title: 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.
authors.affiliation: Neurological Clinical Research Unit, Instituto de Medicina Molecular, Hospital Santa Maria, Lisbon, Portugal. migcoelho2002@yahoo.es
authors.forename: Miguel
authors.initials: M
authors.lastname: Coelho
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Marti
authors.forename: Eduardo
authors.initials: E
authors.lastname: Tolosa
authors.forename: Joaquim J
authors.initials: JJ
authors.lastname: Ferreira
authors.forename: Francesc
authors.initials: F
authors.lastname: Valldeoriola
authors.forename: Mário
authors.initials: M
authors.lastname: Rosa
authors.forename: Cristina
authors.initials: C
authors.lastname: Sampaio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D010300:Parkinson Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D011174:Portugal / Q000453:epidemiology; D015995:Prevalence; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology
chemical_list: D007980:Levodopa
references.citation: J Neurol Neurosurg Psychiatry. 2007 Jan;78(1):36-42
references.pmid: 16820421
references.citation: Arch Neurol. 2002 Jan;59(1):102-12
references.pmid: 11790237
references.citation: Arch Neurol. 1996 Feb;53(2):175-9
references.pmid: 8639068
references.citation: J Neurol Neurosurg Psychiatry. 1992 Mar;55(3):181-4
references.pmid: 1564476
references.citation: Arch Neurol. 2002 Nov;59(11):1724-8
references.pmid: 12433259
references.citation: Neurology. 1985 Apr;35(4):522-6
references.pmid: 3982637
references.citation: Mov Disord. 2007 Jun 15;22(8):1077-92
references.pmid: 17394234
references.citation: N Engl J Med. 2003 Nov 13;349(20):1925-34
references.pmid: 14614167
references.citation: Arch Gen Psychiatry. 1961 Jun;4:561-71
references.pmid: 13688369
references.citation: Mov Disord. 2005 Feb;20(2):190-9
references.pmid: 15551331
references.citation: Neurology. 2005 Jun 14;64(11):1925-30
references.pmid: 15955945
references.citation: Arch Neurol. 2008 Sep;65(9):1191-4
references.pmid: 18779422
references.citation: J Psychiatr Res. 1975 Nov;12(3):189-98
references.pmid: 1202204
references.citation: Neurology. 1967 May;17(5):427-42
references.pmid: 6067254
references.citation: Arch Neurol. 1993 Feb;50(2):140-8
references.pmid: 8431132
references.citation: Mov Disord. 2007 Oct 15;22(13):1892-900
references.pmid: 17588236
references.citation: J Neurol Neurosurg Psychiatry. 1993 Jun;56(6):690-3
references.pmid: 8509785
references.citation: J Neural Transm (Vienna). 2007 Mar;114(3):341-5
references.pmid: 17146589
references.citation: J Neurol Neurosurg Psychiatry. 1999 Sep;67(3):300-7
references.pmid: 10449550
references.citation: Arch Neurol. 1999 May;56(5):595-601
references.pmid: 10328255
references.citation: Neurobiol Aging. 2003 Mar-Apr;24(2):197-211
references.pmid: 12498954
references.citation: Am J Ophthalmol. 2000 Aug;130(2):261-2
references.pmid: 11004314
references.citation: Int J Geriatr Psychiatry. 2005 May;20(5):418-22
references.pmid: 15852454
references.citation: Brain. 2007 Aug;130(Pt 8):2123-8
references.pmid: 17586867
references.citation: Neurology. 1973 Aug;23(8):783-90
references.pmid: 4578348
references.citation: J Neurol Neurosurg Psychiatry. 1999 Oct;67(4):492-6
references.pmid: 10486397
references.citation: Arch Neurol. 2001 Feb;58(2):259-64
references.pmid: 11176964
references.citation: N Engl J Med. 2006 Aug 31;355(9):896-908
references.pmid: 16943402
references.citation: Arch Neurol. 2003 Mar;60(3):387-92
references.pmid: 12633150
references.citation: Mov Disord. 2007 Aug 15;22(11):1528-37
references.pmid: 17523198
references.citation: J Neural Transm (Vienna). 2000;107(1):59-71
references.pmid: 10809404
references.citation: J Neurol. 2005 Oct;252(10):1223-8
references.pmid: 15834642
references.citation: Neurology. 2002 Aug 13;59(3):408-13
references.pmid: 12177375
references.citation: Mov Disord. 2008 Apr 30;23(6):837-44
references.pmid: 18307261
references.citation: Arch Neurol. 1996 Jun;53(6):538-42
references.pmid: 8660156
references.citation: Mov Disord. 2008 Jul 30;23(10):1361-9
references.pmid: 18546344