A systematic review has been undertaken looking at prognostic predictors for end of life palliatiev care for Parkinson’s disease and related disorders, supported by the International Working Group on PD and Palliative Care and the Parkinson’s Foundation. 42 studies were reviewed and four areas were seen to be improtant:
- Demographic and clinical markers – age, sex, body mass, comorbid illnesses
- Motor dysfunction and global disability
- Falls and infections
- Non-motor symptoms.
Based on these findings the Group suggest that patients showing these areas may be considered to be near to end of life:
- Advanced disease – with either of these criteria
Nutritional impairment – reduced intake, BMI below 18, 10% weight loss over 6
months, refusal of artificial feeding
Life threatening complications – aspiration pneumonia / falls / fractures / sepsis
Motor symptoms poorly repsonsive to dopaminergic medication or unable to tolerate
medication
- Rapid / accelerating motor dysfunction or non-motor dysfunction
- Advanced dementia
Comments:
These suggested indicators are similar to those suggested in other studies, which have often been based on consensus rather than systematic review. They will be useful for clinicians to help all involved, patients, families and professionals, to become more aware of end of life and make the suitable changes to care and preparations for the care of the person as the end of life approaches.
References:
Akbar U, McQueen RB, Bemski J et al. Prognostic predictors relevant to end-of-life palliative care in Parkinson’s disease and related disorders: a systematic review. J Neurol Neurosurg Psychiatry 2021; 92: 629-636.