Late-Stage Symptoms of Parkinson's Disease

As Parkinson's disease progresses to its later stages, symptoms become more complex and challenging to manage. These symptoms not only reflect the natural progression of the disease but may also be influenced by long-term medication side effects. In the advanced phase, approximately 15% to 30% of patients may experience hallucinations, most commonly visual. These disturbances can be accompanied by a range of cognitive impairments, including memory loss, confusion, and even full-blown dementia.

Common Non-Motor Symptoms in Advanced Parkinson's

Alongside cognitive decline, patients may develop significant autonomic nervous system dysfunction. This can lead to conditions such as orthostatic hypotension (a sudden drop in blood pressure upon standing), bowel dysfunction, and difficulties with swallowing due to muscle rigidity. Excessive drooling is also frequently observed, further complicating the patient's quality of life.

Motor Complications in Late-Stage Parkinson's

One of the most difficult aspects of managing advanced Parkinson's disease is dealing with motor complications. These typically fall into two categories: motor fluctuations and dyskinesias.

Motion Fluctuations

Motion fluctuations refer to the unpredictable changes in symptom control throughout the day. A common issue is the "wearing-off" phenomenon, where each dose of medication provides a shorter duration of symptom relief. Another troubling pattern is the "on-off" phenomenon, during which patients experience sudden and unpredictable shifts between improved mobility (on phase) and severe stiffness or immobility (off phase).

Dyskinesias

Dyskinesias are involuntary, erratic movements that often resemble dancing or twisting motions. These movements can be both distressing and disabling, significantly impacting the patient's ability to perform daily activities. Managing dyskinesias often requires careful adjustment of medication regimens and, in some cases, consideration of advanced therapies such as deep brain stimulation.