Atypical parkinsonism: Making the case for a neuropalliative rehabilitation approach

Background - Although atypical parkinsonism syndromes share some clinical features with the more common idiopathic Parkinson's disease, they also exhibit condition-specific symptoms, and have a shorter trajectory with a more consistent decline. There is an increasing awareness of the need for palliative care in non-cancer related diagnoses such as parkinsonism. A neuropalliative rehabilitation approach linking expertise in neurology, rehabilitation and palliative care in the proactive and collaborative management of long term neurological conditions, in particular those of shorter duration, is advocated, but appears difficult to achieve. Content - This article presents the main clinical features of the key atypical parkinsonism syndromes - multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration and dementia with Lewy bodies; identifies the ‘red flags’ that alert professionals to differentiate them from idiopathic Parkinson’s disease; and discusses their multidisciplinary management within the context of neuropalliative rehabilitation. Conclusion - Despite the publication of best practice guidelines, research highlights a marked lack of referral of people with atypical parkinsonism for palliative care. Earlier diagnosis and the timely employment of a neuropalliative rehabilitation approach is believed key to the successful management of the shorter and more steeply deteriorating trajectory of atypical parkinsonism syndromes.