Multidisciplinary Care for Parkinson’s Disease

by Norika Malhado-Chang, MD, Co-director of Parkinson’s Disease Multidisciplinary Clinic

and Director of Medical Student Education in Neurology, at UC Davis

One important aspect of Parkinson’s Disease (PD) that sets it apart from other conditions is its complexity.  Twenty years ago, PD was purely considered a “movement disorder,” resulting in symptoms affecting mobility, such as stiffness, slowness, and difficulty walking. Now, we know that only scratches the surface! In addition to motor symptoms, PD

involves an array of non-motor symptoms like constipation, sleep disturbance, depression, anxiety, cognitive impairment, and trouble with speech and swallowing to name a few. Therefore, it really makes sense to approach this from a multidisciplinary care perspective.

What does multidisciplinary care entail?  It is a model of healthcare that harnesses the expertise of a variety of specialists to provide truly comprehensive care for the whole person. Fifty years ago, a patient would have all their medical issues managed by their primary care physician. As the medical field has evolved, we have subspecialists trained in a variety of diseases to provide expert care in a certain area. Within the realm of Parkinson’s, we should capitalize on the talents and skills of others in the healthcare field by employing a “team” approach.  If I were to recruit an all-star team for PD, it would include:

1.  Parkinson’s Neurologist - may include a Movement Disorders Fellow and a Nurse Practitioner

2. Neuro Physical Therapist - unlike most PT’s who are orthopedics-focused, Neuro PT’s have special training in neurologic conditions, like PD. They may even have certification in LSVT BIG or PWR-Parkinson’s Wellness Recovery

3. Speech/Swallow Therapist - some specialize in PD, with certification in LSVT LOUD to help with both voice and swallowing

4. Psychiatrist or Geri-psychiatrist - doctors who are experts in depression, anxiety, and psychosis

5. Psychologist or counselor - both for the person with PD and the spouse

6. Social Worker - an MSW provides valuable information about community resources, caregiver assistance, medication financial assistance programs, etc.

7. Occupational therapist - OT’s help with hand & finger dexterity, specialized utensils & assistive devices for getting around

8. Personal Trainer

9.  Gastroenterologist and/or urologist - constipation and bladder dysfunction can become challenging and require a specialized approach

10. Dietician or Nutritionist - maintaining proper nutrition while optimizing the effect of one’s medications can be a tough balancing act, and nutritionists can be quite helpful in this regard

11. Palliative care specialist

12. Financial planner

This may look like a fantasy sports team line-up, but this is the future of Parkinson’s care. The days when you saw a neurologist alone will be gone, and the “clinic of the future” will have all these specialists in one place to help you from all different angles.  For the time being, getting all these specialists in the same place, at the same time, is a challenge (but we’re working on it!).

So, for now, each person should assume the role of Team Manager and look to recruit these specialists to work in their corner.  With a condition as complex as Parkinson’s, enlisting the help of professionals across this spectrum ensures a holistic and comprehensive approach that, in all likelihood, might slow the complications of PD or even slow progression of the disease.  This, in turn, will help you stay proactive and live your best life with Parkinson’s. (Parkinson Path, 2019)