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Depression, cognition and quality of life in parkinsonian patients.

Much of the new knowledge of Parkinson’s disease has been generated by basic research into its physiology and biochemistry [1, 2]. Genetics and the mechanisms of neuronal cell death are giving new insights into the aetiology of the disease and possible interventions [3]. Developments of new therapies in Parkinson’s disease continue to excite interest and generate publications [4]. It is, however, the problems of advanced Parkinson’s disease that most geriatricians find challenging. Problems of disordered thought and memory, mood and social function occur in many elderly parkinsonian patients [5, 6]. MacMahon and Thomas have created a useful paradigm for disease management in Parkinson’s disease [7]. Their clinical pathway has the merit of being simple, describing a spectrum of care in four phases—diagnostic, maintenance, complex management and palliative care. Anxiety, depression and carer stress, confusion and hallucinations are all seen as markers of the need for complex management, with the aim of optimizing symptom-control and minimizing disability. The support of relatives is seen as important at this stage as well as in the palliative stage.