MEDICAL AND SOCIAL CARE IN ELDERLY PARKIN SONIAN-PATIENTS

Seventy-four in- and out-patients mean age 71.9 years) with Parkinsoni an syndromes (summarized as ''PS'': idiopathic Parkinson's disease, va scular pseudo Parkinsonian syndrome (VPS), and Parkinson-dementia (PDK )) were prospectively evaluated as to present clinical state according to usual rating scales, as to clinical syndrome and physician's diagn osis and treatment at the start of the illness, and as to current medi cal and social care. 54 % of the patients had history and findings of tremor, 14 % had visual hallucinations, 19 % had depression. Ratings o n part Il of the ''Unified Parkinson's Disease Rating Scale'' (UPDRS) describing ''activities of daily living'' correlated highly with the r atings of part III (''motor evaluation'') and with another activity of daily living scale according to Schwab and England. The mean differen ce between time of diagnosis and start symptoms (the ''diagnostic dela y'') was nearly 21 months. Initial symptoms did not show an impact on this difference. 68 % of patients were presently treated by general ph ysicians and were significantly older than those treated by neurologis ts. 59 % were in-patients during the study and were more likely to car ry a diagnosis of VPS or PDK. 75 % of those patients who were ever inp atients during their illness had the disease for up to six years befor e they were first hospitalized. 77 % of the patients had drug treatmen t; 88 % of these took L-Dopa preparations. 23 % of patients with drug treatment had L-Dopa-associated motor complications. 15 % of patients lived alone, 66 % with their family, and 19 % in a nursing home. 24 % of patients had assistance in their household by a professional careta ker. 16 % of patients retired early from work. The long-term care of o lder Parkinsonian patients is a task for general medicine based on neu rogeriatric expertise.