title: [Advanced Parkinson's disease: clinical characteristics and treatment (part 1)].
abstract: BACKGROUND
  A large percentage of patients with Parkinson's disease (PD) develop motor fluctuations, dyskinesias, and severe non-motor symptoms within 3 to 5 years of starting dopaminergic therapy, and these motor complications are refractory to treatment. Several authors refer to this stage of the disease as advanced Parkinson's disease.
  
  
  OBJECTIVE
  To define the clinical manifestations of advanced PD and the risk factors for reaching this stage of the disease.
  
  
  METHODS
  This consensus document has been prepared by using an exhaustive literature search and by discussion of the contents by an expert group on movement disorders of the Sociedad Española de Neurología (Spanish Neurology Society), coordinated by two of the authors (JK and MRL).
  
  
  CONCLUSIONS
  Severe motor fluctuations and dyskinesias, axial motor symptoms resistant to levodopa, and cognitive decline are the main signs in the clinical phenotype of advanced PD.
authors.affiliation: Servicio de Neurología, Hospital Sant Pau, IIB Sant Pau, CIBERNED, Universitat Autònoma de Barcelona, Barcelona, España. Electronic address: JKulisevsky@santpau.cat.
authors.forename: J
authors.initials: J
authors.lastname: Kulisevsky
authors.forename: M R
authors.initials: MR
authors.lastname: Luquin
authors.forename: J M
authors.initials: JM
authors.lastname: Arbelo
authors.forename: J A
authors.initials: JA
authors.lastname: Burguera
authors.forename: F
authors.initials: F
authors.lastname: Carrillo
authors.forename: A
authors.initials: A
authors.lastname: Castro
authors.forename: J
authors.initials: J
authors.lastname: Chacón
authors.forename: P J
authors.initials: PJ
authors.lastname: García-Ruiz
authors.forename: E
authors.initials: E
authors.lastname: Lezcano
authors.forename: P
authors.initials: P
authors.lastname: Mir
authors.forename: J C
authors.initials: JC
authors.lastname: Martinez-Castrillo
authors.forename: I
authors.initials: I
authors.lastname: Martínez-Torres
authors.forename: V
authors.initials: V
authors.lastname: Puente
authors.forename: A
authors.initials: A
authors.lastname: Sesar
authors.forename: F
authors.initials: F
authors.lastname: Valldeoriola-Serra
authors.forename: R
authors.initials: R
authors.lastname: Yañez
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects / Q000627:therapeutic use; D015415:Biomarkers; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D032921:Consensus; D003704:Dementia / Q000209:etiology; D018450:Disease Progression; D020820:Dyskinesias / Q000209:etiology; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy*; D010641:Phenotype; D011788:Quality of Life; D012307:Risk Factors; D012727:Sex Characteristics
chemical_list: D000978:Antiparkinson Agents; D015415:Biomarkers
keywords: Advanced Parkinson's disease; Clinical phenotype; Enfermedad de Parkinson avanzada; Escalas de calidad de vida; Escalas de valoración motora; Escalas de valoración no motora; Factores de riesgo; Fenotipo clínico; Motor scales; Non-motor scales; Quality of life scales; Risk factors