The late stage of Parkinson’s –results of a large multinational study on motor and non-motor complications

A. Schrag, A.L.A.J. Hommel, S. Lorenzl, W.G. Meissner, P. Odin, M. Coelho, B.R. Bloem, R. Dodel, Joaquim Ferreira, Margherita Fabbri, François Tison, Alexandra Foubert-Samier, Joy Read, Marjan Meinders, Raymond Koopmans, Carmen Richinger, Kristina Rosqvist, Michael Wittenberg, Petra Neuser
Parkinsonism & Related Disorders. 2020-06-01; 75: 91-96
DOI: 10.1016/j.parkreldis.2020.05.016

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Schrag A(1), Hommel ALAJ(2), Lorenzl S(3), Meissner WG(4), Odin P(5), Coelho M(6), Bloem BR(7), Dodel R(8); CLaSP consortium.

Collaborators: Ferreira J, Fabbri M, Tison F, Foubert-Samier A, Read J, Meinders M, Koopmans R, Richinger C, Rosqvist K, Wittenberg M, Neuser P.

Author information:
(1)UCL Queen Square Institute of Neurology, University College London, Rowland Hill Street, NW3 2PF, London, UK. Electronic address: .
(2)Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, the Netherlands; Groenhuysen, Elderly Care Organization, Roosendaal, the Netherlands.
(3)Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Neurologie Universität München – Klinikum Großhadern, Munich, Germany and Institute of Nursing Science and -Practice, Salzburg, Austria.
(4)Service de Neurologie, CHU de Bordeaux, 33000, Bordeaux, France; Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33000, Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000, Bordeaux, France; Dept. Medicine, University of Otago, Christchurch, New Zealand and New Zealand Brain Research Institute, Christchurch, New Zealand.
(5)Division of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden and Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Neurology, Lund, Sweden.
(6)Instituto de Medicina Molecular Universidad di Lisboa, Lisboa, Portugal.
(7)Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, the Netherlands.
(8)Department of Geriatric Medicine, University Hospital Essen, Essen, Germany; Department of Neurology, Philipps-University of Marburg, Germany.

There is little information on the late stages of parkinsonism.

We conducted a multicentre study in 692 patients with late stage parkinsonism in six European countries. Inclusion criteria were disease duration of ≥7 years and either Hoehn and Yahr stage ≥4 or Schwab and England score of 50 or less.

Average disease duration was 15.4 (SD 7.7) years and mean total UPDRS score was 82.7 (SD 22.4). Dementia according to MDS-criteria was present in 37% of patients. Mean levodopa equivalence dose was 874.1 (SD 591.1) mg/d. Eighty two percent of patients reported falls, related to freezing (16%) or unrelated to freezing (21% of patients) or occurring both related and unrelated to freezing (45%), and were frequent in 26%. Moderate-severe difficulties were reported for turning in bed by 51%, speech by 43%, swallowing by 16% and tremor by 11%.
Off-periods occurred in 68% and were present at least 50% of the day in 13%, with morning dystonia occurring in 35%. Dyskinesias were reported by 45% but were moderate or severe only in 7%. Moderate-severe fatigue, constipation, urinary symptoms and nocturia, concentration and memory problems were encountered by more than half of participants. Hallucinations (44%) or delusions (25%) were present in 63% and were moderate-severe in 15%. The association with overall disability was strongest for severity of falls/postural instability, bradykinesia, cognitive score and speech impairment.

These data suggest that current treatment of late stage parkinsonism in the community remains insufficiently effective to alleviate disabling symptoms in many patients.


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