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Review
. 2022 May 18;12(5):813.
doi: 10.3390/jpm12050813.

Personalized Care in Late-Stage Parkinson's Disease: Challenges and Opportunities

Margherita Fabbri  1 , Miguel Coelho  2 , Michela Garon  3 , Roberta Biundo  4   5   6 , Tiago A Mestre  7 , Angelo Antonini  3   5 , On Behalf Of iCARE-Pd Consortium
Affiliations
Review

Personalized Care in Late-Stage Parkinson's Disease: Challenges and Opportunities

Margherita Fabbri et al. J Pers Med. .

Abstract

Late-stage Parkinson's disease (LSPD) patients are highly dependent on activities of daily living and require significant medical needs. In LSPD, there is a significant caregiver burden and greater health economic impact compared to earlier PD stages. The clinical presentation in LSPD is dominated by motor and non-motor symptoms (NMS) that most of the time have a sub-optimal to no response to dopaminergic treatment, especially when dementia is present. Non-pharmacological interventions, including physiotherapy, cognitive stimulation, speech, occupational therapy, and a specialized PD nurse, assume a key role in LSPD to mitigate the impact of disease milestones or prevent acute clinical worsening and optimize the management of troublesome NMS. However, the feasibility of these approaches is limited by patients' cognitive impairment and the difficulty in delivering care at home. The present care challenge for LSPD is the ability to offer a person-centered, home-delivered palliative care model based on Advanced Care Planning. An ongoing European multicentric project, PD_Pal, aims to address this challenge.

Keywords: Parkinson’s disease; caregiver; cognitive impairment; home care; late stage; palliative care.

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Conflict of interest statement

Margherita Fabbri has no conflict of interest. She reports honoraria to speak from Bial and AbbVie. Miguel Coelho has no conflict of interest. He has received consultancy fees from Zambon, BIAL, AbbVie, Boston and Medtronic. Michela Garon has no conflict of interest. Roberta Biundo has no conflict of interest. She reports honoraria to speak from Bial. She is supported by the Ministry of Health under Grant Number GR-2016-02361986. Tiago A. Mestre has no conflict of interest. He has received personal compensation for serving as a Consultant for CHDI, Sunovion, Valeo Pharma, Roche, Biogen and nQ. He has received personal compensation serving on a Speakers Bureau for Abbvie, Valeo Pharma. He has received research support from the Canadian Institutes of Health Research, the Ontario Research Fund, Michael J Fox Foundation, Parkinson Canada, University of Ottawa/Parkinson Research Consortium. Angelo Antonini has no conflict of interest. He has received compensation for consultancy and speaker-related activities from UCB, Boehringer Ingelheim, Ever Pharma, General Electric, Britannia, AbbVie, Kyowa Kirin, Zambon, Bial, Theravance Biopharma, Jazz Pharmaceuticals, Roche, Medscape; he receives research support from Bial, Lundbeck, Roche, Angelini Pharmaceuticals, Horizon 2020—Grant 825785, Horizon2020 Grant 101016902, Ministry of Education University and Research (MIUR) Grant ARS01_01081, Cariparo Foundation, Movement Disorders Society for NMS Scale validation. He serves as a consultant for Boehringer–Ingelheim for legal cases on pathological gambling.

Figures

Figure 1
Figure 1
Pillars for Late-stage PD treatment. Left panel: health care professionals involved in LSPD management. Right panel: motor and NMS and available pharmacological options. Bottom: the main objectives of prevention strategies for LSPD patients. COMT−I: Catechol−O-methyl transferase inhibitors; DAAs: dopamine-agonist; SSRI/SNRI: selective serotonin reuptake inhibitor/serotonin and norepinephrine reuptake inhibitor.
See this image and copyright information in PMC

References

    1. Coelho M., Ferreira J.J. Late-stage Parkinson disease. Nat. Rev. Neurol. 2012;8:435–442. doi: 10.1038/nrneurol.2012.126. - DOI - PubMed
    1. Schrag A., Hommel A., Lorenzl S., Meissner W.G., Odin P., Coelho M., Bloem B.R., Dodel R., Clasp C. The late stage of Parkinson’s-results of a large multina-tional study on motor and non-motor complications. Parkinsonism Relat. Disord. 2020;75:91–96. doi: 10.1016/j.parkreldis.2020.05.016. - DOI - PubMed
    1. Kruse C., Kretschmer S., Lipinski A., Verheyen M., Mengel D., Balzer-Geldsetzer M., Lorenzl S., Richinger C., Schmotz C., Tönges L., et al. Resource Utilization of Patients with Parkinson’s Disease in the Late Stages of the Disease in Germany: Data from the CLaSP Study. PharmacoEconomics. 2021;39:601–615. doi: 10.1007/s40273-021-01011-y. - DOI - PMC - PubMed
    1. Dorsey E.R., Bloem B.R. The Parkinson Pandemic—A Call to Action. JAMA Neurol. 2018;75:9–10. doi: 10.1001/jamaneurol.2017.3299. - DOI - PubMed
    1. De Pablo-Fernández E., Lees A.J., Holton J.L., Warner T.T. Faculty Opinions recommendation of Prognosis and neuropathologic correlation of clinical subtypes of parkinson disease. JAMA Neurol. 2020;76:470–479. doi: 10.1001/jamaneurol.2018.4377. - DOI - PMC - PubMed

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