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Treatment of Advanced Parkinson Disease and Related Disorders

Miyasaki, Janis M. MD, MEd, FRCPC, FAAN

doi: 10.1212/CON.0000000000000347
Review Articles

ABSTRACT Purpose of Review: Parkinson disease often spans decades of a patient’s lifetime. Over time, nonmotor symptoms predominate and may limit dopaminergic therapy. Neurologists continue to play a vital role in treatment. In addition to balancing neurobehavioral complications of Parkinson disease with motor benefit, addressing nonmotor symptoms common in the advanced stage may improve quality of life and reduce symptom burden. Symptoms such as dysphagia, constipation, urinary dysfunction, orthostatic hypotension, and pain respond to nonpharmacologic and pharmacologic therapies.

Recent Findings: Evidence for treatment of many nonmotor symptoms is weak or lacking. The evidence for treatment of the atypical parkinsonian syndromes (progressive supranuclear palsy, multiple system atrophy, and corticobasal degeneration) in advanced stages is even more scant.

Summary: Engaging palliative care physicians in the joint care of patients can provide patients with access to expertise in end-of-life issues. Neurologic illnesses have specific hospice criteria to guide clinicians for referrals. Evidence supports that assisting patients with advance directives can result in improved satisfaction with care and improved quality of life in the last weeks of life. Neurologists can remain engaged in their patients’ care throughout the course of illness.

Address correspondence to Dr Janis M. Miyasaki, 7-133 Clinical Sciences Building, 11350 83rd Ave, University of Alberta, Edmonton, AB T6G 2G3, Canada,

Relationship Disclosure: Dr Miyasaki received personal compensation as a consultant for Merz Pharma Group and as a lecturer for Teva Pharmaceuticals Industries Ltd, has received research/grant support as principal investigator of studies for Parkinson Alberta and Patient-Centered Outcomes Research Institute, and receives royalties from UpToDate Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Miyasaki reports no disclosure.

Supplemental digital content: Direct URL citations appear in the printed text and are provided in the HTML, PDF, and app versions of this article.

© 2016 American Academy of Neurology
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