EAN 2026 | Indicators of advanced-stage Parkinson’s disease
K. Ray Chaudhuri, MD, DSc, FRCP, FEAN, King’s College London, London, United Kingdom, discusses how clinicians can identify when a patient has entered the advanced stage of Parkinson’s disease. Prof. Chaudhuri explains that a key indicator is when conventional oral therapies no longer work sufficiently to manage symptoms. In addition, clinicians can use the 5-2-1 rule and MANAGE-PD criteria. This interview took place at the 12th Congress of the European Academy of Neurology (EAN) in Geneva, Switzerland.
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Transcript
Advanced stage of Parkinson’s disease, or APD as we call it, is actually quite a gray area still, although there have been many attempts at developing criteria that can allow clinicians, experts and non-experts, to decide, well, somebody has reached the advanced stage of Parkinson’s. Broadly, if we think about it in a clinical context, it’s the time when all the traditional oral conventional therapies are not really working...
Advanced stage of Parkinson’s disease, or APD as we call it, is actually quite a gray area still, although there have been many attempts at developing criteria that can allow clinicians, experts and non-experts, to decide, well, somebody has reached the advanced stage of Parkinson’s. Broadly, if we think about it in a clinical context, it’s the time when all the traditional oral conventional therapies are not really working. In other words, you know, the patient’s getting off periods in spite of them or maybe dyskinesias or maybe just generally feeling worse. And you’ve tried the transdermal option that’s also available to us, and maybe that is not either being tolerated or is causing problems. Well, that is a situation where further intervention with oral therapies make little difference. Because what happens in Parkinson’s at this stage is you also get a lot of gastric issues. In other words, absorption of the stomach is also considerably delayed due to various factors. So in this situation where we would think somebody’s reached the advanced stage because it needs device-aided therapy. Now, it could be assessed by a criteria, the so-called 5-2-1 criteria, which is five doses of levodopa, two hours of off per day, one hour of troublesome dyskinesia, along with other features like dysphagia, some non-motor issues like sleep problems, some functional problems like difficulty with mobility, falls, etc. Or you can have a correct part of the criteria derived from this is the MANAGE-PD criteria. So, you know, you can use all of that. But I think clinical judgment remains the most important thing because there is no fixed period when somebody reaches advanced Parkinson’s. It’s very variable. It’s a very sort of variable concept. And again, the concept may be a bit different between those with so-called early onset Parkinson’s, so younger people with Parkinson’s, versus those with late onset Parkinson’s. So you can see they’re very… And so it’s quite a difficult thing to diagnose in many ways.
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