Supporting vascular health in people with Parkinson's

A quality improvement project conducted as part of the Dementia Academy 'Mild cognitive impairment virtual course' which ran from March-September 2021.

Background

People with Parkinson's often have other pathologies or comorbidities, some of which may impact on their cognitive abilities. Whilst little can be done to alter the underlying neuropathology of Parkinson's, other comorbidities, which may increase a patient's cognitive burden, such as poor vascular health, can be impacted positively to improve and preserve cognitive health in those living with Parkinson's.

Clinical Deficit

There were no specific measure(s) in place to monitor and address vascular health in people with Parkinson's within the movement disorders service in Taunton and Somerset Foundation Trust.

Aims of intervention

To improve the vascular health of patients with Parkinson's and thereby reduce the potential for cognitive decline due to comorbid vascular disease.

Methodology

To examine relevant health records via the case notes of 50 patients with Parkinson's under the age of 65 within the movement disorders clinic, considering:

• vascular risk factors,

• relevant investigations

• vascular management plans or treatment changes

Vascular risk* was considered to include the following elements with appropriate investigations identified for each:

• hypertension

• smoking

• alcohol use

• diet

• obesity / weight

• diabetes

• lipid disorder

• exercise

• atrial fibrillation

(*This was drawn from the NICE Impact report on vascular dementia)

To then implement a clear change in clinic process and records dependent on results.

Outcomes

Based on the findings it was clear that some areas of vascular health were monitored, and interventions or information provided but that this was not the case for all areas of vascular risk. Monitoring and interventions were also not consistent across clinics and there was no set system agreed.

As a result:

• a history record with management prompts

• has been developed for the Parkinson's nurses to use within the Movement disorders clinic

• the potential for ECG and appropriate blood tests has been built into the annual review that the nurses conduct with people with Parkinson's

• the results of this work are being presented at a multidisciplinary team meeting

• a repeat audit will be carried out in due course to monitor change.