Parkinson's disease nurse specialists: an important role in disease management.

A concerted effort by health-care professionals is central to delivering effective clinical management of patients with Parkinson's disease. Before the introduction of the first PD nurse specialist, a community study showed PD patients need basic nursing care: for instance, more than half experienced difficulties with constipation, micturition, or sleep patterns. The evolving role (particularly in the United Kingdom) of PD nurse specialists has started to address these problems. Nurse specialists are ideally placed to assess personal concerns and difficulties, furnish educational and emotional support, and facilitate referral to health or social care agencies. They can help physicians or neurologists in the assessment of physical and psychological status, they can monitor the effects and side-effects of the medications used to control the disease, and they can help in managing drug titration. The provision of a telephone support line, respite care facilities, and psychological support and counseling can help with depression, anxiety, hallucinations, and confusional states, some of which may be iatrogenic. An integrated multidisciplinary PD service that incorporates nurse specialists alongside their medical colleagues can offer support at the individual level, education to the wider community and training for a variety of clinical and lay staff. The cost-effectiveness of such a system is attracting considerable international interest and is currently being evaluated.