to handwriting
• Voice differences
• Trouble making facial expressions
• Stiff muscles
• Loss of smell
• Sleep disorders
Autonomic Problems in PD
Gastrointestinal Dysfunction
Urinary Dysfunction
Sexual Problems
Impaired Thermoregulation
Postural Hypotension
3

Who Does PD Affect
• Usually strikes after the age of 65.
• 15% cases affect people younger than 50
years old.
• Mean age of onset remains in the seventh
decade of life.
• Affects all ethnic groups.
• Men are more likely to develop PD (but only
by a few percent).
Potential Risk Factors
Ageing
Genetics
Environment
Potential Protective Factors
• Smoking
• Coffee Drinking
• Tea Drinking
• Diet High in Anti-Oxidants
4

Co-Morbidities with PD
Dementia
• Subcorticofrontal
• Dementia with Lewy Bodies
Depression
• Affects 20% of clients with PD
Diagnosing PD
• CT Scan(Computed Tomography)
• MRI(Magnetic Resonance Imaging)
• Functional Neuroimaging
PET Scan(Positron Emission
Tomography)
SPECT Scan(Single Photon
Emission Computed Tomography)
PET Scan of Normal and Parkinson’s s Patient
NORMAL
PD
Red shows maximum accumulation of 18F-DOPA, followed by yellow, green, and blue
Reference: R. ChirakalResearch Group (2000)
5

Assessment of PD
• Health History
• Careful Observation
• Examination of:
1. Motor Function
2. Sensory Function
3. Autonomic Function
4. Activities of Daily Living
5. Mood
6. Cognitive Function
7. Social Support & Leisure
Activities
Clinical Rating Scales
• The Unified Parkinson’s Disease Rating
Scale (UPDRS)
• Parkinson’s Impact Scale (PIMS)
Drug Therapy
• Levodopa: “Gold Standard”; acts to
replace dopamine
• Dopamine Agonist Therapy:Mimics the
action of levodopa
• Anticholinergics: Help restore balance of
activity between the cholinergic and
dopaminergic system
6

Side Effects of
Levodopa Therapy
• Anxiety/Restlessness/Nervousness
• Sexual Dysfunction
• Nausea
• “On/Off”Fluctuations
• Dyskinesias
• Psychosis
The Neuropsychiatric
“Slippery Slope”
Reduced Deep Sleep
Day Time Sleepiness
Illusions
Vivid Dreams
Hallucinations
Delusions
Organic Confusional Psychosis
Surgical Intervention for PD
A. Lesioning
• Destroying small, well-defined areas of brain
tissue
B. Deep Brain Stimulation
• Main surgical treatment for PD
C. Fetal Cell Implantation
• Dopamine-producing cells are implanted into
the brain
D. Alternative Treatments
7

http://www.greenberg-art.com/.Infographics/qq1sgRobby.jpg
Role of the Healthcare Worker
1. Information and
education
2. Health maintenance
& promotion
3. Psychological
support
Role of the Healthcare Worker
1. Information and Education
Information about PD, treatment
options and its likely course
Details of prescribed medications
8

Role of the Healthcare Worker
2. Health Maintenance & Promotion
a) Sexual dysfunction
b) Orthostatic hypotension
c) Speech, swallowing, and drooling
difficulties
d) Oral hygiene
Role of the Healthcare Worker
2. Health Maintenance & Promotion
e) Constipation
f) Diet
g) Fall prevention
h) Exercise and activity
Role of the Healthcare Worker
3. Psychological Support
Monitor for signs &
symptoms of depression
Help develop positive
coping skills
Provide Parkinson’s
resources
9

Parkinson’s s Disease:
You can make a difference!
10

Parkinson’s Disease
Resource Package

Parkinson’s Disease Symptoms*
Common Symptoms Very Suggestive of PD
Tremor
Feet and gait
Loss of automatic movements
Slowness
Speech and writing
Other Common Symptoms That May Have Other Explanations
General
Gait, stance, and trunk
Hand function
Cognition
Saliva
Resting hand (tremor when the hand is
relaxed or at one’s side when walking)
Resting thumb or finger tremor (observed
when the hand is resting in the lap)
Chin or lip tremor (also a “resting”
tremor, meaning that it is seen when
sitting quietly but not talking or chewing)
Tremor of a leg when seated (also a
resting tremor)
Toes curling or turning up
Feet get stuck (“freezing”)
Shuffling gait
Less animated (facial appearance not
expressive, poker-faced, reduced blinking,
loss of expressive movements of the
hands)
Reduced arm swing
Slowed movements (takes longer to do
things)
Softer voice and less distinct speech
Smaller handwriting
Sense of overall weakness
Fatigue
Sense of restlessness, nervousness
Stiffness, neck or limbs
Mild imbalance
Stooped posture
Difficulty rising from seated position
Difficulty turning over in bed
Difficulty buttoning buttons, using eating
utensils
Difficulty brushing teeth
Slowed thinking
Drooling or sense of increased saliva
*Among those with early PD, the symptoms are often on only one side of the body or are asymmetric
(more on one side than the other). This asymmetry persists throughout life.

Non-Movement Symptoms of PD
Category
Autonomic nervous system
Gastrointestinal
Swallowing
Bladder
Genitalia
Blood Pressure
Psychiatric
Cognitive
Sleep
Sensory symptoms
Other symptoms
Symptom
Constipation
Bloating
Heartburn (reflux)
Impaired swallowing
Drooling
Hesitant urination
Sudden uncontrollable urges to void
(urgency)
Incontinence
Need to urinate frequently, including at
night (nocturia)
Frequent urinary tract infections
Male impotence
Orthostatic hypotension (low blood
pressure when standing; faintness, fatigue
or faints when standing, walking)
Depression
Anxiety
Inner restlessness (akathisia)
Panic attacks
Slowed thinking (bradyphrenia)
Dementia
Hallucinations, delusions
Insomnia
Daytime sleepiness
Acting out dreams (REM sleep behaviour
disorder)
Restless legs syndrome
Sciatica or other limb pain
Pain or discomfort in neck, trunk, or
abdomen
Numbness, tingling
Cramps (painful)
Sensation of heat or cold
Fatigue
Shortness of breath
Reference: Ahlskog et al. (2005). Parkinson’s Disease and Related Disorders. Springer Wien: New York.

MULTIDISCIPLINARY ASSESSMENT FORM
Clara Cross Rehabilitation Unit, St. Martin’s Hospital, Bath
Patient’s Name: ----------------------------------- DOB: ------------------------------------- Registration No: -----------------------------------
Address/Tel: ------------------------------------------------------------------------------------------- Date: --------------------------------------------------------
Medical assessment summary:
Diagnosis – Idiopathic PD with on/off fluctuations. Diagnosed 15 years ago. Pergolide added 2 years
ago. Mini mental 28/30, no hallucinations. Has intermittent Speech Therapy review.
Husband frail with poor memory.
Main problems:
1. Erratic drug response and compliance problems
2. Variable mobility – tending to freeze when ‘off’
3. Falls – exclude postural hypotension
4. High-risk fracture but not on osteoporosis medication
5. Back pain
6. Weight loss
Occupational therapy assessment summary:
1. Problems with bed mobility
2. Difficultly dressing
3. Difficultly with writing
4. Problems with food preparation
5. Needs education regarding PD and coping strategies for ‘off’ periods
6. Needs home visit to check armchair, bed and bathing - rails needed by toilet
7. Safety aspects re: falls
8. May need help at home – caregiver stress
Physiotherapy assessment summary:
1. Flexed posture with R-sided flexion
2. Neck flexion
3. Poor righting reactions and recent falls
4. Poor gait pattern with freezing
5. Back pain
6. Problems with bed mobility
Nursing assessment summary:
1. Difficulty hearing
2. Constipation
3. Urinary frequency and nocturia
4. Weight loss
5. Poor fluid intake
6. Difficulty eating and drinking due to neck flexion
7. Drug regime complicated – difficulty remembering drug times
Patient/caregiver priorities: ------------------------------------------------------------------------------------------------------------------------------------

Key problem areas:
1. Back pain through posture
2. Poor mobility with poor righting reactions and freezing
3. At risk for further falls and high-risk hip fracture
4. Constipation
5. Assessment required to improve functional abilities at home, including bed mobility
6. Nutrition
7. Medication compliance
8. Caregiver stress
Key goals:
1. Promote postural correction and optimize analgesia to ease back
pain
2. Promote safe mobility and teach strategies to reduce freezing
3. Reduce risk of fracture
4. Promote healthy bowel function
5. Facilitate independence in functional activities
6. Management plan to maintain/improve nutrition
7. Simplify medication and determine how to improve compliance
8. Reduce caregiver concerns and stress
Dates achieved:
-------------------------------------------------
-------------------------------------------------
-------------------------------------------------
-------------------------------------------------
-------------------------------------------------
-------------------------------------------------
-------------------------------------------------
-------------------------------------------------
Agreed plan:
• Physiotherapy and review of analgesia for back pain
• Exercises for posture, ease back pain
• Exclude postural hypotension
• Exclude other medical causes of weight loss and falls, check bloods, commence calcium and
vitamin D
• Monitor weight and observe feeding problems at meal times
• Advice re: fluid intake and review laxatives; likely to need dietitian
• Home visit and consider care package
• Education re: movement strategies
• Medication review and establish plan for compliance
To attend CCRU:
Days: Tuesday afternoons
Proposed length of attendance: 5-6 weeks
Key worker: Lesley Brooker Review date: June 12, 2007
Referral to other services: ---------------------------------------------------------------------------------------------------------------------------------
Copies to: GP DN Other
Example of integrated assessment form to facilitate interdisciplinary teamwork. Speech Therapy and Social
Work assessments not included as unfortunately they are not part of the core team at present.
Reference: Playfer, J.R. & Hindle, J.V. (Eds.). (2001). Interdisciplinary Rehabilitation: The Practice,
pg. 261-262. Parkinson’s Disease in the Older Patient. New York: Oxford University Press Inc.

A Paradigm for Disease Management in Parkinson’s Disease: MacMahon and Thomas Four-Stage Clinical
Management Scale [Playford, D. (Ed.). (2003). Neurological Rehabilitation of Parkinson’s Disease. London:
Martin, Dunitz, Taylor & Francis group].
Diagnosis
AIMS
• Development of
disease awareness
• Reduction in
symptoms and
distress
• Acceptance of
diagnosis
Assessment
(Medical and nursing)
• Accurate diagnosis
• Evaluate disability
• Assess support
available
• Estimate patient
understanding
MANAGEMENT
• Develop care plan
• Consider
multidisciplinary
referral:
Specialist nurse
Physiotherapy
OT
Social Worker
Dietician
Assistance and advice
with medication (not
always required)
Provide patient/carer
education
• Employment
• Driving
• Finances
OUTCOMES
• Effective symptom
control
• Reduced patient
distress
Maintenance
AIMS
• Morbidity Relief
• Maintenance of
function and self-care
• Promotion of normal
activities
Re-Assessment
• Avoid unnecessary
medical dependency
• Reduce symptoms
• Avoid side effects
• Alert for complications
(e.g., constipation,
postural hypotension)
MANAGEMENT
• Review care plan
• Provide patient/carer
education
• Assistance & advice
with medication
(single or dual drug
therapy)
• Consider
multidisciplinary
referral:
Speech (and
language)
therapy
Physiotherapy
OT
Social Worker
Dietician
Assess carer needs:
• Benefits
• Support
OUTCOMES
• Symptoms reduction
• Treatment compliance
• Maintenance &
promotion of normal
activities
Complex
AIMS
• Morbidity relief
• Maintenance of
function and self-care
despite advancing
disease
• Assistance and
adaptation of
environment to
promote daily living
activities
Re-Assessment
• Because of increasing
disability and
complexity
• Symptoms control
MANAGEMENT
• Increasingly complex
drug management
from disease process
& side effects
• Advice on practical
problems & prevention
of complications* (see
box below)
• Referral/liaison may
be required:
• As in stage 1+
• Psychiatrist/CPN
• Neuro-surgery
OUTCOMES
• Optimum symptom
control
• Minimization of
disability
• Compliance
Palliative
AIMS
• Relief of symptoms and
distress in patients and
carer’s
• Morbidity relief
• Maintenance of dignity
and remaining function
despite advancing
disease
• Avoidance of treatmentrelated
problems
Re-Assessment
• Symptom Control
MANAGEMENT
• Advice on administration
of medication
• Progressive
dopaminergic drug
withdrawal
• Analgesia
• Sedation
• Counsellingpsychology/psychiatry
• Prevention and
treatment of
complications:
Urinary
incontinence
Pressure sores
Motor fluctuations
OUTCOMES
• Absence of distress
• Maintenance of dignity
• Symptoms controlled
*Complications: Motor fluctuations, dyskinesia, depression, anxiety, self-care, feeding, dysphagia, mobility, falls, confusion,
hallucinations

United Parkinson's Disease Rating Scale (UPDRS)
A. MENTATION, BEHAVIOUR AND MOOD
1. Intellectual Impairment
0 = None.
1 = Mild. Consistent forgetfulness with partial recollection of events and no other
difficulties.
2 = Moderate memory loss, with disorientation and moderate difficulty handling complex
problems. Mild but definite impairment of function at home with need of occasional
prompting.
3 = Severe memory loss with disorientation for time and often to place. Severe
impairment in handling problems.
4 = Severe memory loss with orientation preserved to person only. Unable to make
judgements or solve problems. Requires much help with personal care. Cannot be left
alone at all.
2. Thought Disorder (Due to dementia or drug intoxication)
0 = None.
1 = Vivid dreaming.
2 = "Benign" hallucinations with insight retained.
3 = Occasional to frequent hallucinations or delusions; without insight; could interfere
with daily activities.
4 = Persistent hallucinations, delusions, or florrid psychosis. Not able to care for self.
3. Depression
1 = Periods of sadness or guilt greater than normal, never sustained for days or weeks.
2 = Sustained depression (1 week or more).
3 = Sustained depression with vegetative symptoms (insomnia, anorexia, weight loss,
loss of interest).
4 = Sustained depression with vegetative symptoms and suicidal thoughts or intent.
4. Motivation/Initiative
0 = Normal.
1 = Less assertive than usual; more passive.
2 = Loss of initiative or disinterest in elective (non-routine) activities.
3 = Loss of initiative or disinterest in day to day (routine) activities.
4 = Withdrawn, complete loss of motivation.

B. ACTIVITIES OF DAILY LIVING (for both "on" and "off")
5. Speech
0 = Normal.
1 = Mildly affected. No difficulty being understood.
2 = Moderately affected. Sometimes asked to repeat statements.
3 = Severely affected. Frequently asked to repeat statements.
4 = Unintelligible most of the time.
6. Salivation
0 = Normal.
1 = Slight but definite excess of saliva in mouth; may have nighttime drooling.
2 = Moderately excessive saliva; may have minimal drooling.
3 = Marked excess of saliva with some drooling.
4 = Marked drooling, requires constant tissue or handkerchief.
7. Swallowing
0 = Normal.
1 = Rare choking.
2 = Occasional choking.
3 = Requires soft food.
4 = Requires NG tube or gastrostomy feeding.
8. Handwriting
0 = Normal.
1 = Slightly slow or small.
2 = Moderately slow or small; all words are legible.
3 = Severely affected; not all words are legible.
4 = The majority of words are not legible.
9. Cutting food and handling utensils
0 = Normal.
1 = Somewhat slow and clumsy, but no help needed.
2 = Can cut most foods, although clumsy and slow; some help needed.
3 = Food must be cut by someone, but can still feed slowly.
4 = Needs to be fed.
10. Dressing
0 = Normal.
1 = Somewhat slow, but no help needed.
2 = Occasional assistance with buttoning, getting arms in sleeves.
3 = Considerable help required, but can do some things alone.
4 = Helpless.

11. Hygiene
0 = Normal.
1 = Somewhat slow, but no help needed.
2 = Needs help to shower or bathe; or very slow in hygienic care.
3 = Requires assistance for washing, brushing teeth, combing hair, going to bathroom.
4 = Foley catheter or other mechanical aids.
12. Turning in bed and adjusting bed clothes
0 = Normal.
1 = Somewhat slow and clumsy, but no help needed.
2 = Can turn alone or adjust sheets, but with great difficulty.
3 = Can initiate, but not turn or adjust sheets alone.
4 = Helpless.
13. Falling (unrelated to freezing)
0 = None.
1 = Rare falling.
2 = Occasionally falls, less than once per day.
3 = Falls an average of once daily.
4 = Falls more than once daily.
14. Freezing when walking
0 = None.
1 = Rare freezing when walking; may have start hesitation.
2 = Occasional freezing when walking.
3 = Frequent freezing. Occasionally falls from freezing.
4 = Frequent falls from freezing.
15. Walking
0 = Normal.
1 = Mild difficulty. May not swing arms or may tend to drag leg.
2 = Moderate difficulty, but requires little or no assistance.
3 = Severe disturbance of walking, requiring assistance.
4 = Cannot walk at all, even with assistance.
16. Tremor (Symptomatic complaint of tremor in any part of body.)
0 = Absent.
1 = Slight and infrequently present.
2 = Moderate; bothersome to patient.
3 = Severe; interferes with many activities.
4 = Marked; interferes with most activities.

17. Sensory complaints related to parkinsonism
0 = None.
1 = Occasionally has numbness, tingling, or mild aching.
2 = Frequently has numbness, tingling, or aching; not distressing.
3 = Frequent painful sensations.
4 = Excruciating pain.
C. MOTOR EXAMINATION
18. Speech
0 = Normal.
1 = Slight loss of expression, diction and/or volume.
2 = Monotone, slurred but understandable; moderately impaired.
3 = Marked impairment, difficult to understand.
4 = Unintelligible.
19. Facial Expression
0 = Normal.
1 = Minimal hypomimia, could be normal "Poker Face".
2 = Slight but definitely abnormal diminution of facial expression
3 = Moderate hypomimia; lips parted some of the time.
4 = Masked or fixed facies with severe or complete loss of facial expression; lips parted
1/4 inch or more.
20. Tremor at rest (head, upper and lower extremities)
0 = Absent.
1 = Slight and infrequently present.
2 = Mild in amplitude and persistent. Or moderate in amplitude, but only intermittently
present.
3 = Moderate in amplitude and present most of the time.
4 = Marked in amplitude and present most of the time.
21. Action or Postural Tremor of hands
0 = Absent.
1 = Slight; present with action.
2 = Moderate in amplitude, present with action.
3 = Moderate in amplitude with posture holding as well as action.
4 = Marked in amplitude; interferes with feeding.

22. Rigidity (Judged on passive movement of major joints with patient relaxed in sitting
position. Cogwheeling to be ignored.)
0 = Absent.
1 = Slight or detectable only when activated by mirror or other movements.
2 = Mild to moderate.
3 = Marked, but full range of motion easily achieved.
4 = Severe, range of motion achieved with difficulty.
23. Finger Taps (Patient taps thumb with index finger in rapid succession.)
0 = Normal.
1 = Mild slowing and/or reduction in amplitude.
2 = Moderately impaired. Definite and early fatiguing. May have occasional arrests in
movement.
3 = Severely impaired. Frequent hesitation in initiating movements or arrests in ongoing
movement.
4 = Can barely perform the task.
24. Hand Movements (Patient opens and closes hands in rapid succession.)
0 = Normal.
1 = Mild slowing and/or reduction in amplitude.
2 = Moderately impaired. Definite and early fatiguing. May have occasional arrests in
movement.
3 = Severely impaired. Frequent hesitation in initiating movements or arrests in ongoing
movement.
4 = Can barely perform the task.
25. Rapid Alternating Movements of Hands (Pronation-supination movements of
hands, vertically and horizontally, with as large an amplitude as possible, both hands
simultaneously.)
0 = Normal.
1 = Mild slowing and/or reduction in amplitude.
2 = Moderately impaired. Definite and early fatiguing. May have occasional arrests in
movement.
3 = Severely impaired. Frequent hesitation in initiating movements or arrests in ongoing
movement.
4 = Can barely perform the task.

26. Leg Agility (Patient taps heel on the ground in rapid succession picking up entire leg.
Amplitude should be at least 3 inches.)
0 = Normal.
1 = Mild slowing and/or reduction in amplitude.
2 = Moderately impaired. Definite and early fatiguing. May have occasional arrests in
movement.
3 = Severely impaired. Frequent hesitation in initiating movements or arrests in ongoing
movement.
4 = Can barely perform the task.
27. Arising from Chair (Patient attempts to rise from a straightbacked chair, with arms
folded across chest.)
0 = Normal.
1 = Slow; or may need more than one attempt.
2 = Pushes self up from arms of seat.
3 = Tends to fall back and may have to try more than one time, but can get up without
help.
4 = Unable to arise without help.
28. Posture
0 = Normal erect.
1 = Not quite erect, slightly stooped posture; could be normal for older person.
2 = Moderately stooped posture, definitely abnormal; can be slightly leaning to one side.
3 = Severely stooped posture with kyphosis; can be moderately leaning to one side.
4 = Marked flexion with extreme abnormality of posture.
29. Gait
0 = Normal.
1 = Walks slowly, may shuffle with short steps, but no festination (hastening steps) or
propulsion.
2 = Walks with difficulty, but requires little or no assistance; may have some festination,
short steps, or propulsion.
3 = Severe disturbance of gait, requiring assistance.
4 = Cannot walk at all, even with assistance.
30. Postural Stability (Response to sudden, strong posterior displacement produced by
pull on shoulders while patient erect with eyes open and feet slightly apart. Patient is
prepared.)
0 = Normal.
1 = Retropulsion, but recovers unaided.
2 = Absence of postural response; would fall if not caught by examiner.
3 = Very unstable, tends to lose balance spontaneously.
4 = Unable to stand without assistance.

31. Body Bradykinesia and Hypokinesia (Combining slowness, hesitancy, decreased
armswing, small amplitude, and poverty of movement in general.)
0 = None.
1 = Minimal slowness, giving movement a deliberate character; could be normal for some
persons. Possibly reduced amplitude.
2 = Mild degree of slowness and poverty of movement which is definitely abnormal.
Alternatively, some reduced amplitude.
3 = Moderate slowness, poverty or small amplitude of movement.
4 = Marked slowness, poverty or small amplitude of movement.
D. COMPLICATIONS OF THERAPY (In the past week)
i. DYSKINESIAS
32. Duration: What proportion of the waking day are dyskinesias present
(Historical information.)
0 = None
1 = 1-25% of day.
2 = 26-50% of day.
3 = 51-75% of day.
4 = 76-100% of day.
33. Disability: How disabling are the dyskinesias (Historical information; may be
modified by office examination.)
0 = Not disabling.
1 = Mildly disabling.
2 = Moderately disabling.
3 = Severely disabling.
4 = Completely disabled.
34. Painful Dyskinesias: How painful are the dyskinesias
0 = No painful dyskinesias.
1 = Slight.
2 = Moderate.
3 = Severe.
4 = Marked.
35. Presence of Early Morning Dystonia (Historical information.)
0 = No
1 = Yes

ii. CLINICAL FLUCTUATIONS
36. Are "off" periods predictable
0 = No
1 = Yes
37. Are "off" periods unpredictable
0 = No
1 = Yes
38. Do "off" periods come on suddenly, within a few seconds
0 = No
1 = Yes
39. What proportion of the waking day is the patient "off" on average
0 = None
1 = 1-25% of day.
2 = 26-50% of day.
3 = 51-75% of day.
4 = 76-100% of day.
iii. OTHER COMPLICATIONS
40. Does the patient have anorexia, nausea, or vomiting
0 = No
1 = Yes
41. Any sleep disturbances, such as insomnia or hypersomnolence
0 = No
1 = Yes
42. Does the patient have symptomatic orthostasis
(Record the patient's blood pressure, height and weight on the scoring form)
0 = No
1 = Yes
Reference: Dallas Area Parkinsonism Society (2004). Parkinson’s Progress: How it is
Measured. Accessed April 11, 2007,
http://www.fortunecity.com/meltingpot/farley/817/ameasure.html

PIMS PARKINSON’S IMPACT SCALE PIMS
NAME:
YEAR SYMPTOMS BEGAN:
DATE:
DATE OF BIRTH:
Please indicate by a number (0 – 4) what impact Parkinsonism has had on your life.
0= no change 1= slight 2= moderate 3= moderately severe 4= severe
Use the definitions below to help you measure impact.
Self: (Positive)
Self: (Negative)
Family Relationships:
Community Relationships:
Work:
Travel:
Leisure:
Safety:
Financial Security;
Sexuality:
Refers to how positive you feel about yourself (self-worth, happiness, optimism)
Refers how negative you feel about yourself (level of stress, anxiety or
depression)
Refers to your spouse, partner, children and relatives that you consider part of
your immediate family
Refers to your neighbours, friends, people you work with and those who provide
you with services (store clerk, doctor, pastor, etc.)
Refers to your job and/or the running of your home and your ability to support
yourself and your family
Refers to your ability to reach your destinations i.e.: work and/or social
Refers to your ability to continue enjoyable activities (hobbies, sports,
volunteering
Refers to your ability to do what you want without injuring yourself or others
(driving, being outdoors, in the kitchen, in the bathroom, etc.)
Refers to your ability to support yourself and your family and pay your medical
costs
Refers to your ability to maintain a satisfactory sexual relationship
If your symptoms are stable complete column 1
If your symptoms fluctuate complete columns 2a and 2b (best and worse)
Column 1 Column 2a (Best) Column 2b (Worst)
1. Self-positive
2. Self-negative
3. Family Relationships
4. Community Relationships
5. Work
6. Travel
7. Leisure
8. Safety
9. Financial Security
10. Sexuality
Parkinson’s Impact Scale (PMIS) Parkinsonism and Related Orders, 1996 Vol.2, No.2, pp 55-61
This scale has been developed with the support of
The Parkinson Foundation of Canada and the Canadian office of DuPont Pharma Inc.
4042 E

On-Line Parkinson’s Disease Information
Here is a list of online resources that may be helpful to your clients and their caregivers.
• Parkinson Society of Canada: http://www.parkinson.ca
• The Movement Disorder Virtual University: A website dedicated solely to
professional education in movement disorders and related conditions.
http://www.mdvu.org
• American Parkinson Disease Association: http://www.apdaparkinson.org
• Awakenings: http://www.parkinsonsdisease.com
• Michael J. Fox Foundation for Parkinson’s Research: http://www.michaeljfox.org
• National Institute of Neurological Disorders: http://www.ninds.nih.gov
• The National Parkinson Foundation: http://www.parkinson.org
• The Parkinson’s Disease Foundation: http://www.pdf.org
• Worldwide Education and Awareness for Movement Disorders:
http://www.wemove.org
• Parkinson’s Disease & The Art of Moving: The John Argue Method:
www.parkinsonsexercise.com/
• Parkinson Exercises of Marj Hansen:
www.fortunecity.com/meltingpot/farley/817/assession.html
• Parkinsonploy: www.parkinsonploy.com/html/en/resources/exercise-role.html