Late-stage Parkinson’s disease: the Barcelona and Lisbon cohort

Abstract

Studies of late stages of Parkinson's disease (LS-PD) are limited. To provide an adequate health plan for patients in these most advanced stages, accurate information on their clinical condition is necessary. We characterize clinical features and medication use of LS-PD. A cross-sectional study of LS-PD stage 4 or 5 of Hoehn and Yahr during on states is presented in this paper. Demographics, clinical features and medication data were obtained using a structured questionnaire and physical examination. Patients were asked to grade the perceived impact of symptoms on their health status. Fifty patients (mean age 74.1 years and mean disease duration 17.9 years) were studied. Severe akinetic symmetric parkinsonism was present in most, with negligible rigidity and tremor, and most patients were wheelchair-bound. Severe postural instability and freezing of gait, causing frequent falls and fractures, and prominent dysarthria and dysphagia dominated the motor syndrome. Levodopa remained effective in most patients in relieving motor symptoms including tremor. Motor fluctuations and dyskinesias were present in 78 and 62% of patients, respectively, but were not perceived as disabling. All had neuropsychiatric and dysautonomic symptoms. Visual hallucinations were present in 44%, depression in 62% and dementia in 50%. Lack of tremor (p < 0.01) and absence of depression (p < 0.01) were independently associated with dementia (R(2) = 45%). Symptoms causing greatest impact on perceived health status were falls, gait unsteadiness, urinary dysfunction and sweats. Motor and non-motor non-levodopa responsive problems were frequent and the main cause of disability. Fluctuations and dyskinesias were frequent though not disabling. Dementia is not unavoidable in these very late stages.

Validity of the Brazilian version of the freezing of gait questionnaire

“…Our study found that around 47% of patients with PD that attended a Brazilian specialized movement disorder clinic reported FOG. Other previous studies reported variable findings, and this large variability may be probably explained by methodological differences such as the criteria to identify FOG and by the clinical characteristics of the sample evaluated [14][15][16] . Our patients with PD and FOG had a longer disease duration compared to patients without it, which is consonant with previous studies showing a strong association between FOG and the duration and severity of the disease 4,17 .…”

Systematic Review of the Epidemiology of Urinary Incontinence and Detrusor Overactivity among Patients with Neurogenic Overactive Bladder

“…In addition, patients are often reluctant to discuss symptoms with their health care providers, so it is difficult to assess at what point over the course of the disease they experienced UI and/or DO [45] . This review found that the prevalence of urinary symptoms is likely to increase with the duration of PD and MS. For example, the prevalence of urinary symptoms was 39.3% at a mean disease duration of 4.9 years in a Brazilian study of 61 patients with PD [46] and 64.0% at a mean disease duration of 17.1 years in a Spanish study of 50 patients with PD [47] . In a systematic review of patients with MS, detrusor-sphincter disorders did not appear until an average of 6 years (range 5.0-9.5) after disease onset [17] .…”

Parkinson Kinetic Graph: Are Motor Fluctuations in Parkinson Disease Related with Disease Duration?

“…Probably, using supra-maximal levodopa, minimal response was reached and more adverse effects were present [9] [11] [12] [13]. On the other hand, other…”