CONy 2024 | The Stepped-care approach to holistic and subtype-driven care for patients with Parkinson’s

Karolina Popławska-Domaszewicz, MD, PhD, University Clinical Hospital Poznań, Poznań, Poland & King’s College London, London, UK, and K Ray Chaudhuri, MD, DSc, FRCP, FEAN, King’s College London, London, UK, describe how the concept of Parkinson’s disease (PD) has changed and introduce the Stepped-care approach for holistic patients management. Prof. Chaudhuri highlights that PD is increasingly considered a heterogeneous condition, emphasizing that it is a syndrome and not a single disease. It is now widely understood that dopamine is not the only neurotransmitter involved and that acetylcholine, serotonin, and norepinephrine/noradrenaline may be involved in the etiology of the syndrome. This leads to a range of presentations of the condition, with several defined motor and non-motor subtypes. The approach to treating each subtype will vary, and this has led to the development of the Stepped-care approach to modern holistic and subtype-driven care in the clinic. The initiative incorporates Chaudhuri’s Dashboard of Vitals in Parkinson’s syndrome, which includes five vital components that contribute to the overall wellness of patients with PD (motor function; non-motor symptoms; vision, gut, and oral health; bone health and fall/fracture risk; and comedications and comorbidities). The widespread implementation of this toolkit globally through the Stepped-care initiative will ensure that healthcare professionals do not overlook any of these vital aspects when caring for patients. This interview took place at the 18th Annual Congress on Controversies in Neurology (CONy 2024) in London, UK.

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