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Dementia with Lewy Body and Parkinson's Disease PatientsPatient, Family, and Clinician Working Together for Better Outcomes$
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J. Eric Ahlskog

Print publication date: 2013

Print ISBN-13: 9780199977567

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780199977567.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use. date: 17 June 2021

Hospitalization and Nursing Facilities: Keeping Everyone on the Same Page

Hospitalization and Nursing Facilities: Keeping Everyone on the Same Page

Chapter:
21 Hospitalization and Nursing Facilities: Keeping Everyone on the Same Page
Source:
Dementia with Lewy Body and Parkinson's Disease Patients
Author(s):

J. Eric Ahlskog

Publisher:
Oxford University Press
DOI:10.1093/oso/9780199977567.003.0032

Nearly all of us end up in the hospital for something sooner or later. The unique problems of Lewy disorders and medications can challenge hospital care teams. On a related note, some individuals with DLB or PDD may require care in a nursing facility. This may be transient, requiring rehabilitation and stabilization following a hospitalization; in other cases, it is indefinite because of the complex care necessary for DLB and PDD. In this chapter, the focus is on the care teams in these facilities. Although many staff in these settings are familiar with the medications and problems of DLB and PDD, this knowledge is not universal. Little published literature addresses the special needs of those with PDD or DLB admitted to the hospital or living in extended care facilities. It is hoped that this chapter can be an aid in caring for those with PDD or DLB. People with DLB or PDD are, by definition, cognitively impaired. Sometimes this is associated with hallucinations or delusions. Most individuals also have dopamine deficiency states with parkinsonism. Another common component is autonomic nervous system dysfunction. This dysautonomia may be associated with bladder and bowel disorders but, more importantly, with orthostatic hypotension (potential for fainting when ambulating). Some people with PDD or DLB are mildly impaired by these problems, and others are quite compromised. What follows is a summary of crucial knowledge for nursing and paramedical staffs. 1. As with any dementia, novel environments are disorienting. 2. Hallucinations are a frequent component of DLB and PDD. These may be exacerbated by psychoactive medications, including narcotics for pain. 3. Carbidopa/levodopa is the least likely among the potent drugs for parkinsonism to provoke hallucinations. Other Parkinson drugs should generally not be started. 4. People with DLB or PDD commonly experience dream enactment behavior (REM sleep behavior disorder); this should not be misinterpreted as nocturnal hallucinations. 5. Anticholinergic medications for urinary urgency may cross the blood–brain barrier and impair cognition (e.g., oxybutynin). The only drug from this class that cannot get into the brain is trospium (Sanctura).

Keywords:   gait problems, rigidity (stiffness), stiffness (rigidity), urinary tract infections (UTIs), water pills (diuretics)

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