Objective: To ascertain the number of PD patients admitted to the acute hospital with neuropsychiatric symptoms requiring a review by PD specialist, including medicine reconciliation by a pharmacist.

Background: Parkinson’s is a progressive neurodegenerative condition that requires a complex medication regimen. Patients are often admitted to an acute hospital with behavioural problems apathy and depression. This could be precipitated by infections, electrolyte imbalance but often due to complex drug changes. Parkinson’s UK recommends that patients with PD should have an early specialist input.

Method: The numbers of PD patients admitted to the hospital with neuropsychiatric symptoms were identified from medical informatics between the period of Aug 2018 and July 2019. Data was then collected using a proforma and analysed using Microsoft excel.

Results: 40 patients were included, 55% (22/40) were males. The average age was 81 years. 63% (25/40) of patients had Parkinson’s disease dementia. The presenting symptoms inluded 80% (32/40) drowsy/delirium/confusion, 18% (7/40) hallucinations/aggressive behaviour/confusion, and 3% (1/40) agitated/violent. 30% (12/40) of patients had PD medication changes (within 3 months of the admission) prior to admission whilst 25% (10/40) had their PD medication changed during admission. 38% (15/40) of patients were seen by a PD specialist during admission and the average time for review was 4 days. 23% (9/40) patients were referred to the mental health team. 73% (29/40) of patients had medicine reconciliation prior to their discharge. The average time for which was 3 days.

Conclusion: Our data suggest that patients with neuropsychiatric symptoms should be reviewed promptly by a PD specialist on admission to prevent adverse events and provide safe care. As pharmacotherapy plays an important part in the neuropsychiatric symptoms, review by a specialist pharmacist with an interest in movement disorders may be helpful to reduce any delays.  Such pharmacists can work collaboratively with clinicians , PD Nurses and therapists as part of a multidisciplinary team to improve patient outcomes in the acute setting.

References: [1] National Institute for Health and Care Excellence. (2017). Parkinson’s disease in adults (NICE Guideline No.NG71). [2] The Pharmaceutical Journal, September 2017, Vol 299, 7905, online | DOI: 10.1211/PJ.2017.20203618

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