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      • About advanced Parkinson’s disease (aPD)

      About aPD
      Identifying aPD
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      Parkinson’s disease

      Parkinson’s disease (PD) occurs when the dopaminergic neurons in the brain degenerate due to the deposition of Lewy bodies in the substantia nigra. The dysregulation of dopamine leads to the typical symptoms of PD, such as resting tremor, rigidity, postural instability and bradykinesia, as well as non-motor symptoms.1

      Your patients and their carers may benefit from this guide to advanced PD, to assist them in understanding and recognising the symptoms they are experiencing.

      Access the patient guide to aPD

      MOTOR SYMPTOMS OF PD

      The motor symptoms in PD are caused by dysfunction of the basal ganglia cortical motor circuit. Common motor symptoms include:1

      BRADYKINESIA, manifests as:1

      • difficulty in planning, initiating, and executing movement
      • difficulty in performing sequential tasks
      • loss of spontaneous movements
      • drooling due to swallowing difficulty
      • monotonic and hypophonic speech
      • masked face (loss of facial expression)
      • decreased eye blinking
      • small-amplitude movements of the limbs (e.g., reduced arm swing while walking)
      • micrographia
      • stooped posture.

      RIGIDITY, manifests as increased resistance to passive limb movements over all ranges tested by an examiner.1

      RESTING TREMOR is initially unilateral, at a frequency of 4–6 Hz, prominent in the distal part of the extremities. The tremor can intensify during walking but disappears when the arm involved is moving and during sleep. Resting tremors can also present in the lips and chin.1

      POSTURAL INSTABILITY results from a loss of postural reflexes, and manifests in the advanced stage of PD.1

      As PD progresses, patients might also experience motor fluctuations:

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      Dyskinesia

      These involuntary movements of the limbs and/or head are a side effect of the long-term use of oral medication. They occur in more than half of people with PD who have been taking medication for 5–10 years. This percentage increases over time. Dyskinesia is more common in people who were young when symptoms started.2

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      ‘On/off’ mobility

      Some people who have had PD for a long time experience these periods of poor mobility that come and go unexpectedly. These periods of unpredictability may last for up to several hours. What causes these? They are a late side effect of oral medication, probably caused in combination with the PD – not the medication alone.3

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      Wearing-off

      In the early stages of PD, ‘off’ periods can occur before the next dose of medication is due. This is known as ‘early wearing off’. However, as PD progresses, ‘on/off’ fluctuations become less closely related to the timing of the medication dose – and more unpredictable.4

      Non-motor symptoms of PD

      Known as non-motor symptoms, this is a wide-ranging group of behavioural, neuropsychiatric and physical symptoms that can significantly impact quality of life for people living with PD. Non-motor symptoms may be poorly identified because they are varied, the patient may not associate them with PD fluctuations, or the doctor may be less concerned about them compared to motor symptoms. Nevertheless, non-motor symptoms are known to be frequent and incapacitating. These symptoms are generally more frequent during ‘off’ times, but they can also manifest during the ‘on’ or ‘pre-on’ times.  According to survey results, almost 90 per cent of people with the PD have at least one non-motor symptom, with almost a quarter experiencing four or more.

      The more common non-motor symptoms include, but are not limited to:4-7

      • Depression
      • Anxiety
      • Apathy (lack of emotion)
      • Constipation
      • Sleep disorders
      • Loss of sense of smell
      • Dementia
      • Fatigue
      • Excessive daytime sleepiness
      Contact a representative
      Contact a representative

      Abbreviation: a/PD; advanced/Parkinson’s disease.
      References: 1. Shin HW et al. J Clin Neurol 2022;18(3):259–270. 2. Schrag A and Quinn N. Brain 2000;123(Pt 11):2297–305. 3. Tanner CM. Am J Manag Care 2020;26:S255–S264. 4. Kulisevsky J et al. Neurologia 2013;28(8):503–21. 5. Richard IH et al. J Neuropsychiatry Clin Neurosci 1996;8(4):383–92. 6. Pedrosa Currasco AJ et al. NPJ Parkinsons Dis 2018;4:6. 7. Borek LL et al. CNS Spectr 2006;11(7):541–54. 

      AU-NEUP-230055. June 2024.