Treating Movement Disorders in Geriatric Populations: Q&A With Nicte Mejia, MD, MPH
In This Article
- Movement disorders occur across the lifespan with tremor being the most common
- Elderly adults can experience movement disorders that include parkinsonism, tremor, dystonia, myoclonus and ataxia
- Treatments include medication, surgery, physical and occupational therapy
- Additional challenges include establishing a more diverse movement disorders workforce, creating patient resources in multiple languages and making access to care easier
Nicte Mejia, MD, MPH, is the director of the Massachusetts General Hospital Neurology Community Health and specializes in movement disorders. Dr. Mejia's clinical practice and research focus on advancing health equity, access to quality neurologic care and disparities in neurology, along with gaps in the care of racial and linguistic minority populations. Her work advances the education of trainees and engagement in national efforts including at the American Academy of Neurology.
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Q: What are the most common movement disorders for older adults?
Mejia: There are many different movement disorders across the lifespan. Tremor may be the most common and it is sometimes underdiagnosed. Parkinson's disease and other parkinsonian disorders can exist in younger patients, but their prevalence increases as people age. Older adults can experience all sorts of movement disorders, including parkinsonism, tremor, dystonia, myoclonus and ataxia, among others.
Q: How are movement disorders diagnosed and what are the existing therapies?
Mejia: Movement disorders are usually diagnosed clinically, through a careful conversation and exam with an experienced clinician who may make the diagnosis based on the patient's symptoms and exam findings, but often without having tests to confirm their suspicions. There are many available medications and surgical treatments to maximize function and quality of life, but few if any to cure movement disorders. Still, we need better diagnostic tests and symptomatic treatments.
Q: Are there racial and ethnic health disparities in geriatric patients with movement disorders?
Mejia: There are many studies now that document how women, black, Latino and underinsured patients tend to experience delayed diagnoses, subpar treatment and worse clinical outcomes. I am happy that several movement disorders organizations are tackling these issues face on and creating opportunities for the broader community to eliminate disparities in the care of people living with Parkinson's disease and other movement disorders. Among the challenges, we need a more diverse movement disorders workforce, greater availability of patient resources in a variety of languages, easier ways for people to receive the care and services they need regardless of factors such as where they live or the type of health insurance they may have.
Q: When should a physician refer a patient to a movement disorder specialist?
Mejia: Often times when older patients are moving differently in a way that it is affecting their function or quality of life. For example, if they develop tremor that interferes with eating, writing or if they experience imbalance that is leading to falls.
Q: How do physicians tailor treatment and improve the health of geriatric patients living with movement disorders?
Mejia: It is all about quality of life. What matters to my patients is what matters to me. We work together to maximize their mobility to assure they can continue to do the things they need and love. We also tackle nonmotor symptoms that may often come along with movement disorders, such as memory decline, depression, anxiety, constipation and urinary dysfunction. This often requires working in teams with other physicians, physical therapists, occupational therapists, speech therapists, social workers and nurses.
Learn more about Mass General Neurology Community Health
Refer a patient to the Division of Palliative Care & Geriatric Medicine