Developed in collaboration with CASA Medical.
Parkinsonism is a clinical condition that has both motor and non-motor symptoms, such as bradykinesia, resting tremor, rigidity, postural instability, insomnia and mental health concerns such as slowed thinking and cognition, depression, anxiety, or apathy. Parkinson’s disease is a progressive neurodegenerative disorder that can be either sporadic or, less frequently, genetic. It is caused by insufficient dopamine in the brain and cannot be cured but can be managed. Progression of disease is highly variable between individuals, which often fluctuates and can cause intermittent impairment.
Parkinsonism can also be secondary to a variety of disorders, including infections or brain injury, but drug-induced parkinsonism is most frequent.
Parkinsonism can also be a clinical feature of other neurogenerative diseases such as multiple system atrophies, progressive supranuclear palsy or other Parkinson’s plus syndromes.
This guidance should be used for applicants with clinically confirmed Parkinson's disease, after other causes of parkinsonism have been excluded, and at least 6 months have elapsed from the first presentation for specialist neurology assessment.
Pilot and controller information
- A diagnosis of Parkinson’s disease mandates grounding and reporting to the ME or CAA
- Any recurrence or deterioration in symptoms or function after certification mandates grounding and reporting to the ME. The ME will in turn notify CAA
- If there is any change in medication, including dosage, for Parkinson's disease, pilots and controllers should stand down from aviation duties and present to their ME for review prior to return to aviation activities.
- Initial applications must be assessed by CAA AvMed
- Renewal applications may be certified by MEs within the criteria outlined below. If these criteria are not met CAA AvMed assessment is required
Aeromedical implications
Effect of aviation on the condition
- G-induced loss of consciousness in the context of autonomic dysfunction or orthostatic hypotension due to medications.
- Jet lag may exacerbate sleep disorders associated with the condition.
- Access to and timing of medication may be inconsistent, particularly for long-haul pilots due to time-zone changes and shift duties for controllers.
- Stress and workload exacerbate fatigue and both motor and non- motor symptoms.
Effect of the condition on aviation
- Overt incapacitation from:
- hyper-somnolence
- wearing-off effect
- dyskinesia
- Subtle incapacitation from:
- cognitive impairment
- pain
- psychiatric symptoms such as bradypsychia, depression, hallucinations, psychosis
- reduced reaction times
- visual impairment
- impaired fine motor control and coordination
- impaired verbal communication
- anosmia
Effect of treatment on aviation
- Dopamine receptor agonists: Sedative effects, orthostatic dizziness, hallucinations, impulse control disorders, withdrawal syndrome
- Levodopa + dopa decarboxylase inhibitor: Dizziness, nausea, vomiting, hypotension, dyskinesia, dystonia, headache, hallucinations, confusion, unpredictable motor fluctuations, wearing-off effects, somnolence.
- Monoamine-oxidase-B inhibitors (MAOI): blurred vision, insomnia, myoclonus, orthostatic hypotension and sedation.
- Anticholinergic (muscarinic) drugs: impaired memory, confusion, hallucinations, and dry mouth.
Approach to medical certification
Based on the condition
- Confirmed diagnosis of idiopathic Parkinson’s disease (differential diagnoses and other causes of secondary parkinsonism may have a less favourable prognosis)
- Early in the disease with minimal symptoms of aeromedical significance
- Absence of cognitive deficits, psychiatric symptoms or visual impairment
- Any associated symptoms requiring medication (orthostatic hypotension, neuropsychiatric issues other than well-managed depression or anxiety, severe bladder dysfunction).
Based on treatment
- Medications do not include dopamine agonists or anticholinergics.
- Medications provide satisfactory symptom control.
- Medications cause minimal side effects of aeromedical significance.
- Demonstrated medication compliance.
- Treatment with surgery, deep brain stimulation or pump-delivered dopaminergic therapy is disqualifying.
Demonstrated stability
- There is considerable variation in the rate of progression of the disease.
- Absence of rapid and progressive safety relevant/aeromedically significant impairment.
- Symptom control with stable medication dosing.
General considerations
- Medical certification requires careful consideration of symptoms, function, effectiveness and duration of effect of treatment, absence of treatment side effects of safety relevance, and may require an operational flight assessment
- Return to aviation activities may require risk mitigation like co-pilot/safety pilot or other conditions on the medical certificate
- Consideration for return to aviation activities after diagnosis and thereafter for ongoing medical certification will require operational flight test / controller proficiency check report
- There is a need for 6 monthly reviews by treating neurologist to maintain ongoing medical certification.
- Medication changes will require a trial period to rule out any aeromedically significant side effects.
Risk assessment protocol - information required
New cases
Neurologist report
- Confirmed diagnosis
- Clinical status
- initial presentation (please include dates)
- symptoms and signs – fluctuations in cognitive and motor function
- progress
- history of falls, motor vehicle or aircraft accidents
- assessment against standardised disease rating scale (eg. MDS-UPDRS III). Scoring sheet will be required for baseline and future comparison.
- the report should include an assessment of sleep disturbance, mood disturbance, visual dysfunction, autonomic dysfunction, sense of smell, speech, and dyskinesia in response to treatment.
- mental health status and any changes
- Investigations conducted
- indication for imaging if performed
- result of imaging including MRI
- results of any other investigations performed and reason for testing
- Management
- treatment and compliance
- side-effects
- monitoring
- Prognosis
- Follow-up plan.
Neuropsychological assessment
- Screening for cognitive impairment should be performed at the time of initial diagnosis and periodically thereafter.
- Tests of frontal executive function must be included.
- Neuropsychological screening should be undertaken in 'ON' and 'OFF' state (where appropriate)
- Screening for dementia is required.
Ophthalmologist report
A report from a CAA Credentialed Optometrist will be required including:
- CAA NZ Special Eye Report
- colour vision sensitivity
- contrast sensitivity
- ocular balance
Operational flight test
- An Operational Flight Assessment conducted by a flight examiner or Chief Flying Instructor is required.
All reports must be valid within the last 3 months.
Renewal
Neurologist report
- Clinical status
- initial presentation (please include dates)
- symptoms and signs including fluctuations in motor and cognitive function
- Progress over the previous 6 months
- history of falls, motor vehicle or aircraft accidents
- assessment against standardised disease rating scale (eg. MDS-UPDRS). Scoring sheet will be required for baseline and future comparison.
- the report should include an assessment of sleep disturbance, mood disturbance, visual dysfunction, autonomic dysfunction, sense of smell, speech, and dyskinesia in response to treatment.
- mental health status and any changes
- Investigations conducted
- indication for imaging if performed
- result of imaging
- results of any other investigations performed and reason for testing
- Management
- treatment
- side-effects
- monitoring
- Prognosis
- Follow-up plan.
Neuropsychological assessment
- Test selection must include repeats of initial baseline tests to enable comparison. If not possible, an explanation must be provided.
- This is required if there is progression in any other symptoms of the primary diagnosis or related comorbidities (such as mood disorders, motor or autonomic dysfunction) of if the DAME considers it is necessary.
Ophthalmologist report
- Test selection must include repeats of initial baseline tests to enable comparison. If not possible, an explanation must be provided.
Operational flight test
- This is required if there is progression in any other symptoms of the primary diagnosis or related comorbidities (such as mood disorders, motor or autonomic dysfunction) of if the DAME considers it is necessary.
- A flight test conducted by an Approved Testing Officer, Flying Operations Inspector or Chief Flying Instructor is required.
Test protocol will be supplied to the testing officer on request to CASA (Aviation Medicine).
All reports must be valid within the last 3 months.
ME aeromedical decision guide
If all criteria in the table below for an applicant are met, the applicant meets the acceptable criteria for certification by the ME. Evidence supporting the ME’s decision (for example reports and results) must be sent to CAA.
An AMC referral to CAA AvMed is required if a pilot’s or controller’s condition does not meet all the above criteria and they consent to their condition being considered under flexibility to the CAR 67 rules.
ME letters
Parkisons medical certificate letter [DOCX 23 KB]
