Opinion
Video
Treatment Options for Parkinson's Disease
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Panelists discuss how medical professionals determine the most appropriate treatment options for patients with advanced Parkinson disease and the challenges patients face as their disease progresses over time.
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Managing Advanced Parkinson Disease: Treatment Selection and Quality of Life Considerations
Advanced Parkinson disease (PD) presents unique challenges for both patients and clinicians. This summary outlines key considerations for treatment selection and addresses quality of life changes over time.
Treatment Selection in Advanced PD
The determination of optimal treatment regimens for advanced PD patients should be guided by:
- Disease progression markers: Motor fluctuations, dyskinesias, and nonmotor symptom severity
- Patient-specific factors: Age, cognitive status, comorbidities, medication tolerance
- Treatment response patterns: Previous efficacy, adverse effect profiles, and duration of benefit
- Functional goals: Prioritizing mobility, independence, or symptom control based on individual needs
Challenges in Later-Stage Disease
Patients who have had PD for several years typically face:
- Motor complications: “Wearing-off” phenomena, unpredictable ON-OFF fluctuations, and treatment-resistant symptoms
- Treatment complexity: Multiple medication adjustments, increased dosing frequency, and polypharmacy issues
- Nonmotor burden: Cognitive decline, autonomic dysfunction, sleep disorders, and psychiatric manifestations
- Treatment-resistant symptoms: Postural instability, freezing of gait, and speech difficulties
Quality of Life Trajectory
As PD advances, quality of life changes typically involve:
- Increasing dependence: Gradual loss of autonomy in activities of daily living
- Social impact: Reduced participation in social activities and changing family dynamics
- Psychological adjustment: Adaptation to changing functional abilities and coping with uncertainty
- Care burden: Growing reliance on caregivers and support services
Treatment decisions should balance symptomatic control with minimizing adverse effects, while incorporating patient preferences and maintaining focus on functional independence for as long as possible.
