Standard strategies for diagnosis and treatment of patients with newly diagnosed Parkinson disease

In France, newly diagnosed patients with Parkinson disease (PD) are mostly referred by a general practitioner (GP) to a public (hospital-based) or private practice neurologist for confirmation of the diagnosis and treatment initiation. Most neurologists rely on a clinical evaluation according to National Health Authority (HAS) recommendations and guidelines.¹ MRI scans and dopamine transporter imaging are increasingly being performed for the differential diagnosis of atypical parkinsonism, for drug-induced parkinsonism and tremor, in early-onset patients, or to deal with the anxiety of patients and their families. Clinical scales such as the Unified Parkinson's Disease Rating Scale are scarcely used in routine practice. Therapeutic strategies are not or little affected by who is covering the cost of treatment or by how medical facilities and professionals are reimbursed, ensuring that health care guidelines are usually respected. Indeed, the expenses for drugs and other inpatient and ambulatory health care are almost fully covered by the health insurance within the frame of chronic diseases (“Affection de longue durée n°16”), providing that the parkinsonian syndrome is irreversible and requires the administration of antiparkinsonian drugs for at least 6 months. Some newly diagnosed patients, before being registered by the free care system for chronic diseases, may only have partial coverage of costs (65%). However, most of them have complementary private insurance allowing full reimbursement of their expenses.