Advanced Parkinson’s disease (PD) often brings a set of motor and non-motor features that are particularly challenging to manage. Medication options can be limited by side-effects and quality of life can be severely affected by an accumulating burden of nonmotor symptoms. Here, we reviewed the literature and our clinical experience with the aim of providing a practical approach to the management of advanced PD. We provide guidelines for treatment of physical and neurobehavioral concerns, that occur in advanced PD.
MarrasCBeckJCBowerJH, et al.Prevalence of Parkinson’s disease across North America. NPJ Parkinsons Dis. 2018;4:21. doi:10.1038/s41531-018-0058-0
2.
SeppiKChaudhuriKRCoelhoM. Update on treatments for nonmotor symptoms of Parkinson’s disease—an evidence-based medicine review. Mov Disord. 2019;34(2):180–198. doi:10.1002/mds.27602
3.
HelyAMMorrisJGLReidWGJTrafficanteR. Sydney multicenter study of Parkinson’s disease: non-L-dopa-responsive problems dominate at 15 years. Mov Disord. 2005;20(2):190–199. doi:10.1002/mds.20324
4.
FasanoAFungVSCLopianoL, et al.Characterizing advanced Parkinson’s disease: OBSERVE-PD observational study results of 2615 patients. BMC Neurol. 2019;19(1):50. doi:10.1186/s12883-019-1276-8
5.
HoehnMMYahrMD. Parkinsonism onset, progression and mortality. Neurology. 1967;17(5):427–442.
6.
KumarHAnsariSKumarV, et al.Severity of caregiver stress in relation to severity of disease in persons with Parkinson’s. Cureus. 2019;11(4):e4358. doi:10.7759/cureus.4358
7.
Martinez-FernandezRSchmittEMartinez-MartinPKrackP.The hidden sister of motor fluctuations in Parkinson’s disease: a review on nonmotor fluctuations. Mov Disord. 2016;31(8):1080–1094. doi:10.1002/mds.26731
KatzMGotoYKlugerBM, et al.Top ten tips palliative care clinicians should know about Parkinson’s disease and related disorders. J Palliat Med. 2018;21(10):1507–1517. doi:10.1089/jpm.2018.0390
12.
ReynoldsGOOttoMWEllisTDCronin-GolombA. The therapeutic potential of exercise to improve mood, cognition, and sleep in Parkinson’s disease. Mov Disord. 2016;31(1):23–38. doi:10.1002/mds.26484
13.
OrgetaVMcDonaldKRPoliakoffEHindleJVClareLLeroiI. Cognitive training interventions for dementia and mild cognitive impairment in Parkinson’s disease. Cochrane Database Syst Rev. 2020;2(2):CD011961. doi:10.1002/14651858.CD011961.pub2
14.
SzetoJYYLewisSJG. Current treatment option for Alzheimer’s disease and Parkinson’s disease dementia. Cur Neuropharmacol. 2016;14(4):326–328. doi:10.2174/1570159x14666151208112754
15.
MarshL. Depression and Parkinson’s disease: current knowledge. Curr Neurol Neurosci Rep. 2013;13(12):409. doi:10.1007/s11910-013-0409-5
16.
WuPLLeeMHuangTT. Effectiveness of physical activity on patients with depression and Parkinson’s disease: a systematic review. PLoS One. 2017;12(7):e0181515. doi:10.1371/journal.pone.0181515
17.
EganSJLaidlawKStarksteinS. Cognitive behavior therapy for depression and anxiety in Parkinson’s disease. J Parkinsons Dis. 2015;5(3):443–451. doi:10.3233/JPD-150542
18.
RyanMEatmonCVSlevinJT. Drug treatment strategies for depression in Parkinson’s disease. Expert Opin Pharmacother. 2019;20(11):1351–1363. doi:10.1080/14656566.2019.1612877
19.
Bomasang-LaynoEFadlonIMurrayANHimelhochA.Antidepressive treatments for Parkinson’s disease: a systematic review and meta-analysis. Parkinsonism Relat Disord. 2015;21(8):833–842. doi:10.1016/j.parkreldis.2015.04.018
20.
CostaFHRossoALMaultaschHNicarettaDHVincentMB. Depression in Parkinson’s disease: diagnosis and treatment. Arq Neuropsiquiatr. 2012;70(8):617–620. doi:10.1590/s0004-282x2012000800011
21.
GoetzCGTannerCMKlawansHL. Bupropion in Parkinson’s disease. Neurology. 1984;34(8):1092–1094.
22.
SchragATaddeiRN. Depression and anxiety in Parkinson’s disease. Int Rev Neurobiol. 2017;133:623–655. doi:10.1016/bs.irn.2017.05.024
23.
FerreiraRMda Costa AlvesWMGde LimaTA. The effect of resistance training on the anxiety symptoms and quality of life in elderly people with Parkinson’s disease: a randomized controlled trial. Arq Neuropsiquiatr. 2018;76(8):499–506. https://dx-doi-org.web.bisu.edu.cn/10.1590/0004-282x20180071.
24.
PagonabarragaJKulievskyJ. Apathy in Parkinson’s disease. Int Rev of Neurobiol. 2017;133:657–678. doi:10.1016/bs.irn.2017.05.025
25.
De LauLMLVerbaanDMarinusJvan HiltenJJ. Survival in Parkinson’s disease: relation with motor and non-motor features. Parkinsonism Relat Disord. 2014;20(6):613–616. doi:10.1016/j.parkreldis.2014.02.030
26.
FfytcheDHCreeseBPolitisM. The psychosis spectrum in Parkinson’s disease. Nat Rev Neurol. 2017;13(2):81–95. doi:10.1038/nrneurol.2016.200
27.
FfytcheDHAarslandD. Psychosis in Parkinson’s disease. Int Rev of Neurobiol. 2017;133:585–622. doi:10.1016/bs.irn.2017.04.005
28.
SamuelMRodriguez-OrozMAntoniniA, et al.Impulse control disorders in Parkinson’s disease management, controversies, and potential approaches. Mov Disorder. 2015;30(2):150–159. doi:10.1002/mds.26099
29.
TrojanoLPapagnoC. Cognitive and behavioral disorders in Parkinson’s disease: and update. II: Behavioral disorders. Neurol Sci. 2018;39(1):53–61. doi:10.1007/s10072-017-3155-7
30.
RolinskiMFoxCMaidmentIMcShaneR. Cholinesterase inhibitors for dementia with Lewy bodies, Parkinson’s disease dementia and cognitive impairment in Parkinson’s disease. Cochrane Database Syst Rev. 2012;(3):CD006504. doi:10.1002/14651858.CD006504.pub2
31.
EbersbachGIpCWKlebeS, et al.Management of delirium in Parkinson’s disease. J Neural Transm (Vienna). 2019;126(7):905–912. doi:10.1007/s00702-019-01980-7
32.
MatignoniEGodiLCitterioA, et al.Comorbid disorders and hospitalization in Parkinson’s disease: a prospective study. Neurol Sci. 2004;25(2):66–71. doi:10.1007/s10072-004-0232-5
33.
GanziR. Empowering elderly patients to overcome “self-imposed immobility” due to fear of falling. Hong Kong Med J. 2018;8(24):642–643.
34.
KruschkeCButcherHK.Evidence-based practice guidelines: fall prevention for older adults. J Gerontol Nurs. 2017;43(11):15–21. doi:10.3928/00989134-20171016-01
35.
DehailPGaudreaultNZhouH, et al.Joint contractures and acquired deforming hypertonia in older people: which determinants?Ann Phys Rehabil Med. 2019;62(6):435–441. doi:10.1016/j.rehab.2018.10.005
36.
JaulEBarronJRosenzweigJPMenczelJ. An overview of co-morbidities and the development of pressure ulcers among older adults. BMC Geriat. 2018;18(1):305–316. doi:10.1186/s12877-018-0997-7
37.
PrakashACPrakashA.Prevention and management of pressure ulcer in neurosurgical wards at RIMS: a single centre experience. IOSR J Dent Med Sci. 2019;18(2):59–66. doi:10.9790/0853-1802075966
38.
OsualaEO.Innovation in prevention and treatment of pressure ulcer: nursing implication. Trop J Med Res. 2014;17(2):61–68. doi:10.4103/1119-0388.140411
39.
ClarkM.Wound dressings and pressure ulcers. In: BoatengJ, ed. Therapeutic Dressing and Wound Healing Applications. 1st ed. 2020. John Wiley & Sons Ltd.
40.
ChenCYGanYHowCH. Approach to frailty in the elderly in primary care and the community. Practice integration and lifelong learning. Singapore Med J. 2018;58(5):240–245. doi:10.11622/smedj.2018052
41.
SmithNBrennanLGauntDM, et al.Frailty in Parkinson’s disease: a systematic review. J Parkinsons Dis. 2019;9(3):517–524. doi:10.3233/JPD-191604
KaifJG. Management of dysphagia and drooling in patients with Parkinson’s disease. Neurodegen Dis Manage. 2013;3(1):71–79. doi:org/10.2217/nmt.12.77
44.
KalfJGde SwartBJMBloemBRMunnekeM. Prevalence of oropharyngeal dysphagia in Parkinson’s disease: a meta-analysis. Parkinsonism Relat Disord. 2012;18(4):311–315. doi:10.1016/j.parkreldis.2011.11.006
45.
FabbriMCoelhoMAbreuD, et al.Dysphagia predicts poor outcome in late-stage Parkinson’s disease. Parkinsonism Relat Disord. 2019;64:73–81. doi:10.1016/j.parkreldis.2019.02.043
46.
FujiokaSFukaeJOguraH, et al.Hospital-based study on emergency admission of patients with Parkinson’s disease. eNeurologicalSci.2016;4:19–21. doi:10.1016/j.ensci.2016.04.007
47.
AltmanKWRichardsAGoldbergLFruchtSMcCabeDJ. Dysphagia in stroke, neurodegenerative disease and advanced dementia. Otolaryngol Clin North Am. 2013;46(6):1137–1149. doi:10.1016/j.otc.2013.08.005
48.
ArgoloNSampaioMPinhoPMeloANobregaAC. Do swallowing exercises improve swallowing dynamic and quality of life in Parkinson’s disease. Neurorehabilitation. 2013;32(4):949–955. doi:10.3233/NRE-130918
49.
MulkerrinSEdwardsVRobertsR. Management of people with swallowing difficulties in late-stage neurodegenerative disease. Nurs Prescrib. 2018;18(4):176–179. doi:org/10.12968/npre.2018.16.4.176
50.
Van HoorenMRABaijensLWJVoskuilenSOosterlooMKremerB. Treatment effects for dysphagia in Parkinson’s disease: a systematic review. Parkinsonism Relat Disord. 2014;20(8):800–807. doi:10.1016/j.parkreldis.2014.03.026
51.
KaufmanHPalmaJA. Treatment of autonomic dysfunction in Parkinson disease and other synucleinopathies. Mov Disorder. 2018;33(3):372–390. doi:10.1002/mds.27344
52.
VaughanCPMarklandADSmithPP, et al.Report and research agenda of the American Geriatrics Society and National Institute on Aging Bedside-To-Bench Conference on Urinary Incontinence in Older Adults: translational research agenda for a complex geriatric syndrome. J Am Geriatr Soc. 2018;66(4):773–782. doi:10.1111/jgs.15157
53.
SakakibaraRPanickerJFInazzi-ArgoEIacovelliVBruschiniH, The Parkinson’s Disease Subcommittee, The Neurourology Promotion Committee in the International Continence Society. A guideline for the management of bladder dysfunction in Parkinson’s disease and other gait disorders. Neurourol Urodyn. 2016;35(5):551–563.
54.
VurtureGPeyronnetBFeiginA, et al.Outcomes of intradetrusor onabotulinum toxin A injection in patients with Parkinson’s disease. Neurourol Urodyn. 2018;37(8):2669–2677. doi:10.1002/nau.23717
55.
PossoverM. The laparoscopic implantation of neuroprothesis to the sacral plexus for therapy of neurogenic bladder dysfunctions after failure of percutaneous sacral nerve stimulation. Neuromodulation. 2010;13(2):141–142. doi:10.1111/j.1525-1403.2009.00230.x
56.
KabaySCKabaySYucelMOzdenH. Acute urodynamic effects of percutaneous posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with Parkinson’s disease. Neurourol Urodyn. 2009;28(1):62–67. doi:10.1002/nau.20593
57.
Mc ClurgDPanickerJWalerRW. Stimulation of the tibial nerve: a protocol for a multicentred randomised controlled trial for urinary problems associated with Parkinson’s disease—STARTUP. BMJ Open. 2020;10(2):e034887. doi:10.1136/bmjopen-2019-034887
58.
ChenTYPonsotYCarmelMBouffardNKennellyMJTuLM. Multi-centre study of intraurethral valve-pump catheter in women with a hypocontractile or acontractile bladder. Eur Urol. 2005;48(4):628–633. doi:10.1016/j.eururo.2005.04.020
59.
PoirierAAAubeBCoteMMorinNDi PaoloTSouletD. Gastrointestinal dysfunctions in Parkinson’s disease: symptoms and treatments. Parkinsons Dis. 2016;2016:6762528. doi:10.1155/2016/6762528
60.
SoykanISarosiekIShifflettJWootenGFMcCallumRW. Effect of chronic oral domperidone therapy on gastrointestinal symptoms and gastric emptying in patients with Parkinson’s disease. Mov Disorder. 1997;12(6):952–957.
61.
CostillaVCFoxx-OrensteinAEMayerAPCrowellM. Office-based management of fecal incontinence. Gastroenterol Hepatol(N Y). 2013;9(7):423–433.
62.
ShenYHuangJYLiJLiuCF. Excessive daytime sleepiness in Parkinson’s disease: clinical implications and management. Chin Med J. 2018;131(8):974–981. doi:10.4103/0366-6999.229889
63.
LengYMusjekESHuKCappicioFPYaffeK. Association between circadian rhythms and neurodegenerative diseases. Lancet Neurol. 2019;18(3):307–318. doi:10.1016/S1474-4422(18)30461-7
64.
VidenovicAKlermanEBWangWMarconiAKuhtaTZeePC. Timed light therapy for sleep and daytime sleepiness associated with Parkinson disease. JAMA Neurol. 2017;74(4):411–418. doi:10.1001/jamaneurol.2016.5192
65.
VaraneseSPerfettiBGilbert-WolfRThomasAOnofriMDi RoccoA. Modafinil and armodafinil improve attention and global mental status in Lewy bodies disorders: preliminary evidence. Int J Geriatr Psychiatry. 2013;28(10):1095–1097. doi:10.1002/gps.3952
66.
SuzukiKMiyamotoMMiyamotoT, et al.Istradefylline improves daytime sleepiness in patients with Parkinson’s disease: an open-label, 3-month study. J Neurol Sci. 2017;380:230–233. doi:10.1016/j.jns.2017.07.045
67.
MaceCZ. The complexities of advance care planning in patients with idiopathic Parkinson’s disease. Br J Neurosci Nurs. 2017;13(4):178–186. doi:org/10.12968/bjnn.2017.13.4.178
68.
LumHDKlugerBM. Palliative care for Parkinson disease. Clin Geriatr Med. 2020;36(1):149–157. doi:10.1016/j.cger.2019.09.013
69.
FoxSCashellAKernohanWG, et al.Palliative care for Parkinson’s disease: patient and carer’s perspective explored through qualitative interview. Palliat Med. 2017;31(7):634–641. doi:10.1177/0269216316669922
70.
OliverDVeroneseS. Specialist palliative care for Parkinson’s disease. Ann Palliat Med. 2020;9(Suppl 1):S52–S62. doi:10.21037/apm.2019.12.01
71.
KlugerBMMiyasakiJKatzM, et al.Comparison of integrated outpatient palliative care with standard care in patents with Parkinson disease and related disorders. JAMA Neurol. 2020;7(5):551–560. doi:10.1001/jamaneurol.2019.4992
72.
DarweeshSKLRaphaelKGBrundinP, et al.Parkinson matters. J Parkinsons Dis. 2018;8(4):495–498. doi:10.3233/JPD-181374
73.
MaroisCAmadorMDPayanC, et al.Outcome of gastrostomy in parkinsonism: a retrospective study. Parkinsonism Relat Disord. 2017;43:110–113. doi:10.1016/j.parkreldis.2017.06.012