Advanced Parkinson disease

Introduction
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By Stephen T Gancher MD

This clinical article includes discussion of Vascular parkinsonism. -ed.

Parkinson disease is most often thought of as a condition that produces resting tremor, bradykinesia, and a festinating, propulsive gait disorder. As the disease advances, though, a number of other problems develop. These other manifestations are wide-ranging and include dysarthria, dysphagia, truncal flexion, a freezing gait disorder, dysautonomia, depression, apathy, psychosis, and dementia. In patients with longstanding Parkinson disease, these symptoms and features become the most noticeable and disabling aspects of the disease. In this clinical article, the clinical features, underlying neuropathology, and medical and surgical treatments of these later-stage features are discussed.

Key Points

  • Patients with advancing Parkinson disease develop a number of motor, autonomic, sensory, cognitive, and behavioral symptoms that produce major impairments in quality of life.
  • The most significant problems include falls, orthostatic hypotension, dysphagia, psychosis, and dementia.
  • Although treatment of many of these symptoms is challenging, early recognition and treatment may significantly reduce morbidity and mortality that can result from these conditions.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
Anesthesia
References cited
Contributors