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Palliative approach to Parkinson disease and parkinsonian disorders

David Oliver, BSc FRCP FRCGP
Simon Veronese, MD, MSc, PhD
Section Editors
R Sean Morrison, MD
Howard I Hurtig, MD
Deputy Editor
John F Dashe, MD, PhD


Parkinson disease (PD) and the parkinsonian neurodegenerative disorders typically develop relatively slowly over several years. Affected patients and their families face increasing physical, psychosocial, and spiritual issues over this period of time. Palliative care has an important role in these conditions throughout the progression of disease, and particularly in the later stages as death approaches.

This topic will review the palliative care aspects of PD and related neurodegenerative disorders. Other clinical aspects of these disorders are reviewed elsewhere. (See "Clinical manifestations of Parkinson disease" and "Diagnosis and differential diagnosis of Parkinson disease" and "Pharmacologic treatment of Parkinson disease" and "Management of nonmotor symptoms in Parkinson disease" and "Nonpharmacologic management of Parkinson disease" and "Motor fluctuations and dyskinesia in Parkinson disease" and "Device-assisted and surgical treatments for Parkinson disease" and "Progressive supranuclear palsy (PSP): Clinical features and diagnosis" and "Progressive supranuclear palsy (PSP): Management and prognosis" and "Multiple system atrophy: Clinical features and diagnosis" and "Multiple system atrophy: Prognosis and treatment" and "Corticobasal degeneration" and "Clinical features and diagnosis of dementia with Lewy bodies" and "Prognosis and treatment of dementia with Lewy bodies".)


Symptoms and signs of parkinsonism (ie, bradykinesia, rest tremor, and rigidity) can be prominent in several neurodegenerative disorders, including PD, dementia with Lewy bodies, progressive supranuclear palsy, multiple system atrophy, and corticobasal degeneration. The average lifespan of patients diagnosed with these disorders is reduced.

Parkinson disease — PD is one of the more common progressive neurodegenerative diseases. The prevalence of PD increases with age. The cardinal features of PD are tremor, bradykinesia, and rigidity. Postural instability generally occurs late in the course of the disease. Other motor features of PD include craniofacial (eg, masked facial expression, hypophonia), visual (eg, hypometric saccades, eyelid opening apraxia), musculoskeletal (eg, micrographia, stooped posture), and gait (eg, shuffling, short-stepped gait, freezing) abnormalities (table 1). In addition to motor involvement, PD is a complex disorder with diverse clinical features that include neuropsychiatric and nonmotor manifestations (table 2). (See "Clinical manifestations of Parkinson disease".)

The nonmotor manifestations of PD include the following:

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Literature review current through: Nov 2017. | This topic last updated: Sep 24, 2017.
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