PARKINSONS-DISEASE AS COMMUNITY-HEALTH PROBLEM - STUDY IN NORWEGIAN NURSING-HOMES

Objective - To examine the extent of underdiagnosis and overdiagnosis of Parkinson's disease and to determine quality of treatment in a defined population. Design - Clinical evaluation of an elderly population. Setting - 40 Norwegian nursing homes. Subjects - 3322 residents of nursing homes, of whom 500 were selected by nursing staff for evaluation on the basis of a structured information programme on Parkinson's disease and 269 were examined in detail by neurologists. Main outcome measures - Patients' scores on clinical rating scales, diagnosis of parkinsonism, and effect of changing drug treatment. Results - 169 (5.1%) patients were found to have clinical idiopathic Parkinson's disease, 31 of whom had not had the disease diagnosed previously. In addition, 31 patients without the disease were taking antiparkinsonian drugs unnecessarily. Eighty patients were judged to be receiving "optimal" treatment. In the remaining 58, the treatment was changed, and 36 patients showed a definite functional improvement after a 12 week observation period. Conclusions - The quality of life of many elderly patients with Parkinson's disease could be improved by increasing medical and neurological services.