In Parkinson's, a progressive disease, the motor relay centers of the brain degenerate over time. As a consequence, people with the condition will experience uncontrollable shaking in the limbs and extremities, painful muscle rigidity that restricts motion, bradykinesia (i.e., slow movement, trouble initiating action) and impaired postural balance. The National Institute of Neurological Disorder and Stroke emphasizes that the final stages of the disease process are increasingly touched by problems with fine movement and non-motor related symptoms, including dementia. These later symptoms demand that terminal patients have access to ongoing personal care.
Decay of Gross Motor Function and General Health
Advanced Parkinsonism is characterized by almost complete immobility. Patients have extreme difficulty initiating and completing simple movements, and often require assistance with everyday routines like bathing or dressing. Hand-eye coordination deteriorates. Moreover, motor disturbances that could once be controlled with medication become treatment resistant. Parkinson's hopeDigest--an online resource for patients and caregivers--points out that while the condition is not terminal, people with late stage Parkinson's are more susceptible to bouts of pneumonia than those with other types of neurodegeneration. In fact, aspiration pneumonia remains the leading cause of death.
Difficulty with Oral Motor Function
Advanced Parkinsonism affects actions linked with fine muscle movements, including those involved with speech, mastication and swallowing. People with the condition sometimes talk more softly, have diminished fluidity of speech, or difficulty articulating words. Their voice might grow hoarse. Because of this suite of speech problems, many patients will be reluctant to communicate in public. According to the Parkinson's Disease Foundation, the muscles used for swallowing will also tend to work less efficiently in terminal patients, leading to a buildup of food or saliva in the mouth and raising the risk of choking. Once eating becomes difficult, people with Parkinson's can develop malnutrition and suffer notable weight loss.
Dementia
Dementia is the single most debilitating aspect of end stage Parkinson's. While general processing of information declines, more specific deficits can arise in the way individuals blend and shape ideas, estimate distance or generate spatial maps. People with Parkinson's related dementia cannot allocate attention between tasks. They lose concentration easily, and during the most severe course of the disease may not even recognize emotional expressions on another person's face. Rivastigmine (Exelon), a medication first approved by the U.S. Food and Drug Administration for the treatment of mild-to-moderate Alzheimer's disease, can improve some of these symptoms.
References
- National Institute for Neurological Disorder and Stroke, Parkinson's Disease: Hope Through Research
- Parkinson's hopeDigest: Pneumonia and Parkinson's
- Parkinson's Disease Foundation, Frequently Asked Questions: Swallowing & Weight Loss
- National Parkinson Foundation: What Specific Cognitive Problems Do People with PD Face?
- Novartis Pharmaceuticals Corporation "Exelon Product Insert" June 2006: Parkinson's Dementia Treatment
