ABSTRACT
In the early stages of Parkinson’s disease (PD), motor symptoms generally predominate and, in most cases, patients experience a robust response to dopaminergic therapy. Indeed, the lack of such a response often portends one of the more aggressive “atypical” parkinsonian syndromes such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP), cortical basilar ganglionic degeneration (CBG), or vascular Parkinson’s (VP).1 Following the initiation of dopaminergic therapy, patients may maintain a relatively stable course for several years with little change in their independence. However, inevitably, as the disease progresses, therapeutic strategies that originally focused on motor symptoms alone will begin to include a complex compilation of nonmotor symptoms as well (Table 67.1). Indeed, the medical management of patients with advanced PD can be one of the most challenging faced by the primary care physician, general neurologist, and/or movement disorder specialist. This chapter discusses treatment issues in patients with advanced-stage Parkinson’s disease. Many of the topics discussed here are covered throughout this book;
Motor Nonmotor Bradykinesia Postural instability Cognitive decline Psychoses Tremor Depression and anxiety End-of-dose wearing-off Autonomic dysfunction Freezing Skeletal changes Dyskinesia Pain Dystonia Sleep disorders Myoclonus Visual dysfunction
thus, the goal of this chapter is to provide a more condensed, but comprehensive, overview of management issues in the patient with advanced PD.
