Motor and non-motor symptoms in advanced Parkinson’s disease: current insights and future directions

Advanced Parkinson’s disease (PD) is characterized by significant motor and non-motor complications, including levodopa-resistant symptoms such as freezing of gait (FoG), postural instability, and dysphagia, alongside autonomic dysfunction. As the disease progresses, managing these symptoms becomes increasingly complex. This thesis explores the role of advanced therapies, including levodopa-carbidopa intestinal gel (LCIG) and deep brain stimulation (DBS), in addressing some disabling symptoms such as postural abnormalities, freezing of gait (Fog), speech disturbance, and some nonmotor symptoms such as dysautonomic disturbance and pain. Additionally, it investigates the role of monoamine oxidase type B (MAO-B) inhibitors in managing both motor and cognitive fluctuations in advanced PD. Integrating wearable sensor technologies allows continuous monitoring of motor complications such as dyskinesias and FoG daily, offering a novel approach to individualized treatment. This thesis stresses the demand for a multidisciplinary, patient-centered approach to managing advanced PD, with particular attention to autonomic dysfunctions and axial symptoms, potentially aided by using wearable sensors to obtain an objective measurement to improve the patient’s quality of life.