{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T14:47:42Z","timestamp":1782398862183,"version":"3.54.5"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Aging Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Parkinson\u2019s disease (PD) is a prevalent neurodegenerative disorder with a rapidly increasing incidence worldwide and complex treatment requirements. It is predominantly treated on an outpatient basis. However, detailed clinical data from outpatient practice remain scarce. We therefore set out to evaluate PD care practices in the outpatient setting. As preliminary work for a pilot project, this report represents the first systematic exploratory survey to assess outpatient treatment patterns in Germany. The aim of this survey is to document the current outpatient treatment approaches for PD, to identify potential gaps in the existing clinical guidelines, and to highlight the lack of outpatient-specific evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional baseline survey was conducted online using a standardized questionnaire among neurologically specialized outpatient practices in Germany. Serving as a baseline assessment of the regional status quo of current care practices, the survey forms the foundation for the subsequent multicenter pilot study AmParkReg, into which these results will later be integrated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The survey revealed a high degree of homogeneity in routine clinical assessments across various practice types with an emphasis on psychomotor examination, particularly rigidity assessment, reflecting established dopaminergic treatment monitoring. However, the integration of non-motor symptom assessment and comprehensive multimodal diagnostics remains limited. Time constraints and regional variations in practice warrant further investigation. Methodological limitations include regional sampling bias and the lack of temporal data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings underscore the urgent need for ambulatory-specific, evidence-based care standards in PD. The development of longitudinal, multisectoral studies and the strengthening of ambulatory care guidelines are critical for optimizing patient outcomes. This work provides foundational data to refine ambulatory management and fosters the integration of precision approaches into routine PD care in Germany.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnagi.2026.1820262","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T05:40:01Z","timestamp":1781070001000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Searching for a needle in a haystack\u2014ambulatory research in Parkinson\u2019s disease in Germany"],"prefix":"10.3389","volume":"18","author":[{"given":"Ingmar","family":"Wellach","sequence":"first","affiliation":[{"name":"Association for Quality Development in Neurology and Psychiatry (QUANUP e.V.)","place":["Hamburg, Germany"]},{"name":"Department of Neurology and Neurogeriatrics, Medical School and University Medical Center OWL, Hospital Lippe, Bielefeld University","place":["Lemgo, Germany"]},{"name":"Neurology and Psychiatry Practice Hamburg Walddoerfer","place":["Hamburg, Germany"]},{"name":"Evangelical Amalie Sieveking Hospital","place":["Hamburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Becker","sequence":"additional","affiliation":[{"name":"Association for Quality Development in Neurology and Psychiatry (QUANUP e.V.)","place":["Hamburg, Germany"]},{"name":"Neurology and Psychiatry Practice Hamburg Walddoerfer","place":["Hamburg, Germany"]},{"name":"Evangelical Amalie Sieveking Hospital","place":["Hamburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Association for Quality Development in Neurology and Psychiatry (QUANUP e.V.)","place":["Hamburg, Germany"]},{"name":"Neurology and Psychiatry Practice Hamburg Walddoerfer","place":["Hamburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Doblinger","sequence":"additional","affiliation":[{"name":"Association for Quality Development in Neurology and Psychiatry (QUANUP e.V.)","place":["Hamburg, Germany"]},{"name":"Neurology and Psychiatry Practice Hamburg Walddoerfer","place":["Hamburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susann","family":"Eichler","sequence":"additional","affiliation":[{"name":"Department of Science and Academic Medicine, Medical School and University Medical Center OWL, Hospital Lippe, Bielefeld University","place":["Detmold, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Hillmer","sequence":"additional","affiliation":[{"name":"Department of Science and Academic Medicine, Medical School and University Medical Center OWL, Hospital Lippe, Bielefeld University","place":["Detmold, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Honorine","family":"Atanga","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurogeriatrics, Medical School and University Medical Center OWL, Hospital Lippe, Bielefeld University","place":["Lemgo, Germany"]},{"name":"Department of Science and Academic Medicine, Medical School and University Medical Center OWL, Hospital Lippe, Bielefeld University","place":["Detmold, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Redecker","sequence":"additional","affiliation":[{"name":"Association for Quality Development in Neurology and Psychiatry (QUANUP e.V.)","place":["Hamburg, Germany"]},{"name":"Department of Neurology and Neurogeriatrics, Medical School and University Medical Center OWL, Hospital Lippe, Bielefeld University","place":["Lemgo, Germany"]},{"name":"Neuropraxis Detmold","place":["Detmold, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1055\/a-0624-1671","article-title":"Patients' perspective on provided health services in Parkinson's disease in Germany - a cross-sectional survey","volume":"45","author":"Binder","year":"2018","journal-title":"Akt. Neurol."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1111\/ene.14627","article-title":"From trials to clinical practice: temporal trends in the coverage of specialized allied health services for Parkinson's disease","volume":"28","author":"Bloem","year":"2021","journal-title":"Eur. J. Neurol."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"S36","DOI":"10.1055\/s-0042-103325","article-title":"Parkinson's disease at the border between inpatient and outpatient care","volume":"84","author":"Buhmann","year":"2016","journal-title":"Fortschr. Neurol. Psychiatr."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1007\/s00702-025-02923-1","article-title":"Parkinson\u2019s day-clinic: which patients should be selected and what services should be offered for successful therapy?","volume":"133","author":"Buhmann","year":"2026","journal-title":"J. Neural Transm. (Vienna)"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s40801-023-00410-1","article-title":"Economic burden of Parkinson's disease: a multinational, real-world, cost-of-illness study","volume":"11","author":"Chaudhuri","year":"2024","journal-title":"Drugs Real World Outcomes"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1055\/s-0031-1301278","article-title":"Problems with the implementation of national guidelines \u2013 therapy","volume":"38","author":"Csoti","year":"2012","journal-title":"Aktuelle Neurol."},{"key":"ref8","volume-title":"Parkinson's Disease: Regional Differences in Diagnosis Prevalence and Comorbidity Analyses in contract Medical care \u2013 Evaluation of Nationwide billing data for the period 2010 to 2019","author":"Dammertz","year":"2022"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"5093","DOI":"10.1007\/s10072-025-08306-4","article-title":"Caregiver burden in Parkinson\u2019s disease: a nationwide observational survey","volume":"46","author":"Donzuso","year":"2025","journal-title":"Neurol. Sci."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1001\/jamaneurol.2017.3299","article-title":"The Parkinson pandemic-a call to action","volume":"75","author":"Dorsey","year":"2018","journal-title":"JAMA Neurol."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"S3","DOI":"10.3233\/JPD-181474","article-title":"The emerging evidence of the Parkinson pandemic","volume":"8","author":"Dorsey","year":"2018","journal-title":"J. Parkinsons Dis."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1002\/mds.25664","article-title":"Health-related quality of life in early Parkinson's disease: the impact of nonmotor symptoms","volume":"29","author":"Duncan","year":"2014","journal-title":"Mov. Disord."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1055\/s-0038-1627133","article-title":"Hospital treatment for patients with Parkinson's disease within the DRG-system","volume":"27","author":"Ebersbach","year":"2008","journal-title":"Nervenheilkunde"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"MR000008","DOI":"10.1002\/14651858.MR000008.pub4","article-title":"Methods to increase response to postal and electronic questionnaires","volume":"2010","author":"Edwards","year":"2009","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"602","DOI":"10.1007\/s00115-020-01027-3","article-title":"Care of patients with Parkinson's disease in Germany: status quo and perspectives as reflected in the digital transition","volume":"92","author":"Eggers","year":"2021","journal-title":"Nervenarzt"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1461","DOI":"10.1007\/s00702-018-1918-9","article-title":"The Hamburg Parkinson day-clinic: a new treatment concept at the border of in- and outpatient care","volume":"125","author":"Fr\u00fcndt","year":"2018","journal-title":"J. Neural Transm. (Vienna)"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"106026","DOI":"10.1016\/j.parkreldis.2024.106026","article-title":"Determining the impact of specialized care on health outcomes and health care utilization in parkinsonism","volume":"124","author":"Goerz","year":"2024","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1563636","DOI":"10.3389\/fneur.2025.1563636","article-title":"Outpatient interface challenges for drug safety in Parkinson's disease patients: a questionnaire based cross-sectional study","volume":"16","author":"Greten","year":"2025","journal-title":"Front. Neurol."},{"key":"ref19","first-page":"10","article-title":"Delayed administration and contraindicated drugs place hospitalized Parkinson's disease patients at risk","volume":"43","author":"Grissinger","year":"2018","journal-title":"P. T."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1965","DOI":"10.1002\/mds.30239","article-title":"Differences in Parkinson's disease populations: teaching hospitals versus other settings and implications for clinical trials","volume":"40","author":"Gros","year":"2025","journal-title":"Mov. Disord."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"500","DOI":"10.3389\/fneur.2018.00500","article-title":"Do we need to rethink the epidemiology and healthcare utilization of Parkinson's disease in Germany?","volume":"9","author":"Heinzel","year":"2018","journal-title":"Front. Neurol."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1007\/s002280050103","article-title":"What happens to long-term medication when general practice patients are referred to hospital?","volume":"50","author":"Himmel","year":"1996","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1186\/s42466-024-00325-4","article-title":"Diagnosis and treatment of Parkinson\u2019s disease (guideline of the German Society for Neurology)","volume":"6","author":"H\u00f6glinger","year":"2024","journal-title":"Neurol. Res. Pract."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e085312","DOI":"10.1136\/bmjopen-2024-085312","article-title":"How does communication affect patient safety? Protocol for a systematic review and logic model","volume":"14","author":"Howick","year":"2024","journal-title":"BMJ Open"},{"key":"ref25","volume-title":"Health care in Germany: Learn More \u2013 The German healthcare system. Last Update: December 18, 2024 InformedHealth.org [Internet]","year":"2006"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1136\/jnnp-2019-322338","article-title":"Parkinson\u2019s disease: etiopathogenesis and treatment","volume":"91","author":"Jankovic","year":"2020","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref27","volume-title":"European Physical Therapy Guideline on Idiopathic Parkinson Syndrome","author":"Keus","year":"2014"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"543426","DOI":"10.1155\/2012\/543426","article-title":"Improving community healthcare for patients with Parkinson's disease: the dutch model","volume":"2012","author":"Keus","year":"2012","journal-title":"Parkinsons Dis."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1186\/s42466-025-00422-y","article-title":"Multidisciplinary inpatient care for Parkinson\u2019s disease: a single-Centre cohort study on improvements in gait, overall motor function, and quality of life","volume":"7","author":"Kleinholdermann","year":"2025","journal-title":"Neurol. Res. Pract."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1111\/imj.14782","article-title":"Reducing medication errors for hospital in patients with parkinsonism","volume":"51","author":"Lance","year":"2021","journal-title":"Intern. Med. J."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fnagi.2018.00001","article-title":"Weight loss and malnutrition in patients with Parkinson's disease: current knowledge and future prospects","volume":"10","author":"Ma","year":"2018","journal-title":"Front. Aging Neurosci."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1186\/s12883-024-03778-x","article-title":"The PRIME-NL study: evaluating a complex healthcare intervention for people with Parkinson\u2019s disease in a dynamic environment","volume":"24","author":"Maas","year":"2024","journal-title":"BMC Neurol."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1002\/mds.23462","article-title":"The impact of non-motor symptoms on health-related quality of life of patients with Parkinson's disease","volume":"26","author":"Martinez-Martin","year":"2011","journal-title":"Mov. Disord."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1016\/j.parkreldis.2013.07.010","article-title":"Importance of motor vs. non-motor symptoms for health-related quality of life in early Parkinson's disease","volume":"19","author":"M\u00fcller","year":"2013","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref35","article-title":"KBV quality report 22024: reporting year 2023","year":"2025"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1177\/1941874411427734","article-title":"Inpatient management of Parkinson disease: current challenges and future directions","volume":"2","author":"Oguh","year":"2012","journal-title":"Neurohospitalist"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"715","DOI":"10.3233\/JPD-202346","article-title":"People with Parkinson's disease: what symptoms do they Most want to improve and how does this change with disease duration?","volume":"11","author":"Port","year":"2021","journal-title":"J. Parkinsons Dis."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"2581","DOI":"10.3390\/jcm9082581","article-title":"Specialized staff for the Care of People with Parkinson\u2019s disease in Germany: an overview","volume":"9","author":"Prell","year":"2020","journal-title":"J. Clin. Med."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1509","DOI":"10.1002\/mds.28097","article-title":"Integrated care in Parkinson's disease: a systematic review and meta-analysis","volume":"35","author":"Rajan","year":"2020","journal-title":"Mov. Disord."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"151","DOI":"10.3390\/cells8020151","article-title":"Dynamics of Parkinson's disease multimodal complex treatment in Germany from 2010\u22122016: patient characteristics, access to treatment, and formation of regional Centers","volume":"8","author":"Richter","year":"2019","journal-title":"Cells"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1007\/s00415-018-9104-4","article-title":"Cardiovascular autonomic neuropathy and falls in Parkinson disease: a prospective cohort study","volume":"266","author":"Romagnolo","year":"2019","journal-title":"J. Neurol."},{"key":"ref43","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2023\/6667339","article-title":"Compliance with national and international guidelines in the treatment of nonmotor symptoms in late-stage Parkinson's disease","volume":"2023","author":"Rosqvist","year":"2023","journal-title":"Parkinsons Dis."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"e48447","DOI":"10.7759\/cureus.48447","article-title":"Improving Parkinson's medicine administration in hospitals: the impact of an out-of-hours drug box","volume":"15","author":"Saleem","year":"2023","journal-title":"Cureus"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1007\/s00115-024-01666-w","article-title":"Multidisciplinary complex treatment of Parkinson's disease: cornerstone of an individualized treatment","volume":"95","author":"Scherbaum","year":"2024","journal-title":"Nervenarzt"},{"key":"ref46","year":""},{"key":"ref47","doi-asserted-by":"publisher","first-page":"1507","DOI":"10.1002\/mdc3.13868","article-title":"Contributory factors to caregiver burden in Parkinson's disease","volume":"10","author":"Soares","year":"2023","journal-title":"Mov. Disord. Clin. Pract."},{"key":"ref49","doi-asserted-by":"publisher","first-page":"1833","DOI":"10.3233\/JPD-202000","article-title":"Lack of accredited clinical training in movement disorders in Europe, Egypt, and Tunisia","volume":"10","author":"Tam\u00e1s","year":"2020","journal-title":"J. Parkinsons Dis."},{"key":"ref50","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1212\/CPJ.0000000000000746","article-title":"Symptom burden among individuals with Parkinson disease: a national survey","volume":"10","author":"Tarolli","year":"2020","journal-title":"Neurol. Clin. Pract."},{"key":"ref51","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1111\/j.1445-5994.2006.01123.x","article-title":"Reasons for admission to hospital for Parkinson's disease","volume":"36","author":"Temlett","year":"2006","journal-title":"Intern. Med. J."},{"key":"ref52","doi-asserted-by":"publisher","first-page":"1206","DOI":"10.1007\/s00115-022-01273-7","article-title":"Treatment practice of patients with Parkinson's disease in Saxony: a secondary data-based analysis of utilization in the observation period 2011-2019","volume":"93","author":"Timpel","year":"2022","journal-title":"Nervenarzt"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1007\/s00115-018-0590-5","article-title":"Characteristics and dynamics of inpatient treatment of patients with Parkinson's disease in Germany: analysis of 1.5 million patient cases from 2010 to 2015","volume":"90","author":"T\u00f6nges","year":"2019","journal-title":"Nervenarzt"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"7377","DOI":"10.1007\/s00415-024-12546-3","article-title":"Guideline \"Parkinson's disease\" of the German Society of Neurology (deutsche gesellschaft f\u00fcr Neurologie): concepts of care","volume":"271","author":"T\u00f6nges","year":"2024","journal-title":"J. Neurol."},{"key":"ref55","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1055\/s-0043-103275","article-title":"Epidemiology of Parkinson\u2019s disease and current concepts of outpatient care in Germany","volume":"85","author":"T\u00f6nges","year":"2017","journal-title":"Fortschr. Neurol. Psychiatr."},{"key":"ref56","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1002\/mdc3.70247","article-title":"A systematic review of the Parkinson's foundation hospital care recommendations","volume":"13","author":"Veilleux Carpentier","year":"2026","journal-title":"Mov. Disord. Clin. Pract."},{"key":"ref57","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1016\/j.tins.2010.09.004","article-title":"\u03b1-Synuclein and dopamine at the crossroads of Parkinson's disease","volume":"33","author":"Venda","year":"2010","journal-title":"Trends Neurosci."},{"key":"ref58","doi-asserted-by":"publisher","first-page":"1217","DOI":"10.1007\/s00702-024-02807-w","article-title":"Multidisciplinary care in Parkinson\u2019s disease","volume":"131","author":"Weise","year":"2024","journal-title":"J. Neural Transm."},{"key":"ref59","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1038\/s41531-025-01167-w","article-title":"\u03b1-Synuclein in Parkinson\u2019s disease: a central point of convergence with depression","volume":"11","author":"Yusuf","year":"2025","journal-title":"npj Parkinsons Dis."},{"key":"ref60","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1055\/s-0038-1641682","article-title":"Falls in patients with mild and advanced Parkinson's syndrome and their prevention through physical therapy","volume":"37","author":"Ziegler","year":"2018","journal-title":"Nervenheilkunde"}],"container-title":["Frontiers in Aging Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnagi.2026.1820262\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T13:58:43Z","timestamp":1782395923000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnagi.2026.1820262\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,10]]},"references-count":57,"alternative-id":["10.3389\/fnagi.2026.1820262"],"URL":"https:\/\/doi.org\/10.3389\/fnagi.2026.1820262","relation":{},"ISSN":["1663-4365"],"issn-type":[{"value":"1663-4365","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,10]]},"article-number":"1820262"}}