Physician Focus on Parkinson's
Issue 19 (Fall 2011) - Quarterly CME Newsletter on Parkinson's Disease
To receive CME credit for this activity, please complete the post-test and evaluation below. You must score 70% or better on the post-test in order to receive your CME certificate. Once submitted, a certificate will be issued within two weeks to the email address provided.
Click here to view Issue 19 online.
To view the AMA Physician's Guide to Assessing and Counseling Older Drivers, click here. To view the Parkinson's Disease Foundation's guide regarding driving and PD, click here.
If you have any questions, please contact intellyst® Medical Education at 720-748-8800.
Target Audience
Neurologists, NPs and PAs specializing in neurology, and other healthcare professionals who treat patients with Parkinson's disease.
Statement of Need
Parkinson’s disease (PD) has traditionally been classified as a movement disorder as its cardinal symptoms include tremor, rigidity, slowed movement and postural instability. However the importance of psychiatric and other non-motor symptoms (NMS) in the detection of disease and their impact on quality of life has forced clinicians to envision PD as a complex disorder that requires careful and thorough evaluation throughout their patients’ lifetimes. It is necessary to understand that NMS often present early in disease, and it is the worsening of these symptoms that may spur individuals to seek medical attention. With disease progression, these symptoms invariably become more debilitating and are a clinical challenge to control over the long run. In addition to dopaminergic therapy, patients may require additional pharmacologic agents to control symptoms, adding to their burden of cost and complexity as they seek to sustain quality of life.
Learning Objectives
At the conclusion of this activity, participants should be able to:- Recognize the importance of identifying depression, anxiety and impulse control disorders in the PD patient
- Name treatment options for PD patients with depression, anxiety or impulse control disorders
- Describe challenges for the PD patient and caregiver with regard to driving
Lawrence Elmer, MD (Case Study Contributor)
Gary VanderArk, MD (Independent Reviewer)
Richard Robinson (Medical Writer)
Accreditation Statement
intellyst® Medical Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit Designation
intellyst® Medical Education designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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| The diagnosis of an anxiety disorder in Parkinsons disease is appropriate when the patient: |
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| Which of these would lead you to rule out a diagnosis of anxiety disorder in the context of PD? |
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A PD patient reports sleep disturbance, loss of interest in sex, and diminished desire to participate in social activities, and displays a flat affect during the interview. The patients appetite is normal, he has maintained his weight for the past 6 months, and reports no suicidal ideation. Is this patient likely to be depressed?
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| Based on the evidence, which of these is NOT likely to be the best choice for initial treatment of depression for a PD patient? |
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| According to results from Menza et al., 8 weeks of treatment with _____ was superior to placebo, while 8 weeks of treatment with _____ was not. |
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| In the DOMINION study of impulse control disorders in PD patients, increased risk of ICD was associated with: |
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| In the DOMINION study, the overall prevalence of at least one ICD in the PD population was: |
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| The spouse of a patient reports that the patient has begun to gamble online for several hours per day, and may be using up their retirement savings. The patient is currently taking levodopa, a dopamine agonist, a COMT inhibitor, and an antidepressant. Initial treatment for this patient should include consideration of which of these? |
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| Which skills necessary for driving are likely to be impaired in PD? |
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| Rate your level of agreement with the following statement, with 1 indicating you disagree completely and 5 indicating you agree completely: |
| Once a person develops Parkinsons disease, the best assumption is that they are not safe to drive, unless they demonstrate otherwise. | |
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Please evaluate the activity objectives by selecting how well each has been met, with 5 indicating excellent and 1 indicating poor.
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| Recognize the importance of identifying depression, anxiety and impulse control disorders in the PD patient. | |
| Name treatment options for PD patients with depression, anxiety or impulse control disorders. | |
| Describe challenges for the PD patient and caregiver with regard to driving. | |
Please evaluate the effectiveness of the case study by Dr. Lawrence Elmer, in both areas listed below, with 5 indicating excellent and 1 indicating poor.
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| Usefulness of information presented. | |
| Objectivity/fair balance of content. | |
| Do you intend to make changes or apply this information to your practice as a result of this activity? |
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Please explain your response to the above question:
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| Commercial bias is defined as information presented in a certified educational activity that attempts to sway participant opinion in favor of a commercial product/device, furthering a commercial entity's business initiatives. Using this definition, please answer the following 2 questions: |
| The therapeutic recommendations presented in this activity did not encourage inappropriate or excessive use of products/devices. |
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If disagree, please describe.
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| The information presented in this activity did not serve to advance a proprietary interest of any commercial entity. |
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If disagree, please describe.
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NEW!!! We will be posting an Ask the Expert" section of subsequent issues of Physician Focus on Parkinsons. Please take this unique opportunity to ask a question of our editorial board (Lawrence Elmer, MD; Robert Hauser, MD; Lauren Seeberger, MD; Andrew Siderowf, MD). Your question and the expert panel response may be published in the next issue.
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