Table 2.

Management considerations for a hospitalized Parkinson’s disease patient.

Hospitalization issue/prevention	Management consideration
PD patient admitted to the hospital	Obtain early neurological consultation
Early ascertainment of a medicine list	Obtain early information on prescription medications as well as the length of time taking over-the-counter medication which could impact cognition and motor symptoms (e.g. diphenhydramine).
Rehabilitation and aspiration prevention	Mobilize the patient as much as possible
Understand dosing intervals	Pay as much attention to the dosing interval as to actual doses of both prescription and over-the-counter medications
Determine if patients can self-medicate	If the hospital allows patients to take their own medications, it may be required that the medication doses and times match the medicine bottle (this may not be the case for many PD cases)
Mental status change	Consider temporarily simplifying the medication regimen if a mental status change is present (e.g. carbidopa/levodopa only)
Prevention of aspiration	Minimize aspiration risk (consider swallow therapy chin-down swallow, EMST, education)
Patients who cannot take meds P.O.	Consider nasogastric tubes, apomorphine, and dopamine patches when patients can’t take medicines by mouth
Nutrition and swallowing assessment	Consider PEG tubes earlier, especially if there is a potential for improvement in quality of life
Confusion and encephalopathy	Aggressively screen for and treat genitourinary and other infections
Skin changes	Treat decubital sores aggressively
Drugs that may worsen PD	Avoid dopamine-blocking drugs (including metoclopramide and many common anti-nausea drugs such as prochlorperazine) with the exceptions of quetiapine and clozapine which are useful for psychosis
Fall prevention	Use fall prevention, bisphosphonates, Vitamin D, physical therapy and assistive devices in those at risk
Assess bone strength	Have a low threshold for bone density scans for those at risk of falling
Orders that caution abrupt drug holiday	Do not stop dopamine drugs abruptly (stopping may result in neuroleptic malignant syndrome (NMS))
Dizziness, faintness, syncope	For orthostatic hypotension consider a cardiac workup, a tilt table test, reducing/discontinuing anti-hypertensives that raise blood pressure, reducing dopaminergics, hydration, stockings, and in some cases medications
Avoid pulmonary emboli	Use prophylactic subcutaneous heparin to avoid deep venous thrombosis
Screen for non-motor features	Treat anxiety, depression and non-motor features including cognitive issues (medically and behaviorally), make sure medications are taken on time; and if wearing off non-motor effects are seen, consider moving dosage intervals closer
Patient/family pre-education	Educate patients and families prior to elective procedures and hospitalization
Encourage patient advocacy	Encourage family members to request neurological and other interdisciplinary consultations when in the hospital setting