Non-motor complications in late stage Parkinson’s disease: recognition, management and unmet needs

TY - JOUR

T1 - Non-motor complications in late stage Parkinson’s disease

T2 - recognition, management and unmet needs

AU - Rukavina, Katarina

AU - Batzu, Lucia

AU - Boogers, Alexandra

AU - Abundes-Corona, Arturo

AU - Bruno, Veronica

AU - Chaudhuri, K. Ray

N1 - Funding Information: The authors would like to thank the editorial support of Ms Aleksandra Podlewska for her help with design of figures as well as the Parkinson?s disease Non-motor Study Group (NMSG) of the International Parkinson?s and Movement Disorders Society. Authors, KK, LB, AAC and VB are part of the subtheme research groups of the NMSG. Funding Information: K Rukavina is supported by NIHR BRC and has received a consultancy fee from Valid Insight and Britannia. KR Chauduri has acted on advisory board for AbbVie, UCB, GKC, Bial, Cynapsus, Novartis, Lobsor, Stada, Medtronic, Zambon, Profile, Sunovion, Roche, Therevance, Scion and Britannia, and has received honoraria for lectures from AbbVie, Britannia, UCB, Mundipharma, Zambon, Novartis, Boeringer Ingelheim, and grants (Investigator Initiated) from Britania Pharmaceuticals, AbbVie, UCB, GKC, Bial, Aacdemic grants: EU, IMI EU, Horizon 2020, Parkinson’s UK, NIHR, PDNMG, EU (Horizon 2020), Kirby Laing Foundation, NPF, MRC, Welcome Trust. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed. Funding Information: Although great research efforts are being made to effectively manage and prevent the onset of cognitive impairment in PD, the individual patient’s contribution to this cause could potentially work in synergy with the delivery of an effective treatment. . There is preliminary evidence, for instance, that physical activity, especially in the form of aerobic exercise, might benefit cognitive functions []. However, research on this topic has focused on mild to moderate stages of PD, and, to our knowledge, no studies have specifically looked at the effects of exercise on cognition in late stage PD. This could be directly explained by the intrinsic motor limitations of late stage PD. A recent UK study funded by the Wellcome Trust addressing the effect of dance therapy (ballet) in PD will however aim to include patients with late stage PD in the program (clinicaltrials.gov, NCT04719468). Publisher Copyright: © 2021 Informa UK Limited, trading as Taylor & Francis Group. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021

Y1 - 2021

N2 - Introduction: The burden of non-motor symptoms (NMS) is a major determinant of health-related quality of life in Parkinson’s disease (PD), particularly at its late stage. Areas covered: The late stage is usually defined as the period from unstable advanced to the palliative stage, characterized by a combination of emerging treatment-resistant axial motor symptoms (freezing of gait, postural instability, falls and dysphagia), as well as both non-dopaminergic and dopaminergic NMS: cognitive decline, neuropsychiatric symptoms, aspects of dysautonomia, pain and sleep disturbances (insomnia and excessive day-time sleepiness). Here, the authors summarize the current knowledge on NMS dominating the late stage of PD and propose a pragmatic and clinically focused approach for their recognition and treatment. Expert opinion: The NMS progression pattern is complex and remains under-researched. While dopamine-dependent NMS may improve with dopamine replacement therapy, non-dopamine dependent NMS worsen progressively and culminate at the late stages of PD. Furthermore, some PD specific features could interact negatively with other comorbidities, multiple medication use and frailty–the evaluation of these aspects is important in the creation of personalized management plans in the late stage of PD.

AB - Introduction: The burden of non-motor symptoms (NMS) is a major determinant of health-related quality of life in Parkinson’s disease (PD), particularly at its late stage. Areas covered: The late stage is usually defined as the period from unstable advanced to the palliative stage, characterized by a combination of emerging treatment-resistant axial motor symptoms (freezing of gait, postural instability, falls and dysphagia), as well as both non-dopaminergic and dopaminergic NMS: cognitive decline, neuropsychiatric symptoms, aspects of dysautonomia, pain and sleep disturbances (insomnia and excessive day-time sleepiness). Here, the authors summarize the current knowledge on NMS dominating the late stage of PD and propose a pragmatic and clinically focused approach for their recognition and treatment. Expert opinion: The NMS progression pattern is complex and remains under-researched. While dopamine-dependent NMS may improve with dopamine replacement therapy, non-dopamine dependent NMS worsen progressively and culminate at the late stages of PD. Furthermore, some PD specific features could interact negatively with other comorbidities, multiple medication use and frailty–the evaluation of these aspects is important in the creation of personalized management plans in the late stage of PD.

KW - cognition

KW - dysautonomia

KW - late stage

KW - neuropsychiatric symptoms

KW - non-motor symptoms

KW - pain

KW - Parkinson’s disease

KW - quality of life

UR - http://www.scopus.com/inward/record.url?scp=85100973745&partnerID=8YFLogxK

U2 - 10.1080/14737175.2021.1883428

DO - 10.1080/14737175.2021.1883428

M3 - Review article

C2 - 33522312

AN - SCOPUS:85100973745

SN - 1473-7175

VL - 21

SP - 335

EP - 352

JO - Expert Review of Neurotherapeutics

JF - Expert Review of Neurotherapeutics

IS - 3

ER -