Non-motor complications in late stage Parkinson's disease: recognition, management and unmet needs. (4th March 2021)

• Record Type: Journal Article
• Authors: Rukavina, Katarina; Batzu, Lucia; Boogers, Alexandra; Abundes-Corona, Arturo; Bruno, Veronica; Chaudhuri, K Ray
• Is Part Of: Expert review of neurotherapeutics. Volume 21:Number 3(2021)
• Page Start: 335
• Page End: 352
• Publication Date: 2021-03-04
• Subjects: Parkinson's disease -- non-motor symptoms -- late stage -- quality of life -- cognition -- neuropsychiatric symptoms -- dysautonomia -- pain; Neuropharmacology -- Periodicals; 615.7805
• DOI: 10.1080/14737175.2021.1883428
• Languages: English
• ISSNs: 1473-7175

Abstract

ABSTRACT: Introduction : The burden of non-motor symptoms (NMS) is a major determinant of health-related quality of life in Parkinson's disease (PD), particularly at its late stage. Areas covered : The late stage is usually defined as the period from unstable advanced to the palliative stage, characterized by a combination of emerging treatment-resistant axial motor symptoms (freezing of gait, postural instability, falls and dysphagia), as well as both non-dopaminergic and dopaminergic NMS: cognitive decline, neuropsychiatric symptoms, aspects of dysautonomia, pain and sleep disturbances (insomnia and excessive day-time sleepiness). Here, the authors summarize the current knowledge on NMS dominating the late stage of PD and propose a pragmatic and clinically focused approach for their recognition and treatment. Expert opinion : The NMS progression pattern is complex and remains under-researched. While dopamine-dependent NMS may improve with dopamine replacement therapy, non-dopamine dependent NMS worsen progressively and culminate at the late stages of PD. Furthermore, some PD specific features could interact negatively with other comorbidities, multiple medication use and frailty – the evaluation of these aspects is important in the creation of personalized management plans in the late stage of PD.