TREATMENT OF ADVANCED PARKINSON'S DISEASE AND ASSOCIATED PSYCHIATRIC DISTURBANCES

Parkinson's disease is a neurodegenerative disease, with increasing incidence, but with important therapeutic development in the last 50 years. Besides the 7 classes of oral medication used in all the stages of the disease, three types of invasive treatment are reserved for the advanced stages of Parkinson's disease, associated to the oral medication, or less frequent as monotherapy: apomorphine, levodopa-carbidopa intestinal gel (Duodopa (R)) and deep brain stimulation (DBS). A careful analysis of the patient, age, co-morbidities, psychosocial and economic factors is necessary to decide which treatment is suitable in each case. To increase patients' and caregivers' quality of life associated non-motor symptoms should also be treated, especially psychiatric disturbances (anxiety, depression, psychosis, and dementia) as well as comorbidities.